C10011522 / invoice 10000

10/03/2026 ACTH stim 
following stopping trilostane for 2 weeks 
22.8kg 
had fred forte this am, EOD now, on antinol for jts, eye lubricant 
had dx last 2 days normal today 
panting and drinking more since stopping trilostane 
urinated blood consent for urinalysis today 

free catch urine- haematuria 
add on bladder scan - Ann called Samantha approved costs 
given traz 100mg 
torb IV for ultrasound 

BB Ultrasound: 
CLINICAL INDICATION
Investigation for possible urinary tract infection and elevated renal enzymes.
FINDINGS
URINARY BLADDER: Anechoic contents, very mild wall thickening at 0.16 cm, tapered normally into the trigone.
KIDNEYS: Left: 5.9 cm. Slight loss of corticomedullary definition, slightly irregular border, homogeneous cortex. Renal pelvis unremarkable. Right: 5.33 cm. Smooth borders, normal corticomedullary definition. Renal pelvis unremarkable.
ADRENALS: Right: 0.5 cm at the caudal pole, hypoechoic with rim sign. Left: Not imaged.
SPLEEN: 1.57 cm. Homogeneous with smooth borders, normal echotexture and structure. Small hyperechoic lesion (0.83 cm x 0.19 cm) on the medial border.
PANCREAS: Not imaged.
LIVER: A large, irregular, heterogeneous lesion measuring at least 12 cm with multiple small hypoechoic cavities.. Some normal liver echotexture noted cranially.
GALL BLADDER: Largely unremarkable, though images were suboptimal.
LYMPH NODES: A slightly heterogeneous lymph node (0.95 cm x 1.86 cm) was located just cranial to the right kidney. MILN not obvious. 
STOMACH: Contained possible food contents causing speckling, limiting full wall assessment. Visible segments showed normal wall layering with a thickness of 0.21-0.22 cm. The proximal duodenum and pyloric junction were not well-visualised due to shadowing.
SMALL INTESTINE: Significant gas content made imaging difficult. Width varied from 0.2 cm to 0.49 cm with normal wall layering.
Free fluid - A very small amount of free fluid was present between the caudal liver lobes.
Cystocentesis - bladder 

Assessment:
1. Large, cavitated liver mass. ddx likely neoplastic primary v secondary? 
2. Mild left renal changes.
3. Very mild generalised bladder wall thickening.
4. Small splenic hyperechoic lesion likely infarct etc, incidental. 
5. Mildly reactive right medial iliac lymph node. Likely 2ndary to 1. 

Plan:
talk on discharge 
wether worth sending acth stim? 
sending urine cysto to lab 
SW