C10018586 / invoice 20000

Vetnostics attached - kh    Vital Signs    

Reason: Vomited 7 Times Since Going HomeAppointment Notes: EDSmall portion of food not long after getting home7x vomit, large, containing foam & bilePassive, sounds more like regurgitationFirst ~3pmHR 12037.5C    Vital Signs    

sedation: 0.2mg/kg IM butorphanol givenIVC placed L dorsal pedal (cephalic veins wouldn't thread - had multiple catheters previously)0.1mg/kg torb IV0.5mls in total alfaxan given only Mask oxygen the entire time Recovered well from sedationUltrasonography:Will finish typing Friday - u/s in use after my scan Bladder normalLMILN measures:RMILN measures:LAD 7.0mmRAD 7.0mm Pancreas normalAssessment:Bilaterally plump adrenalsHepatomegaly - mixed echogenicity esp L lateral aspect - ddx cushings v neoplasia Splenic nodules - 1cm near hilus, other 2mm tail of spleen - ddx - benign nodules v neoplasiaDiscussed with Debbie - need to test for hyperA Discussed clotting times and FNA's of liver + spleen (splenic lesions very small and position near hilar vessels makes sampling risky)Debbie doesn't want to do anything major and wouldn't put Zayne through any sort of surgery or risk Happy to do bloods and surgery plan: TSH if T4 lowWill ring Friday with results and organise for him to be booked in for ACTH stim test - likely next weekSTOP CBD - hasn't reacted well and may be contributing towards liver valuesStart hepatoadvancedParacetamol 250mg PO BIDNO Nsaids--- 11/03/2026 15:50:28 FM:Tried ringing Debbie back to chat about sedation and white frothy vomits (had a couple since going home)Advised likely to be the sedative/opiod Recommend coming up for cerenia +/- metomide if neededDebbie will monitor and come up if neededFollow up call tomorrow pls    Vital Signs    Weight: 23.4;