C10032548 / invoice 10000

FO called this afternoon re:
- Lily still hopping
- had been on meloxicam however suspect pancreatitis so advised stop
- owner concerned about pain relief and asked to begin melox
- Spoke with JZ, dispending gabapentin as additional pain relief with paracetamol 
ML

Ultrasound Assessment: 
1. Thickened right pancreatic lobes with hyperechoic peripancreatic fat surrounding both the 
right and left lobes most likely reflects pancreatitis. Blood test may be helpful for further 
evaluation 

2. Reduced Corticomedullary definition may reflect chronic kidney disease (CKD). Blood tests 
and urinalysis are recommended to evaluate kidney function further. 

3. Mixed Echogenicity liver - DDx- combined processes such as vacuole hepatopathy with 
benign nodular hyperplasia, are considered most likely however inflammation from conditions 
such as hepatitis, is also possible. Neoplasia is considered less likely. FNAs are required for 
definitive diagnosis. 

4. The stomach is mostly empty with small amounts of fluid and gas. There is no evidence of 
foreign material or a gastric outflow obstruction. Occasionally foreign material can be 
obscured by gas artefact therefore repeat imaging is strongly recommended should clinical 
signs of vomiting continue. Abnormalities of the stomach wall including ulceration or 
neoplasia may require endoscopic examination for a definitive diagnosis.  


THORACIC X-RAYS 
A 3 view thoracic study has been performed. The heart size and shape are normal. The cranial and 
caudal pulmonary arteries and veins are normal and equal in size. The aorta and caudal vena caval 
are normal. The lungs have a normal pulmonary pattern. The pleural space is normal. The 
mediastinal width is normal. The oesophagus is empty. The trachea is normal in position but has 
some slight variation in width in the thoracic region while the cervical trachea is normal. The thoracic 
lymph nodes including the craniospinal, sternal and tracheobronchial lymph nodes are not visible. The 
included abdomen has normal serosal detail. The included musculoskeletal structures are normal. 

Assessment 
Narrowing of the thoracic trachea in some views may reflect weakened tracheal cartilages and 
tracheal collapse however dynamic studies are recommended for a complete evaluation. The 
esophagus is mostly empty with no evidence of an esophageal obstruction or megaesophagus. 
Dynamic esophageal and hiatal studies could be performed for complete evaluation.


1. Tracheal Collapse
2. Possible Pancreatitis 
3. Mild change present in the liver which likely represent a benign process such as vacuolar hepatopathy. 

Plan: 
Discussed above findings with client. 
1. Possible tracheal collapse is evident on the radiographs. However, fluoroscopy would be required to definitively diagnose the condition. O to consider and let us know if they want a medicine referral. 
2. Could offer CPLI blood test here to help further investigate pancreatic changes. Otherwise, treatment for pancreatitis involves feeding a bland diet, analgesia with paracetamol, anti-nausea with ondansetron.

Reason: Courtesy phone call post surgery/ procedure
Nurse: JW

TTCONA couldn't leave msg - SMS sent - check up after US yesterday