Changes

*'''[[Pericardial Effusion|Idiopathic Haemorrhagic Pericardial Effusion]]''' refers to a type of haemorrhagic pericardial effusion with no apparent cause.  It is most common in large breed dogs with a peak age of onset of 6 years.

*'''[[Pericardial Effusion|Idiopathic Haemorrhagic Pericardial Effusion]]''' refers to a type of haemorrhagic pericardial effusion with no apparent cause.  It is most common in large breed dogs with a peak age of onset of 6 years.

*'''Rupture of an atrial wall''' into the pericardial sac may occur with masses (particularly right atrial haemangiosarcomas), uraemia and with severe mitral valve disease.

*'''Rupture of an atrial wall''' into the pericardial sac may occur with masses (particularly right atrial haemangiosarcomas), uraemia and with severe mitral valve disease.

*'''Disorders of secondary haemostasis''', including Haemophilia A or B, Von Willebrand's disease, rodenticide toxicity, severe hepatic insufficiency and ''Angiostrongylus vasorum'' infection in dogs.  Cattle which ingest dicoumarins (mycotoxins which act in a similar way to warfarin and other rodenticides) in sweet clover may develop haemorrhage from the umbilical vessels into the peritoneal cavity.

*'''Disorders of secondary haemostasis''', including Haemophilia A or B, rodenticide toxicity, severe hepatic insufficiency and ''Angiostrongylus vasorum'' infection in dogs.  Cattle which ingest dicoumarins (mycotoxins which act in a similar way to warfarin and other rodenticides) in sweet clover may develop haemorrhage from the umbilical vessels into the peritoneal cavity.

*Haemorrhagic or serosanguinous peritoneal fluid may be found in '''colicking horses''' that have intestinal strangulation or obstruction.  This finding may support a decision to manage the case surgically.

*Haemorrhagic or serosanguinous peritoneal fluid may be found in '''colicking horses''' that have intestinal strangulation or obstruction.  This finding may support a decision to manage the case surgically.

*'''Iatrogenic effusions''' may occur after surgery, fine needle aspiration or biopsy of abdominal organs, especially in animals with coagulopathies.

*'''Iatrogenic effusions''' may occur after surgery, fine needle aspiration or biopsy of abdominal organs, especially in animals with coagulopathies.

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

Haemorrhagic effusions may occur in any of the major body cavities:

Haemorrhagic effusions may occur in any of the major body cavities.  In the '''abdomen''', there may be signs of abdominal pain (due to the underlying cause of the effusion), an abdominal fluid thrill or a palpable mass, most commonly a splenic haemangiosarcoma.

*In the '''abdomen''', there may be signs of abdominal pain (due to the underlying cause of the effusion), an abdominal fluid thrill or a palpable mass, most commonly a splenic haemangiosarcoma.

 

*In the '''chest''', haemothorax may cause tachypnoea and dyspnoea if severe. Dullness will be evident on thoracic percussion if a pleural effusion has developed and the heart sounds will be muffled on auscultation.

In the '''chest''', haemothorax may cause tachypnoea and dyspnoea if severe. Dullness will be evident on thoracic percussion if a pleural effusion has developed and the heart sounds will be muffled on auscultation.

*'''Pericardial effusions''' may be sufficiently severe to cause '''cardiac tamponade''' and right-sided heart failure. The heart sounds will be muffled on auscultation and there may be hepatojugular reflux, a jugular pulse or signs of left-sided forward failure.  Idiopathic haemorrhagic effusions do not usually clot and are therefore unlikely to result in restrictive pericarditis.

 

*The loss of significant quantities of blood may cause '''pallor''', '''tachycardia and tachypnoea''', a '''haemic murmur''', '''collapse''' and severe '''exercise intolerance'''.

'''Pericardial effusions''' may be sufficiently severe to cause '''cardiac tamponade''' and right-sided heart failure. The heart sounds will be muffled on auscultation and there may be hepatojugular reflux, a jugular pulse or signs of left-sided forward failure.  Idiopathic haemorrhagic effusions do not usually clot and are therefore unlikely to result in restrictive pericarditis.

