C10029871 / invoice 10000

Reason: V+ And Loose StoolPresenting Complaint:- Acute onset of straining to defecate, explosive diarrhoea, and vomiting of faecal-smelling material.History:- The owner reports that Moose began straining to defecate today, passing only a small amount of faeces initially before being unable to pass more.- Over the last two to three days, Moose has been observed lying prone with his hind legs extended.- Tonight, he was restless and appeared sick. When let outside, he ran to the bathroom and had an episode of explosive, mushy, dense diarrhoea. This was followed by an episode of vomiting material that had the appearance and odour of faeces.- There was no blood observed in the vomit or the diarrhoea.- Appetite has been normal today, with food consumed earlier. Water intake was not specifically observed but is presumed to be adequate given the normal appetite.- Moose has a history of allergies, for which he receives Lokivetmab (Cytopoint) injections approximately every 30 to 45 days. He is not currently on any other medication for his allergies. He also has a history of chewing his tail due to allergies.- No other significant past medical history was reported.- There are no known allergies to medications.Subjective:QARObjective:Temp:      38.9      MM:  Pink            CRT:   <2          HR:  112-160 BPM           FP: Normal and synchronous             RR: 20 BPMBCS:    5/9                Wgt: 7.15   kg Pain Score (Glasgow pain score):   0/20CV:  Normal Heart Rate. No murmurs, no pulse deficits. Average MAP=      Did not obtainRESP:   Lung sounds are normal.  No coughing, no dyspnea SPO2=Did not obtainGIT:   Has been vomiting and having diarrhea . No obvious pain on abdominal palpationU/G:  Unable to palpate a bladderNeuro:  Basic cranial nerve exam is normal. MGCS=18M/S:  NADInteg:  NADOphth:  NADLNs: Lymph nodes are normal sizeProblem List:VomitingDiarrheaAssessment:  The primary problems are acute gastroenteritis characterised by straining to defecate, explosive diarrhoea, and vomiting of faecal-smelling material. The vomiting of faecal-like material raises suspicion for potential coprophagia or, less likely given the clinical signs, a gastrointestinal obstruction.- Differential diagnoses for vomiting include:- Gastrointestinal related: dietary indiscretion, inflammation, infection (viral, bacterial, parasitic), toxin, neoplasia, obstruction.- Non-gastrointestinal related: pancreatitis, endocrine disease, liver disease, renal disease, neurologic disease, neoplasia, toxin.- Differential diagnoses for diarrhoea include:- Primary: Infectious (bacterial, viral, fungal, parasites, dysbiosis), inflammation, neoplasia, mechanical, toxin, motility disorder.- Secondary: Exocrine pancreatic insufficiency, pancreatitis, liver disease, kidney disease, hypoadrenocorticism, hypothyroidism, central nervous system disease, motility disorder.- A recent change in diet a month ago is considered an unlikely cause for the current signs.Treatment:Maropitant 1 mg/kg SQPlan: - Outpatient treatment was elected by the owner.- An injection of Maropitant (an anti-emetic) was administered to control the vomiting.- The owner was counselled on the use of probiotics. The owner has a probiotic at home (ZaniPet) and will continue its use. The option of providing Pro-Kolin, which contains Enterococcus faecium and binding agents, was discussed but declined as the owner already has a probiotic.- The option of sending home an anti-nausea medication (Ondansetron) was discussed to be used in conjunction with Maropitant for better control of nausea, but the owner declined at this time.- The owner was informed of the public holiday fees as the presentation was after midnight on a public holiday (Labour Day).- The owner has RSPCA pet insurance, and a claim can be processed.- The owner was advised to monitor Moose closely. If there is no improvement, or if he is not eating or drinking by the morning, or if his condition worsens, he should be brought back for re-assessment and further diagnostics. Given the public holiday, follow-up with his regular veterinarian may not be possible today.    Vital Signs