C10012625 / invoice 10000

Reason: Straining To UrinateAppointment Notes: Special payment terms existINCOMPLETE HXHISTORY:Presented for stranguria and pollakiuria since approximately 4:30 am this morning. The owner reports observing him attempting to urinate repeatedly, only producing a few drops each time. He has been panting and is polydipsic. A walk was attempted to encourage urination, but he continued to stop frequently to posture and strain without success. The owner notes he has consumed a significant amount of water today but has not passed a normal stream of urine since early this morning. There was one episode of emesis this morning after ingesting grass; the vomitus contained only grass and some bile, with no food present. Appetite and defecation are reported as normal, with a normal bowel motion observed prior to presentation.Specific History Questions:- Vomiting: One episode of vomiting grass and bile this morning.- Mentation/Behaviour: Panting noted at home.- Defecation: Normal bowel motion, no diarrhoea.- Urination: Stranguria and pollakiuria reported since 4:30 am.- Diet & Appetite: Appetite normal.- Drinking: Polydipsia reported.Current meds:- nilProphylaxis: unknownPre-existing conditions:- Desexed approximately 1 year ago.Toxins: nil access to known toxins including cycads, lillies baits, molds, medications or other known toxic plantsTriage:HR: 120RR: 28Temp: Mm: pinkCrt: 1-2sMentation: BAREXAMINATION:Body Condition Score: 4/9Hydration status (%): clinically euhydratedPain score: 0/4Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Mentation appropriate. Plr positive , menace positive, palpebral positive . No abnormal strabismus or nystagmus positional or otherwise noted. Normal facial sensation and motor. Normal facial symmetry. Normal gag reflex. No neck pain. CPs and withdrawals present in all limbs. Patella reflexes intact. Cutaneous trunci reflex WNL. Strongly ambulating with no observable ataxia. Normal posture. Perineal reflex WNL. Adequate anal tone. Full exam not performed.Musculoskeletal: ambulating normally x4, nil back/neck painGastrointestinal:- Oral: NSF, dental score 2/4- Abdominal: Abdominal palpation revealed a very small bladder, approximately 2x3cm in size, soft and non-painful.- Rectal: Not performedUrinary: nsfReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: WNL on palpationEyes: NSFPROBLEM LIST:1. Stranguria/Pollakiuria2. Small bladder on palpation despite history of polydipsia3. Crystalluria on in-house wet preparationDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:1. Stranguria/Pollakiuria: Urethral obstruction (partial vs complete), urolithiasis (urethral, cystic), UTI, cystitis (sterile/inflammatory), neoplasia, prostatitis.2. Small bladder: Partial urethral obstruction, upper urinary tract obstruction (ureteral), anuria/oliguria secondary to AKI, inflammatory cystitis causing urge incontinence.3. Crystalluria: Urolithiasis (struvite, calcium oxalate, urate, cystine), UTI, diet-related, metabolic disease.DIAGNOSTICS:PCV: XTP: XSerum: XInterpretation: Dog: [37-55%, 50-80g/L]Cat: [25-45%, 55-85g/L]Urine was collected for testing in house.Collection method: cystocentesisBefore or after IV fluids were started: beforeThe results of this test were:USG: Colour: yellowTurbidity: clearpH: Protein: NegBlood/Hb: NegKetones: NegBilirubin: NegGlucose: NegWet preparation: Presence of crystals noted, morphology indistinct.Stained preparation: No bacteria seen. Evidence of inflammation.Interpretation: In-house urinalysis reveals evidence of inflammation and crystalluria without obvious bacteriuria. The specific type of crystal is not clear on wet preparation. This supports differentials of cystitis and urolithiasis. Urine has been submitted for external laboratory analysis, including culture and sensitivity, to definitively rule out infection and further characterise the sediment.Digital radiography was performed.Abdominal: rla lla vdaExtra-abdominal structures: no significant abnormalitiesSerosal detail: goodLiver/spleen: normal size and outlineGIT: No obvious radiopaque foreign body, or intestinal gas dilation< height of L2 in dogs, L4 in catsKidneys:Left, normal size and outline, Right, difficult to visualise completely, No obvious renolithsBladder: bladder present, no obvious radiopaque urolithsInterpretation:Radiographs confirm no evidence of radio-opaque uroliths within the bladder or visualised urethra. This rules out common stone types like struvite and calcium oxalate as a cause for complete obstruction but does not rule out radiolucent stones (urate, cystine) or a non-urolith cause for the clinical signs.ASSESSMENT:Presented with stranguria and pollakiuria. Examination revealed a surprisingly small and non-distended bladder, which is incongruous with the history of polydipsia and straining. This raised concern for a partial or complete urinary obstruction. In-house urinalysis showed crystals and inflammation but no bacteria. Abdominal radiographs ruled out radio-opaque uroliths in the bladder and urethra. The primary differentials remain urinary tract inflammation (cystitis), partial obstruction with radiolucent uroliths, or an upper urinary tract issue preventing bladder filling. Plan is for further diagnostics including bloodwork and external urinalysis.TREATMENT (Fluid Therapy & Medications refer to Smartflow):- Meloxicam injection for analgesia and anti-inflammatory effects discussed with owner.PLAN:- Bloods to be taken for in-house analysis to assess kidney function and systemic health.- Urine sample submitted to an external laboratory for full urinalysis, cytology, and culture and sensitivity.- Discussed giving an anti-inflammatory injection for pain relief.- Depending on results, may require dietary modification for crystalluria.- If signs worsen or obstruction is suspected, emergency surgery may be required.- Owner to monitor for ability to urinate, lethargy, vomiting, or inappetence.CLIENT COMMUNICATION:A detailed discussion was had with the owner regarding the clinical signs of stranguria. The discrepancy between the history of polydipsia/straining and the finding of a small bladder on examination was explained. The possibilities of a urinary tract infection, bladder inflammation (cystitis), or a urinary obstruction (blockage) were discussed. It was explained that an obstruction is an emergency.The plan for diagnostics was outlined, including a cystocentesis to obtain a sterile urine sample, in-house urinalysis, and abdominal radiographs to check for bladder stones. The limitations of x-ray in detecting all stone types were explained (struvite/calcium oxalate are visible; cystine/urate are not).The findings of the in-house urine check (inflammation, crystals, no bacteria) and the x-ray (no radio-opaque stones) were communicated. The possibility of a partial obstruction from radiolucent stones, or stones in the upper urinary tract (kidneys/ureters), was discussed as a remaining concern. The recommendation for blood tests to assess kidney function and sending the urine to an external lab for a definitive analysis and culture was made and accepted.The option to perform these diagnostics tonight versus at their regular vet tomorrow was offered, as the dog was not completely obstructed at the time of exam. The owner elected to proceed with the work-up tonight. An estimate for the diagnostics was provided. The owner will wait nearby and will be called with an update in 30-40 minutes.--------------------------------------------------------------------------------    Vital Signs