C10017555 / invoice 10000

Reason: Acute inappetence and blood diarrhoea with hx IBD/pancreatitisStudent name: Leanna (Se Yoon) KimReviewed by EMJackiHistoryJacki is a 4y 5 m old FS Cavalier King Charles Spaniel presenting for acute gastrointestinal signs including inappetence, vomiting, diarrhoea progressing to haematochezia, and apparent abdominal discomfort from this morning. O reports Jacki was well until recently, but over the last 24–48 hours she has shown a marked reduction in appetite and did not eat yesterday, with only minimal intake today despite being offered her normal diet. Today she has eaten only approximately ½ cup Royal Canin Hypoallergenic, about 100 g cooked kangaroo, and approximately 50 g kangaroo loaf, which is significantly reduced from usual intake. O describes her as having “no appetite” and requiring hand-feeding today. She appeared more restless and “groanier” overnight, suggestive of discomfort. O reports onset of diarrhoea from this morning, initially worsening rapidly from softer stool overnight to very unpleasant diarrhoea through the day, progressing from faecal score 4/7 (yesterday)  to 6/7 (today) and then became 7/7, described as mucousy, and blood-tinged. Photos reportedly showed progression over the morning and midday. Vomiting history includes a small foamy vomit about one month ago, another episode about one week ago described as pale/yellow-green “baby sick” with possible tree material, and a more recent small volume vomit/watery vomit episode. At current presentation, concern is primarily reduced appetite, diarrhoea with blood/mucus, and possible abdominal pain.Jacki has a significant previous gastrointestinal history. She has known IBD/lymphocytic plasmacytic enteropathy managed primarily with diet. She also has a history of pancreatitis and a previous major hospitalisation in January 2026 for lethargy and inappetence associated with marked gastric wall thickening, severe gastritis, suspected gastric ulceration, melaena, and abdominal pain. At that time abdominal ultrasound showed circumferentially thickened gastric wall with loss of layering, surrounding hyperechoic mesenteric fat, and reactive abdominal lymphadenopathy. Differentials included severe gastritis/gastric ulceration, IBD flare, ulcers (Helicobacter-associated disease vs gastrinoma), and less likely lymphoma. She required several days of hospitalisation with IV fluids, antiemetics, gastroprotectants, antibiotics, fentanyl and ketamine CRIs, and appetite support, and gradually improved. She was discharged on ongoing medical therapy including sucralfate, omeprazole, cephalexin, ondansetron, metoclopramide, maropitant, and mirtazapine, with subsequent recheck showing return of appetite and normal energy. There is also a prior history of intermittent vomiting episodes including grass-eating followed by vomiting white foam.O reports Jacki is a nervous dog and travels frequently and she walks 2-3 times a day each day. She is kept on a tightly controlled diet due to prior gastrointestinal disease, consisting of Royal Canin Hypoallergenic with cooked kangaroo and kangaroo-based loaf, and is usually fed by hand. She lives on a large property but is closely supervised and does not normally scavenge. There is concern for possible dietary or environmental indiscretion including possible ingestion of fungus/mould associated with a cheese container lid and recent medication administration with cottage cheese. Previous flare-ups have reportedly been suspected to relate to dietary indiscretion. No confirmed toxin exposure reported.Current/home medicationsOmeprazole, usually BID with low-fat cottage cheese; recently reduced to SID for 4 days due to causing morning diarrhoea, then resumed BID on day of consultMirtazapine or Metoclopramide per owner description, reportedly given today at approximately 11 AM for appetite stimulation (unclear medication described by owner as quarter of 500 mg tablet daily, name uncertain)Paracetamol/Panadol, quarter of 500 mg tablet given at approximately 10:30 AM for suspected abdominal discomfortPreventative care/history:Parasite