C10016419 / invoice 10000

Reason: VomitingHistory:Presented by: GwynethVomiting a few days no blood Not interested in smako or chicken Vomited this morning was foaming Unsure if any diarrhoea O has not seen it A little flat The day before had trilostaneSunday urine tablet Examination:Thoracic auscultation unremarkable LN unremarkable Oral exam Grade 2Ocular exam bilateral NSAural exam clear Hydration status 5% -7% dehydratedSkin exam lipoma present on chest Neurological exam NADMusculoskeletal exam NADGenital exam NADRectal exam full of mucous and blood Abdominal palpation comfortable Differential Diagnosis:Pancreaitis, colitits Plan: FluidsUltrasoundMedsClient communication: Called Gwyneth informed of the plan gave her the estimate and Sedation:ACP 0.01mls/kg +/- methone 0.03mls/kgIV Fluids: IV & Fluid Therapy: IV catheter R cephalic with hartmans @ 7% dehydration planPrevomax inj 0.67ml IV Metronidazole inj 14.0ml IV @12:00 and 17:00Laboratory:  Test: diagnosticResults: BUN - pre renal,  ALB elevated dehydrationALT and ALP GGT elevated - hyperadrenocortisim, liver disease Diagnostic Imaging:  UltrasoundFindings: Echogenicity (anechoic, isoechoic, hypoechoic, hyperechoic)Liver hyperechoic to spleen diffuse multifocal well marginated hypoechoeic lesions Gall Bladder unremarkable (8.32mm by 39.29mm)Stomach / Fundus (2.57mm)Spleen head/hilus/tail all visualised small hyperechoic lesion (2.29mm by 3.52mm) Left Kidney (41.17mm) Three cysts present 1) 2.68mm by 4.30mm  2) 2.97mm by 3.89mm 3) 2.82mm by 3.75mmLeft Adrenal enlarged 6.93mm, 7.01mm, 7.93mmSmall Intestine (3.35mm, 3.28mm, 2.73mm, 5.04mm)Colon enlarged (3.35mm)Urinary Bladder apex/body trigone all visualised unremarkable (0.66mm)Right Kidney (43.87mm) Three cysts 1)5.13mm by 6.84mm  2) 3.44 by 3.57 3) 3.26 by 2.67mm Right Adrenal mass presnt enlarged (11.95mm, 10.04mm, 10.45mm) Mass 9.38mm by 6.32mmDuodenum (5.61mm)Pyloric Antrum (3.52mm, 2.71mm)Pancreas (7.37mm) hyperechoic to surrounding mesentary, subjectivity enlarged Aortic bifurcation NADAssessment:Pancreatitis ColititisPlan: Low fat gastro foodRecomend to come back tomorrow for another day of fluids    Vital Signs    Weight: 6.65;       MMColour: Pink;       Temperature: 38.6;       HeartRate: 120;       DentalGrade: 2;       RespirationRate: panting;       CRT: < 1 sec;