Difference between revisions of "Gastroenteritis, Haemorrhagic"

Revision as of 12:31, 11 August 2010

Also known as:

HGE

Description

Haemorrhagic gastroenteritis is characterised by acute vomiting and diarrhoea. Gastrointestinal integrity is lost, 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 rubbish, chemical or foreign body ingestion.

Signalment

Middle-aged, small-breed dogs such as:

Miniature Poodle
Berlinda 2005, WikiMedia Commons
Toy Poodle
Manuel González Olaechea y Franco 2006, WikiMedia Commons
Miniature Schnauzer
MagnusK 2006, WikiMedia Commons
Yorkshire Terrier
Jlcerso 2007, WikiMedia Commons
Dachshund (Standard Short-haired)
Igor Bredikhin 2006, WikiMedia Commons

Diagnosis

Clinical Signs

Include acute and progressive haematoemesis and/or haematochezia, with vomiting preceding diarrhoea. Other signs include depression, anorexia, abdominal pain, dehydration and hypovolaemic shock occurs over a period of 8 - 12 hours. Pyrexia can occur but is rare. In severe cases patients may be critically ill or moribund.

Laboratory Tests

Haematology and Biochemistry

Reveals haemoconcentration with PCV > 60%. Normal or increased total protein concentrations will be present, but proportionately lower than would be expected from the corresponding increase in PCV due to loss of protein through the intestines. In severe cases a thrombocytopaenia and a Pre-renal or renal azotaemia may occur.

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

Radiography

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 Clostridium perfringens. This is recommended to be given empirically. Initially, food should be withheld. Once vomiting has stopped a bland and highly digestible diet such as chicken and rice can be introduced.

Prognosis

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. [[

@@ Line 8: / Line 8: @@
 ==Description==
-'''Haemorrhagic gastroenteritis''' is characterised by acute [[Vomiting|vomiting]] and [[Diarrhoea|diarrhoea]].  Gastrointestinal integrity is lost, resulting in a rapid movement of blood, fluid and electrolytes into the intestinal lumen.  The aetiology is unknown but it may relate to ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' enterotoxicosis or an immune-mediated reaction.  There is usually no history of garbage, chemical or foreign body ingestion.
+'''Haemorrhagic gastroenteritis''' is characterised by acute [[Vomiting|vomiting]] and [[Diarrhoea|diarrhoea]].  Gastrointestinal integrity is lost, resulting in a rapid movement of blood, fluid and electrolytes into the intestinal lumen.  The aetiology is unknown but it may relate to ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' enterotoxicosis or an immune-mediated reaction.  There is usually no history of rubbish, chemical or foreign body ingestion.
 ==Signalment==
@@ Line 31: / Line 31: @@
 ===Laboratory Tests===
-====Haematology====
+====Haematology and Biochemistry====
-*Haemoconcentration with PCV > 60%
+Reveals haemoconcentration with PCV > 60%. Normal or increased total protein concentrations will be present, but proportionately lower than would be expected from the corresponding increase in PCV due to loss of protein through the intestines.
-*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.
+In severe cases a thrombocytopaenia and a Pre-renal or renal azotaemia may occur.
-.*Thrombocytopaenia (severe cases)
-*Pre-renal or renal azotaemia (severe cases)
 ====Other Tests====
-*Faecal cytology may reveal red blood cells, occasional white blood cells, ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' spores or enterotoxin.  ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' spores or enterotoxin can be found in a normal dog, therefore care has to be taken not to over-interpret this.
+Faecal cytology may reveal red blood cells, occasional white blood cells, ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' spores or enterotoxin.  ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]'' spores or enterotoxin can be found in a normal dog, therefore care has to be taken not to over-interpret this.
@@ Line 46: / Line 44: @@
 ==Treatment==
-*Start treatment prior to a full diagnostic investigations.
+Start treatment prior to a full diagnostic investigations.
-*Aggressive intravenous fluid therapy is important for the treatment and prevention of shock.
+Aggressive intravenous fluid therapy is important for the treatment and prevention of shock.
-**[[Colloids|Colloidal]] or plasma are recommended to replace the intravascular deficit due to loss of protein, followed by [[Crystalloids|crystalloids]] to complete rehydration.
+[[Colloids|Colloidal]] or plasma are recommended to replace the intravascular deficit due to loss of protein, followed by [[Crystalloids|crystalloids]] to complete rehydration.
-**Clinical improvements should be noted within a few hours but resolution of clinical signs may take a few days.
+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 [[Penicillins|ampicillin]] combined with [[Fluoroquinolones|fluoroquinolone]] are appropriate against ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium perfringens]]''.  This is recommended to be given empirically.
+A broad spectrum antimicrobials such as [[Penicillins|ampicillin]] combined with [[Fluoroquinolones|fluoroquinolone]] are appropriate against ''[[:Category:Enteropathogenic and Enterotoxaemic Clostridia|Clostridium 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.
+Initially, food should be withheld.  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.
+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''.
+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''.
+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''.
+Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
 [[Category:Stomach_and_Abomasum_-_Inflammatory_Pathology]][[Category:Intestine_-_Inflammatory_Pathology_by_Type]][[Category:To_Do_-_Caz]]
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