Gastroenteritis, Haemorrhagic

Signalment

Middle-aged, small-breed dogs such as:

• Toy and Miniature Poodles
• Miniature Schnauzers
• Yorkshire Terrier
• Dachshunds

Description

Haemorrhagic gastroenteritis is characterised by acute vomiting and diarrhoea. Gastrointestinal integrity is loss, resulting in a rapid movement of blood, fluid and electrolytes into the intestinal lumen. The aetiology is unknown but it may relate to Clostridium perfringens enterotoxicosis or an immune-mediated reaction. There is usually no history of garbage, chemical or foreign body ingestion.

Diagnosis

Clinical Signs

• Acute and progressive haematoemesis and/or haematochezia, with vomiting preceding diarrhoea
• Critically ill or moribund patient in severe cases
• Depression and anorexia
• Abdominal pain
• Dehydration and hypovolaemic shock occurs over a period of 8 - 12 hours.
• Pyrexia (rare)
• Thrombocytopaenia (severe cases)
• Pre-renal or renal azotaemia (severe cases)

Laboratory Tests

Haematology

• Haemoconcentration with PCV > 60%
• Normal or increased total protein concentrations, but proportionately lower than would be expected from the corresponding increase in PCV due to loss of protein through the intestines.

Other Tests

• Faecal cytology may reveal red blood cells, occasional white blood cells, Clostridium perfringens spores or enterotoxin. Clostridium perfringens spores or enterotoxin can be found in a normal dog, therefore care has to be taken not to over-interpret this.

Diagnostic Imaging

• Abdominal radiograph may reveal fluid and gas filled small and large intestines.

Treatment

• Start treatment prior to a full diagnostic investigations.
• Aggressive intravenous fluid therapy is important for the treatment and prevention of shock.
  • Colloidal or plasma are recommended to replace the intravascular deficit due to loss of protein, followed by crystalloids to complete rehydration.
  • Clinical improvements should be noted within a few hours but resolution of clinical signs may take a few days.
• A broad spectrum antimicrobials such as ampicillin combined with fluoroquinolone are appropriate against C. perfringens. This is recommended to be given empirically.
• Initially, Nil Per Os should be implemented. Once vomiting has stopped a bland and highly digestible diet such as chicken and rice can be introduced.

Prognosis

Good if presented in a timely fashion. The duration of the disease is normally between 24 - 72 hours. Complete recovery in most cases provided there is no complication such as hypoproteinaemia or sepsis. However, recurrence is possible.

References

• Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.
• Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA.
• Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.