C10023840 / invoice 10000

History:
- Blood noted on bedding x3 over past week, few days apart
- First episode: splatter pattern on sheets overnight
- Most recent: bright red blood when sat on bed
- Stools soft but formed, no diarrhoea
- No blood in urine, urinating normally
- No change in appetite, energy levels normal, happy and cuddly
- No weight loss
- Indoor cats for 6-7 years, recently allowed outside for short periods
- History of soft stools in both cats
- Three teeth removed approximately 6 months ago
- Worming up to date (15th of each month)
- Occasional scuffles with Maine Coon brother

Physical Exam Findings:
- Weight: 6 kg
- Mentation: Bright, alert
- Behaviour: Very compliant, no biting
- Temp: 38.2°C
- Oral Cavity: Teeth excellent, no signs of issues
- Abdomen: Palpated, no abnormalities detected
- Urogenital: Dry blood around perianal area, darker clot-like blood noted, anal glands full bilaterally, expressed during examination, no wounds around area, prepuce normal, no signs of infection

Assessment:
- Problem list:
1. Anal gland impaction/infection

Plan:
- Antibiotics: quarter tablet PO BID for 5 days
- Monitor urine for blood
- If no improvement or worsening, bloods and abdominal ultrasound under sedation to be considered
- Return sooner if demeanour changes, worsening, or not himself

Communications:
- Discussed anal gland anatomy and function
- Explained glands can swell if stools change texture and don't fully express
- Discussed possibility of anal gland abscess/infection causing bloody discharge
- Reassured regarding bowel cancer concerns - would expect bloody stools, weight loss, poor appetite, vomiting if present
- Antibiotics will also cover urinary tract infection if present
- Owner to monitor for any changes

POC looking good, can go back to normal food 
small red spot upper left lip think some lip entrapment from catching now on lower canine, need to watch this, could shorten lower canine (SW can do) 
SW 

History recheck post-op dental 
5.7kg

PE

BAR, MM PP, CRT 2>
HR/RR/RE WNL, chest auscultation clear
EENT-surgical sit of right maxillary teeth 2034 inflammed, irritated no dehisence but slight sero-sanguinous dishcagre noted 
Abdomen-NAD
MSK-NAD, BCS. 4/5
Neurological- cnr all intact, 

Assesment 
No wound breakdown
Moderate post-op swelling with slight irritation/infection 

Treatment 
Amoxi-clav 200mg give 1/2 a tab TWICE daily for 7 days 

Plan 
VEt to assess sutures in 10 days 
Trial amoxi-clav due to inflammed irritated gingiva 
Continue meloxicam for 2 days