C10027136 / invoice 10000

Reason:
- Chronic Diarrhoea follow-up, liver enzyme monitoring

History:
- Chronic diarrhoea, previously treated with prednisolone
- Prednisolone discontinued since third week of January
- Stools improved but not completely formed but defecation frequency reduced to once daily. owner happy with that as no more messing.
- Stools manageable without prednisolone
- Previous referral to Animalis for ultrasound
- Diet: Hill's Z/D wet and dry food

Examination:
Mentation: BAR
BCS (0-5): 3/5
mm: pmg               CRT: <2s
HR: 180                  RR: normal
Ln:nad 
Dental Grade: 0
Heart/lungs: NAD. Abdomen: NAD.

Assessment:
1. Chronic diarrhoea
- Improved and mostly controlled since prednisolone discontinued
- Continue current diet (Hill's Zeki)
- Prednisolone available if diarrhoea worsens

2. Liver enzyme monitoring
- Bloods sent to external lab for senior screen (CBC, liver enzymes, kidney enzymes, T4)
- Results expected Monday

Treatment:
None

Plan:
- Continue Hill's Z/D diet
- Prednisolone available if diarrhoea worsens
- Phone with results Monday
- If liver enzymes elevated, may need referral to medicine specialist
- Owner travelling to Japan for approximately two weeks, cats going to boarding facility

O queried why repeat bloods needed - MB called back. Discussed previous ALT elevation, needs to be rechecked to ensure coming down, if not reducing then warrants further investigation into the liver as per Animalius report. O will call back to book in for this.