C10020737 / invoice 20000

Reason: Abdominal ultrasoundSedation: Ecc : methadone + medetomidine SC - per their chartsDiagnostic Imaging:  Ultrasound summary/keyLimitations: patient size. Not observed: left lobe of pancreas, right adrenal, PDJColon: lumen moderately distended with gas and faecal material with distal acoustic shadowing. In the region of the transverse colon, there is focal luminal distension with anechoic fluid, and focal circumferential wall thickening with maintenance of wall layering. The luminal contents (stool vs foreign material) just aborad to this (in the descending colon) has distinct clean distal acoustic shadowing. Small intestines: duodenum and most of jejunum are minimally distended with gas In the distal jejunum and continuing along the ileum to the ICCJN, the lumen is moderately distended with echogenic liquid ingesta with dirty distal acoustic shadowing, and gas. Surrounding the distal jejunum/proximal ileum, the mesentery is focally hyperechoic and blurry, without peritoneal effusion. Peristalsis is observed but luminal fluid-ingesta is sometimes observed moving both forward and back.Stomach: moderately distended with gas, and some liquid, the walls are normal. PDJ not observed.  Kidneys:normal size, shape, margination, echogenicity, echotexture and renal pelvices. The left kidney has mildly reduced corticomedullary distinction. Both kidneys have medullary cysts, the left has 3, the largest measuring 8.7 x 9.5mm. The right has one, the largest measuring 8.4 x 4.8mm Left adrenal is small normal, measuring 4.9mmLeft MILN is mild-moderately enlarged, with smooth oval margination, normal echogenicity, just hypoechoic to surrounding structures, with homogenous echotexture. Thickness 9.3mm. Bladder is markedly distended with anechoic urine, with mildly smoothly thickened walls, with no masses or calculi observed. Prostate: typical of entire male, moderately large, with smooth symmetrical margination, hyperechoic hyperattenuating echogenicity.Spleen: moderately enlarged, otherwise normal (dx sedation)The following were within normal limits for size, shape, margination, echogenicity and echotexture: Liver, gall bladder, pancreas, jejunal LNs, testiclesAssessment:Key· Colon: Focal circumferential wall thickening of the transverse colon, with suspect colonic foreign material vs dense faeces in the descending colon just aborad: ddx colonic foreign material and focal colitis (inflammatory > neoplastic).· Distal jejunum-ileum: Moderate distension with region surrounded by hyperechoic mesentery: ddx previous foreign body obstruction vs focal enteritis-peritonitis.· Kidneys: Medullary cysts and left reduced corticomedullary distinction: ddx congenital kidney disease, renal dysplasia vs degenerative change (chronic kidney disease).Other:· Left adrenal: Small-normal, right not observed: ddx variant vs hypoadrenocorticism.· Splenomegaly: ddx sedation, benign (extramedullary haematopoiesis, lymphoid hyperplasia) > splenitis, neoplasia.· Bladder: Smoothly thickened walls: ddx chronic cystitis (sterile vs infectious).· Prostatomegaly: ddx benign prostatic hyperplasia; prostatitis cannot be excluded.· Left medial iliac lymph node: Enlarged: ddx reactive hyperplasia > metastatic neoplasia.CommentsOllie's ultrasound found a number of changes. There is suspect colonic foreign material (vs dense faeces) in the descending colon with focal wall thickening just orad to this (in the region of the transverse colon). There is also a region of distal jejunum-ileum surrounded by focal inflammation, without current evidence of a small intestinal obstruction, with differential including previously passed foreign material vs focal enteritis-peritonitis. Monitor the faeces for potential passing of foreign material. There was no observed gastric or small intestinal foreign material or small intestinal obstructive pattern, however given the patient size, this cannot be fully ruled out. If the patient is not progressing as expected, consider an abdominal CT scan. Correlate the renal and bladder changes with bloods and urinalysis +/- culture. Correlate the small-normal left adrenal with functional testing if indicated.-----------FULL REPORT-------Ultrasound report. Date: 10/03/2026 Patient: Ollie PridmoreBreed: LabradorDOB: 21/08/2021 (4y6m ME 35kg)Veterinarian: Dr Stephanie Middlemast BSc DVM GCSAUA MANZCVS (SA Radiology)UltrasoundLimitations: patient size.Kidneys: normal size, shape, and margination, normal echogenicity, and normal homogenous echotexture. The left kidney has mildly reduced corticomedullary distinction. Both kidneys have medullary cysts, the left has 3, the largest measuring 8.7 x 9.5mm. The right has one, the largest measuring 8.4 x 4.8mm. Normal doppler appearance.