C10032911 / invoice 10000

Reason: Blocked?? Ref From St Kilda VetHospital Time Period: 1300-History:Referral from St Kilda Vet for obstructed FLUTD. Yesterday eating normally, straining to urinate, passed normal faeces. Went to referring vet and urinalysis indicated bacterial infection and non obstructed FLUTD. Given convenia and maropitant injections and sent home. Went back to referring vet this morning and had methadone injection and sent home with oral gabapentin 100 mg half tablet twice daily. Still straining to urinate and referred for unblocking.Vomited this morning and refused food.Yesterday normal appetite.Previous episode December and was unblocked at referring vet.Has been on urinary diet since then and has been normalNo other conditions.Owner is leaving for Philippines and had suitcase out causing stress.Two cat household. No other changes.Indoor onlyPresented with IV catheter in left cephalic. Owner said bloods taken but results have not been suppliedSubjective:BARObjective:Temp:   39.6         MM:    pink         CRT:       <2      HR:     192        FP:      strong        RR:  40BCS:  5  /9                Wgt:  5.16  kg Pain Score (CSU):   1/4CV:   normal cardiac rate and rhythm, normal BPRESP:      normal resp effort, normal bronchovesicular sounds     GIT: abdomen soft and non painfulU/G: large tight uncomfortable bladder unable to express manuallyNeuro: nadM/S: nadInteg: nadOphth: nadLNs: nadINTERNAL LABORATORYPCV/TS:  36/79	Blood Gases:pH         7.243PCO2    50 HHCO3    18.3BE         -5.9cSO2     19 LElectrolytes:Na+      154K           3.5Cl          123Glucose   5.5Lactate    1.4Ionised Ca    1.32Urea      4.7 LCrea       71 LProblem List:Obstructed FLUTDAssessment: Requires urinary catheter placement under GA24 hours of indwelling catheter and diuresisTreatment:Sedation methadone 0.3 mg/kg IV and medetomidine 0.02 mg/kg IVInduction alfaxan 0.5 ml IVET tube size 3.5 passedMaintenance isoflurane and OxOn initial exam the perianal area is clipped and there is a small lesion on right side of prepuce- looks like recent catheterisationAttempted to pass  a 3.5 Fr Mila catheter, able to pass, flush with 10 ml saline but no urine flow and no urine on suction. Second vet attempted with similar outcomeOedema of preputial region suggests urethral tearDecompressed the bladdder by cycstocenteisisPlan: Diagnostic plan :Therapeutic plan :Discharge plan :Referral plan : MP phoned Southpaws re specialist surgery referral for retrograde catheterisationQuote is $10K given likely uroperitoneumClient Communication:MP phoned owner with plan for transfer to Southpaws for specialist surgeon as unable to pass a urinary catheter to unblock the cat. MPP explained that specialist surgeon needed to pass a retrograde catheter, and then the urethra will heal around the catheter indwelling. There will likely be an extended period for ICU care because likely uroperitoneumEstimate given by Southpaws $10KOwner will call back with decision to go ahead or not, and we have also discussed euthanasia as an option.Financial Update:Options Offered to Client for Ongoing Care:Reason: EuthanasiaExamination:Assessment:Zoletil 0.2 ml IMTreatment; - Euthanasia with pentobarbitone 5 IVPLAN:Owner has decided on private cremationShe is away in Phillipines from tonight. She will leave her sisters number for contact    Vital Signs    Weight: 5.16;       Temperature: 39.6;       HeartRate: 192;       BodyScore: 5;       RespirationRate: 48;       PainScore: 1;       BP: 112/70;       CRT: <2;       MMColour: pink;