Difference between revisions of "Gastroenteritis, Haemorrhagic"

Revision as of 11:50, 12 May 2010

Signalment

Middle-aged, small-breed dogs such as:

Miniature Poodle
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Toy Poodle
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Miniature Schnauzer
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Yorkshire Terrier
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Dachshund (Standard Short-haired)
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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

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, 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.

@@ Line 17: / Line 17: @@
 ==Description==
-'''Haemorrhagic gastroenteritis''' is characterised by acute [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Intestine Diarrhoea - Pathology|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 species#C. perfringens type A|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 [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Intestine Diarrhoea - Pathology|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 ''[[: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.
@@ Line 38: / Line 38: @@
 ====Other Tests====
-*Faecal cytology may reveal red blood cells, occasional white blood cells, ''[[Clostridium species#C. perfringens type A|Clostridium perfringens]]'' spores or enterotoxin.  ''[[Clostridium species#C. perfringens type A|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 50: / Line 50: @@
 **[[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.
-*A broad spectrum antimicrobials such as [[Penicillins|ampicillin]] combined with [[Fluoroquinolones|fluoroquinolone]] are appropriate against ''[[Clostridium species#C. perfringens type A|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.