· Left kidney measures: 8.1 cm (K:A 7.4)· Right kidney measures: 8.5 cm (K:A 7.7)· Aorta: 1.1 cm (normal K:A 5.5-9.1)Adrenals: the right adrenal was not observed. The left adrenal is small normal, with elongated shape, smooth margination, normal hypoechoic echogenicity, and homogenous echotexture. · Left caudal pole measures: 4.9 mm (N >20kg <7.3mm)Bladder: moderate-markedly distended with anechoic urine, no echogenic sediment, with mildly smoothly thickened walls. No calculi or masses observed. · Cranial wall thickness: 2.5 mm· Trigone wall thickness: 3.7 mmProstate: moderately large, typical of an entire male, with smooth symmetrical margination, hyperechoic hyperattenuating echogenicity and homogenous echotexture. No nodules or focal lesions.Spleen: moderately enlarged, with normal shape, and structure, with smooth margination, normal echogenicity (hyperechoic to the liver) and normal homogeneous echotexture. No nodules or focal lesions. Normal doppler appearance.Liver: normal size, shape, and structure, with smooth margination, normal echogenicity (hypoechoic to the spleen) and normal echotexture. No nodules or focal lesions and normal doppler appearance.Gall bladder: moderately distended with anechoic bile, mild fine mobile echogenic sediment, with normal regular smooth walls and normal wall thickness, measuring 0.9 mm. The common bile duct and duodenal papilla were not observed.Pancreas: The right lobe has normal size, shape, and structure, with smooth margination, normal echogenicity (just hypoechoic surrounding structures), and normal homogenous echotexture. The left lobe and body were not observed.· Right lobe thickness: 12.0 mm (N 3.9-16mm)Stomach: lumen moderately distended with anechoic fluid and gas, with normal appearance of walls: normal margination, wall thickness (serosa-lumen) and maintenance of well-defined individual wall layers. Pyloric-duodenal junction not observed.Small intestines: In the distal jejunum and continuing along the ileum to the ileocaecal junction, the lumen is moderately distended with echogenic liquid ingesta with dirty distal acoustic shadowing, and gas. Surrounding the distal jejunum/proximal ileum, the mesentery is focally hyperechoic and blurry. Peristalsis is observed but luminal fluid-ingesta is sometimes observed moving both forward and back. The duodenum and most of the jejunum are minimally distended with gas, with normal appearance of walls: normal margination, wall thickness (serosa-lumen) and maintenance of well-defined individual wall layers. Ileocaecal junction normal.Colon: lumen moderately distended with gas and faecal material with distal acoustic shadowing. In the region of the transverse colon, there is focal luminal distension with anechoic fluid, and focal circumferential wall thickening with maintenance of wall layering, with wall thickness measuring between 3.6-5mm. The luminal contents (stool vs foreign material) just aboral to this (in the descending colon) has a distinct clean distal acoustic shadowing. The colon elsewhere otherwise has normal appearance of walls, wall thickness (serosa-lumen), and maintenance of wall layering.Wall thickness· Stomach: 3.7 mm (N >30kg 2-5mm)· Duodenum: 3.8 mm (N >30kg 3.1-5.7mm)· Jejunum: 3.0-4.0 mm (N >30kg 2.7-4.7mm)· Ileum: 2.6 mm (N >30kg 3.8mm)· Colon: 1.4 mm, focally 3.6-5.0 mm (N >30kg 1-2mm)*Lymph nodes· Medial iliac LNs: The left is mild-moderately enlarged with smooth oval margination, normal echogenicity, just hypoechoic to surrounding structures, with homogenous echotexture. The right is normal size, shape, and structure, with smooth margination, just hypoechoic to surrounding structures with homogenous echotexture. Thickness: L 9.3 mm R 5.2 mm (N 4-5.6mm)*· Jejunal LNs: normal size, shape, and structure, with normal smooth margination, just hypoechoic to surrounding structures with homogenous echotexture. Thickness: 6.4 mm (N 5-8mm)Testicles: the left and right testicles have normal size, shape and structure, with smooth margination, and homogenous echogenicity. No nodules or focal lesions.Assessment:Key· Colon: Focal circumferential wall thickening of the transverse colon, with suspect colonic foreign material vs dense faeces in the descending colon just aborad: ddx colonic foreign material and focal colitis (inflammatory > neoplastic).· Distal jejunum-ileum: Moderate distension with region surrounded by hyperechoic mesentery: ddx previous foreign body obstruction vs focal enteritis-peritonitis.· Kidneys: Medullary cysts and left reduced corticomedullary distinction: ddx congenital kidney disease, renal dysplasia vs degenerative change (chronic kidney disease).Other:· Left adrenal: Small-normal, right not observed: ddx variant vs hypoadrenocorticism.· Splenomegaly: ddx sedation, benign (extramedullary haematopoiesis, lymphoid hyperplasia) > splenitis, neoplasia.· Bladder: Smoothly thickened walls: ddx chronic cystitis (sterile vs infectious).· Prostatomegaly: ddx benign prostatic hyperplasia; prostatitis cannot be excluded.· Left medial iliac lymph node: Enlarged: ddx reactive hyperplasia > metastatic neoplasia.CommentsOllie's ultrasound found a number of changes. There is suspect colonic foreign material (vs dense faeces) in the descending colon with focal wall thickening just orad to this (in the region of the transverse colon). There is also a region of distal jejunum-ileum surrounded by focal inflammation, without current evidence of a small intestinal obstruction, with differential including previously passed foreign material vs focal enteritis-peritonitis. Monitor the faeces for potential passing of foreign material. There was no observed gastric or small intestinal foreign material or small intestinal obstructive pattern, however given the patient size, this cannot be fully ruled out. If the patient is not progressing as expected, consider an abdominal CT scan. Correlate the renal and bladder changes with bloods and urinalysis +/- culture. Correlate the small-normal left adrenal with functional testing if indicated.    Vital Signs    

