Clinician Specialty: Veterinarian
Patient History:
* Chief Complaint: "Fido, a 5-year-old male neutered Golden Retriever, presented for acute onset of vomiting and lethargy over the past 24 hours."
* History of Present Illness: Vomited 3 times yesterday, yellow bile. Has not eaten since yesterday morning. Lethargic, not interested in play. No diarrhoea reported. Owner reports no known access to toxins or foreign objects.
* Past Medical History: Up-to-date on vaccinations and deworming. No significant past medical history.
* Medications: Bravecto (fluralaner) administered 2 months ago.
* Allergies: No known drug or food allergies.
* Family History: Sire had osteoarthritis.
* Social History: Lives indoors with two other dogs and a cat. Gets daily walks in a fenced garden.
Physical Exam and Other Findings:
* Vital Signs: Temperature 39.2°C, Heart Rate 110 bpm, Respiratory Rate 24 bpm.
* General Appearance: Lethargic but responsive, good body condition score (BCS 5/9), well-hydrated mucous membranes (CRT < 2 seconds).
* Systemic Examination:
* Abdominal Palpation: Mild cranial abdominal discomfort on palpation, no overt masses or foreign bodies felt.
* Oral Exam: Mild periodontal disease.
* Lymph Nodes: All peripheral lymph nodes normal size and consistency.
* Cardiopulmonary: Clear lung sounds, no murmurs or arrhythmias detected.
* Laboratory Results:
* Complete Blood Count (CBC): Mild neutrophilia (15.5 x 10^9/L; ref range 6-12 x 10^9/L).
* Serum Biochemistry: Elevated amylase (1500 U/L; ref range 100-1000 U/L) and lipase (2500 U/L; ref range 50-1500 U/L). Glucose, BUN, Creatinine, ALT, ALP all within normal limits.
* Imaging Findings: Abdominal ultrasound revealed hyperechoic peripancreatic fat and a mildly enlarged, hypoechoic pancreas consistent with pancreatitis.
Assessment:
Acute Pancreatitis
- Vomiting
- Lethargy
- Abdominal discomfort
- Elevated amylase and lipase
- Ultrasound findings consistent with pancreatitis
Plan:
* Hospitalisation for supportive care.
* Intravenous fluid therapy (Lactated Ringer's Solution) at 5ml/kg/hr.
* Analgesia: Maropitant (Cerenia) 1 mg/kg SC once daily for antiemetic effect; Buprenorphine 0.01 mg/kg IV q6h for pain management.
* Anti-emetic: Maropitant 1 mg/kg SC q24h.
* NPO for 12-24 hours, then gradual introduction of a low-fat, highly digestible diet.
* Monitor vital signs, hydration status, and appetite closely.
* Repeat bloodwork (CBC, biochemistry) in 24-48 hours to assess response to treatment.
* Owner education on pancreatitis and dietary management upon discharge.
* Follow-up appointment in 5-7 days post-discharge to re-evaluate Fido's condition.