prevention up to date (o mentioned that next thursday will be due date)Heartworm prevention due September; previously on NexGard but discontinued as beef-basedVaccinations due next week / otherwise up to dateRelevant past medical historyInflammatory bowel disease / lymphocytic plasmacytic enteropathyPancreatitisPrior severe gastritis / gastric wall thickening / suspected gastric ulcerationChronic upper airway noisePossible previous mention of cancer in owner history, needs confirmation from formal recordsPrior prolonged hospitalisation for GI diseaseRecurrent vomiting episodesExaminationOn presentation Jacki was bright and alert. Body weight recorded at 12.7 kg. Hydration subjectively adequate; mucous membranes pink and moist with CRT approximately 1–2 seconds. Cardiovascular examination reportedly unremarkable with normal heart rate and no murmur auscultated. Respiratory examination notable for panting, likely related to anxiety/nervousness, and upper airway noise/stertor consistent with known tracheal/upper airway disease. Mild increased upper airway resistance noted but no wheezes or crackles heard on thoracic auscultation.Abdominal palpation revealed tension, particularly in the cranial abdomen/stomach region, with concern for abdominal discomfort/pain. Possible fluid in the abdomen was queried on palpation, though not confirmed clinically. No overt peripheral lymphadenopathy noted. Oral examination unremarkable with teeth reportedly clean and no gingivitis. Eyes and ears were clean/normal with no discharge. Integument generally clean; some faecal contamination around anal sac/perianal region secondary to diarrhoea. Musculoskeletal status normal with appropriate muscle mass. Overall demeanour remained brighter than expected for the severity of owner-reported gastrointestinal signs.Given prior hospital record context, current episode is concerning because previous significant gastric pathology was associated with a similar clinical pattern of reduced appetite, lethargy, abdominal discomfort, and later evidence of severe gastric wall thickening and probable ulcerationPhysical Examination:General appearance demeanour: BAR but slightly anxious/nervous during examination.MM: Pink, moist  CRT: <2 sec  Hydration: AdequateHR: 120 bpm  RR: Panting  Temp: Not taken (patient nervous)Body Weight: 12.7 kg  BCS: 7/9Ears/Eyes: Ears clean with minimal discharge and no malodour. Eyes look comfortable and corneas clear with no redness or significant ocular discharge.Oral exam: Teeth clean, no obvious gingivitis or oral lesions noted.Thoracic auscultation:No murmurs or arrhythmias detected. Lung sounds clear bilaterally; no wheezes or crackles auscultated.Abdominal palpation: Mild tension noted in the cranial abdomen/stomach region on palpation, though overall abdomen soft and mostly comfortable.Urogenital: Perineal region generally clean; diarrhoeic faecal staining noted around anus consistent with recent diarrhoea.Integument: Skin and coat in good condition with no obvious lesions.Lymph nodes: Peripheral lymph nodes palpated and within normal limits.Musculoskeletal: Ambulatory on all four limbs with normal muscle mass and no lameness observed.Nervous system: Appropriate mentation; no obvious neurological deficits noted.Rectal: Not performed. Diarrhea faecal staining observed around the perianal region.Pain Score: Mild abdominal tension noted on palpation; otherwise comfortable (low pain score).DiagnosticsBlood workVLS Serum BiochemistrySodium: 145 mmol/L 135–153**Potassium: 3.90 mmol/L 4.10–5.80Chloride: 109 mmol/L 101–119HCO3: 21 mmol/L 14–25Anion gap: 18.9 mmol/L 12–32Na:K ratio: 37.18 23–100Glucose: 4.73 mmol/L 3.30–6.80Urea: 7.91 mmol/L 3.40–10.80Creatinine: 68 µmol/L 50–130Total Calcium: 2.59 mmol/L 1.60–2.80Phosphate: 1.33 mmol/L 0.70–2.80** Magnesium: 0.66 mmol/L 0.71–1.21** Total Protein: 73 g/L 50–72Albumin: 36 g/L 22–38Globulin: 37 g/L 20–42CK: 170 IU/L 73–510AST: 28 IU/L 18–68ALT: 49 IU/L 11–161ALP: 57 IU/L 7–369GGT: <5 IU/L 0–9Total bilirubin: 1.50 µmol/L 0–4** Cholesterol: 10.70 mmol/L 2.90–9.70** Triglycerides: 4.50 mmol/L 0.20–1.30 Amylase: 460 IU/L 305–960Lipase: 534 IU/L 61–936Lipemia: NormalIcterus: NormalHaemolysis: +(2) VLS CBCRCC: 6.94 x10¹²/L 5.40–8.50Hb: 170 g/L 125–201HCT: 0.47 L/L 0.35–0.58PCV (manual): 0.48 L/L 0.34–0.57MCV: 68 fL 58–80MCH: 25 pg 20–27MCHC: 362 g/L 280–400Reticulocytes %: 0.79 % 0.00–1.50Reticulocytes (abs): 54.8 x10?