C10016413 / invoice 10000

Reason: Sedation and anal gland flushHistory:Recent anal glands compaction. Produced green materail on expression. Still appears irritated. Prev had surolan adminstered which helped alotLaboratory:Thrombocytosis 578 (148-484) Hyperproteinaemia = 84 (52-82) due to hyperalbuminia = 42 (22-39) ALT 318 (10-125) ALP 5775 (23-212)TBIL normal AS called O. Highly recommend abdominal ultrasound to investigate liver pathology. O consented. Ultrasound: AS Notable: Extending from the left liver lobe is a 33.1mm x 52.2mm heterogeneous mass that causes significant capsular bulging. Within the liver parenchyma are notable hyperechoic round focal lesions which measure up to 8.4mm. The hepatic lymph node is enlarged measuring 5.2mm. The remainder the the liver remains normal in echogenicity. There is no evidence of metastatic spread to the spleen. The spleen contains a 5.8mm mylolipoma. The gall bladder contains a small amount of gravity dependant sludge and remains normal in thickness. The cystic duct is moderately enlarged measuring 2.1mm, and the common bile duct is normal measuring 1.5mm. The left and right adrenal glands are bilaterally enlarged measuring 6.4mm, and 6.8mm respectively. The left and right kidneys contain non-obstructive hyperechoic cortical foci which measuring up to 2.5mm, while retaining normal size at 50.0mm, and 51.4mm. The renal pelvis's measuring within normal limits at 1.5mm, and 1.3mm. Normal: Left MILN 3.0mm, R MILN 2.3mmAorta 6.8mm, left panc 6.4mm, right panc 7.9mm, JLN 3.4mmStomach 2.7mm, jejunum 3.6mm, colon 1.6mm, duodenum 6.0mm, ileum 2.1mmICJ and GDJ are clear of obstruction. Procedure: anal sac flush The anal glands were expressed A blue catheter was placed into both anal sacs and flushed multiple times0.3ml of dermotic was placed into both glands Assessment:The large hepatic mass is consistent with hepatic neoplasia. The focal hepatic lesions, and enlarged hepatic lymph node may represent benign/inflammatory change, or malignant spread. Differentials include malignant hepatocellular carcinoma (malignant), and hepatocelluar adenoma (benign), less likely biliary carcinoma. The ALP elevation and cystic duct dilation may indicate mass compression on the bile outflow tract, neoplastic change, cushings disease, or reactive hepatopathy, however given the normal Bilirubin this is not completely obstructive. The bilateral adrenal gland enlargement may represent endogenous corticosteroid release or emerging cushings disease. Anal sacculitis. Treatment:Ursofaulk 15mg/kg (1.5ml) PO SID Hepatoadvanced PO SID  Plan:The liver may may be a good candidate for CT and liverlobectomy - declined by owner. Discussed FNA often have <30% correlation to histopath. Recommend stim test to screen for cushings which may be contributing to hepatopathy. O has elevted for medical care. Ongoing liver support - hepatoadvanced and ursofaulk. Unlikely to be infectious hepatis without CBC elevation. Antibiotics not indicated. However possibility this may develop.Recheck ALT/ALP in 1 week.    Vital Signs    Weight: 5.9;       

Reason: AG FlushAppointment Notes: khO called to book in AG flushAB called Michelle back. Mimi has been really bothered with her AG's even after expressing them, chewing  them, itching, not herself. Wants AG flush as had this done a year or so ago and it really helped. AS to please do quote for tomorrow and give to reception. AB.    Vital Signs    

Reason: AGAppointment Notes: Special payment terms existMedium in size, easy to express.Contents very green in colour, as per last visit.AM    Vital Signs