C10028482 / invoice 10000

REASON - Ultrasound with JarradGrade 2 heart murmurIV catheter placedEcho:Stage B1Sedation - 0.15ml medetomidine + 0.25ml butorphanol IV Abdo:Mildly bright liver with adrenals upper end of normal. Nail trim0.15ml atipamezole IM Wait for report before calling O. Ultrasound report:Impressions.Impressions:Mild Myxomatous Mitral Valve Degenerative disease (MMVD) with discrete mitral valveregurgitation and no significant left atrial or ventricular dilation or other haemodynamicchange (ACVIM stage B1 heart disease)1. Hyperechoic hepatomegaly with adrenal changes, early pituitary dependant hyperadrenocorticism most likely. Consider LDDST or ACTH stimulation. Other differentials for hyperechoic hepatomegaly include lipid vacuolation, non-lipidvacuolation. Chronic inflammation and lymphoma should be considered very unlikely.If warranted consider monitoring coagulation parameters and fine needle biopsy.Comments.1. There are no other significant abdominal findings.The ALP elevation is very mild and adrenal glands are upper limit of normal. therefore suggest can measure water consumption to see if PD. Could consider LDDST to further assess/ repeat ultrasound to see if adrenals enlarge etc? No heart medications required. $930 for dental with IVFT and dental xrays.Rang and ST Maddie and Geoff. Have dispensed tranexamic acid 500mg TID for 3 days before and after dental. They will measure water intake for 3 consecutive days (which may include cats drinking, but not much as eats a lot of wet food) and will let me know data next week. Will then aim to book dental.     Vital Signs