 

The loss of significant quantities of blood may cause '''pallor''', '''tachycardia and tachypnoea''', a '''haemic murmur''', '''collapse''' and severe '''exercise intolerance'''.

===Laboratory Tests===

===Laboratory Tests===

A '''haematological blood profile''' should be obtained to try to assess whether haemorrhagic has occurred and whether a transfusion is required.  If the sample is taken very shortly after the haemorrhage, there may be no changes on the haemogram as interstitial fluid will not yet have moved into the vasculature, diluting the remaining the red blood cells.  The following changes would be expected after an acute haemorrhage:

A '''haematological blood profile''' should be obtained to try to assess whether haemorrhage has occurred and whether a transfusion is required.  If the sample is taken very shortly after the haemorrhage, there may be no changes on the haemogram as interstitial fluid will not yet have moved into the vasculature, diluting the remaining red blood cells.  The following changes would be expected after an acute haemorrhage:

*Reduced packed cell volume (PCV) or haematocrit (HCT).

*Reduced packed cell volume (PCV) or haematocrit (HCT).

*Reduced haemoglobin concentration

*Reduced haemoglobin concentration

Signs of regeneration (increased mean cell volume (MCV) and polychromasia) would not be expected until 48-72 hours after the event in dogs.

Signs of regeneration (increased mean cell volume (MCV) and polychromasia) would not be expected until 48-72 hours after the event in dogs.

Clotting times and a buccal mucosal bleeding time can be measured for detection of coagulopathies or thrombocytopathia (if the number of platelets is known to be normal).  With acute rodenticide poisoning, the OSPT is often elevated initially because factor VII (part of the extrinsic pathway) has the shortest half-life of the vitamin K-dependent factors.  Blood samples may be sent to specialist laboratories for measurement of levels of clotting factors (VIII and IX) and von Willebrand's factor.  Changes on a biochemical profile should indicate any severe hepatic disease and faecal samples can be collected for detection of ''A. vasorum'' if this is suspected.

Clotting times and a buccal mucosal bleeding time can be measured for detection of coagulopathies or thrombocytopathia (if the number of platelets is known to be normal).  With acute rodenticide poisoning, the OSPT is often elevated initially because factor VII (part of the extrinsic pathway) has the shortest half-life of the vitamin K-dependent factors.  Blood samples may be sent to specialist laboratories for measurement of levels of clotting factors (VIII and IX), von Willebrand's factor and proteins present in the absence of vitamin K (PIVKAs).  Changes on a biochemical profile should indicate any severe hepatic disease and faecal samples can be collected for detection of ''A. vasorum'' if this is suspected.

===Diagnostic Imaging===

===Diagnostic Imaging===

Coagulopathies are treated according to their cause.  Factor VIII and Von Willebrand's factor may be supplemented with cryoprecipitate whereas animals with rodenticide poisoning should receive regular injections of vitamin K and intensive monitoring.  Transfusions may be required if the bleeding cannot be controlled.

Coagulopathies are treated according to their cause.  Factor VIII and Von Willebrand's factor may be supplemented with cryoprecipitate whereas animals with rodenticide poisoning should receive regular injections of vitamin K and intensive monitoring.  Transfusions may be required if the bleeding cannot be controlled.

Pericardial effusions that are caused tamponade should be drained by pericardiocentesis but, if the effusion is recurrent, pericardectomy may be indicated.  

Pericardial effusions that are causing tamponade should be drained by pericardiocentesis but, if the effusion is recurrent, pericardectomy may be indicated.  

[[Category:To_Do_-_James]]

[[Category:To_Do_-_James]]

[[Category:Cat]][[Category:Dog]][[Category:Horse]][[Category:Cattle]]

[[Category:Cat]][[Category:Dog]][[Category:Horse]][[Category:Cattle]]