Reason:Continuous vomiting since approximately 11:30 with progression to bile productionHistory:Ollie began vomiting around 11:30 with one initial large vomit followed by continuous vomiting episodes. Currently producing bile with minimal stomach contents. Known to chew toys occasionally with previous vomiting episodes sometimes containing toy fragments, though no toy material observed in today's vomit. History of elbow or hip dysplasia unrelated to current presentation. No recent dietary changes.Subjective:BARObjective:TPR: WNL, MM: pink and slight tacky, CRT: < 2sec, <5% dehydrated.EENT: Clear AU/OU. No nasal discharge.PLN: Soft, symmetrical, normal size/character.Cardiovascular: No heart murmur, regular rhythm, strong synchronous pulses, well-perfused with warm distal extremities.Pulmonary: Normal lung sound and effort.Abdomen: Soft and non-painful. No masses palpated. No fluid wave. Musculoskeletal: Ambulatory x4 with no obvious lameness.Integument: Healthy hair coat. The skin is clean, dry, and intact.Neurologic: Alert and appropriate, cranial nerves intact, normal gait. no neuro deficits on PE.Assessment:Acute vomiting, DDx: FBO vs gastroeteritis vs otherPlan:- Bloodgas: WNL- Abdominal ultrasound performed - no evidence of obstructive pattern or intestinal foreign body- Maropitant 1mg per kilogram injectable dose administered- Maropitant prescribed for home administrationClient Communication:Discussed differential diagnoses including potential intestinal obstruction from toy ingestion versus severe gastroenteritis. Explained ultrasound procedure and associated costs of approximately nine hundred dollars with potential additional two hundred dollars if sedation required. Total estimated cost including consultation fee between one thousand two hundred to one thousand five hundred dollars. Advised that if surgical intervention required, procedure would be scheduled for following day due to timing. Plan to discharge with anti-nausea medication if no obstruction found. Owner agreed to proceed with diagnostic plan and monitoring recommendations.Updated owner on diagnostic findings, likely had eaten something but passed, currently no evidence of FB or obstruction. Plan to send home on antinausea meds.    Vital Signs    Weight: 35;       

Student: Emma BroganReason: Eyelid So Swollen That It Has Taken Over Eye. DAHistory: Left eye affected and pt has been scratching at it and bothered by it in the last hour. Was pawing at his eye in consult. Third eyelid visable and squinting in consult with the left eye. O thinks it is getting more swollen and worse over time. Another dog at home. Walked dog at 11am today but O has been home with him today and does not think it occured directly after the walk Small amount of tears in the last hour.Walks on lead, but there is long grass on the walk 30 mins ago 3rd eyelid exposed on the left eye More prominant when he is relaxed Eating and drinking normally. Last ate this morning at 7:30am  No V+ and D+ Not UTD with vaccinations, is wormed monthlyNo travel outside of VIC No known access to toxins Does not usually have any problems with his eyes No known allergies and does not itch himselfExamination: Subjective: BAR, anxious in consult Objective: HR:88 , no murmurs ascultated, MMs pink, moist RR: panting in consultBCS 6/9 No pain reaction upon palpation of the area near the eye, although the dog was anxios and reluctant to be touched. Limited ability to physically examine due to demeanor. Left eye: Blepharospasm seen while in consult, some serous discharge, slightly inflamed conjunctiva, third eyelid slightly protruding, PLR normal. Flourescein  negative.Right eye: NAD Assessment: Problem list: Swollen, inflammed, uncomfortable eye (unilateral) - ddx: allergies, trauma (scratch from grass, sticks) , forgein body (ex. Grass seed), corneal ulcer.Treatment: Options presented to owner: 1) Go home and monitor eye, represent if there is further deterioriation including excessive inflammation of the conjuntiva, discharge, swelling 2) Steroid eye drop to be given once daily in the left eye O elected option 2. Discussed with O to immediately stop drops if the eye becomes worse after treatment such as further swelling or discharge. Reccomended using an E collar to prevent Ollie from traumatising the eye further.    Vital Signs