C10018714 / invoice 10000

11/03/2026 CLINICIAN: AC
PRESENTING COMPLAINT: Cholecystecomty and liver biopsy for recurrence of pseudomonas infection. on 5th March.  Not eating well. 
HISTORY:Abby is a bit brighter since coming home and no recurrence of liver. Not eating that well at all, vomited a couple of times. Drinking water. Passing soft stool.  On enrofloxacin, paracetamol (stopped as seemed comfortable), ondansetron. Ate some dry food last night but vomited this up the next day 
CLINICAL FINDINGS:
Bright but lean BCS. Peripheral LNs unremarkable. Temp 38.0.  MM pink <2. No jaundice. 
DIAGNOSTICS:
*PCV/TP 40/85, clear
*bilirubin is 11.
-CRP has improved to 32.7 (was >100)
- ALT 165 (was247 prior to surgery). 
ALKP: 3,661 (>2000 prior to surgery).
No free fluid but gastric distention with food despite not eating much over the last few days. Suspect ileus. 
DIAGNOSIS: Pseudomonas cholangitis (cholecystectomy performed) and liver biopsies ( mild chronic inflammation noted with pseudomonas on enrichment culture). Poor appetite with gastric ileus note. 
TREATMENT:
- Enrofloxacin 150mg per day
- Cisapride 5mg twice a day for gastric ileus
- Maropitant 16mg once a day x 4 days, can contnue ondansetron ater this if needed but ondansetron hasn't helped currently. 
*Emeraid intensive -> To reconstitute: mix 3 parts powder and 2 parts water. = 2.21kcal/ml -> 178ml per day 
day 1: Feed 14ml 4 times a day.  ~ 50ml per day 
day 2: Feed 30ml 4 times a day ~ 120ml per day 
day 3: Feed 40ml 4 times a day.  ~ 180ml per day. 
If not improved in 48 hrs she should return.