/L 10–110WCC: 15.57 x10?/L 6.00–17.00Neutrophils: 11.84 x10?/L 3.50–12.00Lymphocytes: 2.02 x10?/L 0.90–3.50Monocytes: 1.09 x10?/L 0.00–1.10Eosinophils: 0.62 x10?/L 0.00–1.40Basophils: 0.00 x10?/L 0.00–1.00nRBCs: 0Plasma protein: 80 g/L 62–85Plasma appearance: NormalCommentsPlatelets occasionally small clumps present - manual estimate: average 6.4/100x FIELD = 95.6 x109/LMany macroplatelets present - machine count not reported due to interference of clums and common macroplatelets.RBC: mild anisocytosisWBC: Morphology appears unremarkableAbdominal Ultrasound:Abdominal ultrasound performed. Gastrointestinal tract demonstrates thickened intestinal walls, most notable in the colon, consistent with inflammatory change and suggestive of colitis. The colon appears mildly thickened with reduced/limited appreciable peristalsis during the examination. Mesenteric lymph nodes appear enlarged, likely reactive secondary to gastrointestinal inflammation.Pancreas: Visualised and within normal limits, with no ultrasonographic evidence of acute pancreatitis. Pancreatic parenchyma appears normal without surrounding hyperechoic mesenteric fat or free fluid.Liver/Spleen: Organs visualised with expected anatomical positioning; liver located cranial to the stomach. A mildly hyperechoic hepatic capsule was noted but no significant focal lesions identified.Overall ultrasonographic findings are most consistent with inflammatory gastrointestinal disease/colitis, with no evidence of pancreatitis at this time.AssessmentJacki is presenting with acute gastrointestinal disease characterised by marked inappetence, vomiting history, acute diarrhoea progressing to watery mucoid haematochezia, and cranial abdominal discomfort. Given her extensive GI history, this episode is most concerning for recurrence or exacerbation of significant upper gastrointestinal disease.Differentials1 Acute flare of underlying IBD/chronic enteropathy: highly plausible given known diagnosis, previous diet responsiveness, and recurrent GI signs.2 Severe gastritis and/or gastric ulceration: strongly considered given prior hospitalisation for markedly thickened stomach with suspected ulceration/melaena, current abdominal pain, vomiting, and anorexia.3 Recurrence of gastric wall disease including inflammatory thickening, ulcerative disease, or less likely infiltrative/neoplastic process.4 Dietary indiscretion / adverse food reaction: possible trigger for IBD flare or acute gastroenteritis.5 Infectious or toxin-related gastroenteritis:  less likely but possible, especially with owner concern re mould/fungus contamination.Overall, current signs are compatible with acute gastroenteritis with abdominal pain, but due to Jacki’s history the case should be treated as potentially more serious than uncomplicated gastroenteritis. Previous imaging documented severe gastric pathology, and recurrence of gastric inflammation/ulceration must be ruled out promptly. The presence of fresh blood and mucus in diarrhoea may reflect colitis, but does not exclude concurrent significant upper GI disease or pancreatitis. Jacki remains BAR and hydrated at present, which is reassuring, but her reduced intake and abdominal discomfort warrant close monitoring and further investigation.PlanTreatment:Symptomatic management for suspected GI flare/colitis.Metronidazole prescribed given previous positive response.Maropitant injection 0.1mg/kg IV administered for anti-emetic support.Metoclopramide tablets 0.4mg/kg PO dispensed for ongoing GI motility support.Monitoring  At-home care:Continue feeding small frequent meals of the current tolerated diet.Monitor appetite, vomiting, stool consistency, and activity level at home.Ensure adequate hydration.Patient stable and discharged home today.    Vital Signs    Weight: 12.7;