C10020517 / invoice 10000

Reason: L4: Potential anaemia, V+, D+, lethargy Chronic diarrhoea with weight loss and hypoproteinaemiaHISTORY: - Chronic diarrhoea ongoing for approximately one month- Weight loss of 4 kilograms over the past month, with additional 400 grams lost this week- Current weight approximately 7 kilograms (down from 7.4 kilograms on Monday)-  appetite loss this week, refusing most foods previously ate hypoallerginic fod - Will only eat small amounts of boiled chicken and ham- Vomited ham this afternoon after eating ham - Watery brown diarrhoea, no visible blood noted by owner- Previous veterinarian prescribed probiotics on Monday with no improvement- Food trial attempted with new diet for two days before refusal- Mild anaemia detected on recent blood work- Severely low albumin levels at approximately 10  - Pre-existing conditions: Sensitive stomach- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged- Current vaccination status: not discussed- Current medications: Probiotics prescribed Monday (no improvement noted)TRIAGE:- Mentation: Dull- HR 120 - RR 24 - mm pink CRT 1 sec moist EXAMINATION:Body Condition Score:  4/9 Pain Scale (0-4):  0Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: quick exam only - Abdominal:  comfortable - Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS: Blood work performed Monday by referring veterinarian showing mild anaemia, increased White cell count. and severe hypoproteinaemia with albumin approximately 10PROBLEM LIST:1. Chronic diarrhoea2. Severe hypoproteinaemia3. Weight loss and inappetence4. Mild anaemiaDIFFERENTIAL DIAGNOSIS: Protein losing enteropathy secondary to inflammatory bowel disease or intestinal neoplasiaASSESSMENT: Hugo presented with chronic diarrhoea, significant weight loss and severe hypoproteinaemia. Recent blood work reveals concerning albumin levels at approximately 10, well below normal range. Hugo has lost 4 kilograms over the past month with additional 400 grams lost this week. Appetite has deteriorated significantly this week with refusal of most foods except small amounts of boiled chicken and ham. Clinical examination reveals no evidence of dehydration or hypovolaemia with pink mucous membranes and adequate capillary refill time. No peripheral oedema detected despite severe hypoproteinaemia. Suspected protein losing enteropathy requiring specialist ultrasound for further evaluation. Urgent referral required given severity of protein loss and ongoing clinical deterioration.TREATMENT: Maropitant injection given during consult Ondansetron 4 mg wafer q 8 hours PLAN:- Urgent referral to specialist internal medicine service for specialist abdominal ultrasound first thing tomorrow morning to Animalius a- Alternatively  Contact Murdoch University Veterinary Hospital or Waves Veterinary Specialists for urgent appointment- Monitor closely at home tonight- Continue ondansetron wafers as needed for nausea- Return immediately if condition deteriorates- Specialist evaluation will determine need for intestinal biopsies and further diagnostic workupDISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today.Treatment summary:- Hugo was brought in today for investigation into chronic diarrhoea, significant weight loss, and a poor appetite.- Blood tests performed by his primary veterinarian showed that he has a very low protein level in his blood and is mildly anaemic and increased white cell count. - Today, he was given an anti-nausea injection to help with his appetite and to prevent vomiting.- The findings are very concerning for a condition called a protein-losing enteropathy, which means he is losing a lot of protein from his intestines. We  will  organise an urgent referral for him to see a specialist for an abdominal ultrasound tomorrow.Exercise:- Please follow the instruction of your veterinarian with regards to reintroduction of exercise.- If no specific instructions have been provided please keep your pet rested for the next 3 days then gradually reintroduce normal activity.Diet:- If your pet has suffered any gastrointestinal upset (vomiting or diarrhoea) please feed your pet bland food with no access to high fat foods or scraps. We recommend either a low fat commercial diet or boiled, skinless chicken with rice. Continue this diet for 3 days and then slowly reintroduce normal food.Recheck:- Please organise a recheck for your pet with your primary care veterinarian in THREE days to assess your pet's improvement unless otherwise advised by your veterinarian.Medications at discharge:- Ondansetron wafers: Place a small wafer between the teeth and gums for absorption as needed for nausea. NEXT DUE: tonightIf your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital.If your pet’s condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency. We are open from 6pm until 8am Monday to Friday and 24h over weekends and public holidays. Phone 1300 040 400.    Vital Signs