C10019496 / invoice 10000

SUBJECTIVE: very sad/lethargic this morning and O can see d/c on face but he won't let her near it - growling (unusual)
looking after dog for son, currently staying on a farm.
otheriwse well, not on any meds

OBJECTIVE:B+A
MM Pink
chest NAD
looks like large hot spot RHS face - growling when go hear

ASSESSMENT:Sedate to treat pyotraumatic dermatitis

PLAN:sedate 0.5ml domitor/0.5ml torb IM (towel around neck - unable to muzzle)
medium level sedation
clip and clean hot spot with pyohex, apply neocort - uanble to see inciting cause, affect whole of RHS of cheek
4mg dex s/c
Home with clav 500mg BID and pred 20mg SID x 3dd then EOD
keep somewhere clean and dry
RV with regular vet in 7 days

ABDOMINAL ULTRASOUND
4mcg/kg medetomidine IV 

- the spleen is normal in shape, it has a normal, regular, mildly hyperechoic soft tissue echogenciity - HOWEVER there is a very small hypoechoic nodule within the body of the spleen measuring 5.7 x 5.8mm 
- the liver is normal in size and echogenicity with sharp borders and normal vascular pattern
- the gal bladder is a normal size and shape with thin, sharply echoic wall and contains anechoic  bile
- the left and right kidneys are similar in appearance with normal in size and shape with normal corticomedullary distinction and absence of renal pelvic dilation - however the medulla appears enlarged? Otherwise the kidney is of normal shape and size - compared with previous images taken on 2/12 (saved on the incorrect file - see GH notes) 
- the left adrenal gland was not imaged
- the right adrenal gland was not imaged
- the urinary bladder is normal in shape, has a normal thin regular wall and contains anechoic fluid
- the stomach is empty. There are normal rugal folds. 
- the duodenum can be traced from the pylorus caudally. It's lumen is empty, there is normal wall layering. The pancreas is not evident, there are no visable masses present in this area
- there is no evidence of mesenteric inflammation or lymphadenopathy

FINDINGS: 
No evident obstructive pattern 
small nodule on the spleen 

Eating yesterday - finishing all food. Less enthusiastic and eating grass this morning.
No vom/no diarrhoea noted - unsure if passing stool however as living on acerage.
No hx of gut issues prior to this.
Diet: various brands/logs and dry food - Now just boiled chicken, bone marrow broth, pumkin puree, last eaten 7 PM.

PE:
BAR 
Pink MM, <2s CRT
HR 124, no murmur detected
RR effort normal, lung fields clear
Abdomen uncomfortable - clipper rash noted.
LN NAD
T 38.4C
Rectal: Scant soft feacies - dry MM.

Assessment: ddx open - Gastroenteritis vs fb vs other

Plan:
Admit for re imaging and supportive care.
IVFT 3.75mg/kg/hr maintenance LRS
Maropitant 1mg/kg IV q24hrly.

PM update: 
Given no concerns on imaging - O wanting to try Bently at home with understanding he is not 100% better and we want him here for a revisit tomorrow morning regardless of how well he is going. IV has been left in incase readmission needed.

Discussed small nodule on spleen - unconcerning and coincidental, to repeat scan in 12 months to reassess size.