C10024908 / invoice 20000

Abdo u/s with EHW 

PE
QAR
MM: Pink , CRT 1 sec 
Teeth Grade 1 dental disease 
Chest: HR 120/min, RR 28/min 
Abdo NAD
Temp 38.2C
Underweight 
rectal exam: NAD , no stools palpable

no sedation needed for abdo u/s 

EHW performed abdo u/s. Verbal report was abdomen looks unremarkable. 
Adrenal glands were a bit small and so as discussed with o , ruling out Addison's disease remains worthwhile. 
Cannot rule out other enteropathies despite normal u/s findings 

TR advised O re above results. 
recommend ACTH stim, given costing etc, o consented to having this done today 
Commence metronidazole from today ( for clostridial overgrowth , refer to last notes) 
remains on psyllium husk and o reports did help with stools.  Also been eating much better now on appetite stimulants - o run out, dispensed couple more tabs to use as needed. 
O has tried multiple diets previously inc hypoallergic wet and dry foods but Odie would not eat any of them. Did trial multiple diets through nutrition plan ( attached) prepared by Sydney animal nutrition 
D+ been going on for months on and off along with reduced appetite/ weight loss. 
Did have small amount haematochezia once, does have increased urgency with defecation --> consistent with large bowel diarrhoea +/- small bowel component 

Tx 
Collected 0 hr sample 
Administered synacthen 5ug/kg (0.11ml) IV 
Collected 1 hr post sample 

Plan 
- to contact o when ACTH stim tests / abdo u/s report comes in , rule out addisons
- commence oral metronidazole (and continue meds previously dispensed)
- continue current diet this stage given just started eating this well 
- Commence synbiotic DC capsule daily
- INI next steps check B12, rpt bile acids, diet trials (now eating better reconsider hypoallergenic trial, higher fibre diets ie Hills Gastrointestinal biome etc) intestinal biopsies, specialist referral

NH spoke to O, explained results. Explained clostridium may be cause of d+ or could be secondary to underlying disease process. O reports faeces still soft but better since introducing psyllium husk. Also rec synbiotic for several months. Elect to hold off on metrogyl until post abdo u/s in case sampling / culture required.
Explained abdo u/s est over phone - explained additional costs if sampling required. O summary with test results and est emailed. O to collect chill pill tomorrow. 
PLAN -
1/ Abdo u/s booked for this Thurs
2/ Likely start metrogyl from thursday re clostridium perfringens Thursday PM.
3/ pending abdo u/s report consider cortisol level for Hypoadrenocorticism, check B12, rpt bile acids, liver biopsy if indicated...

NH tried calling O to explaind faecal results, no answer, l/m requesting O to call back.