Gastroenteritis, Haemorrhagic

Also known as: HGE

Introduction

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, Toy Poodle, Miniature Schnauzer, Yorkshire Terrier, Dachshund.

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. Colloids 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. Broad spectrum antimicrobials such as ampicillin combined with fluoroquinolone are appropriate against Clostridium perfringens.

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.

Literature Search

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Haemorrhagic gastroenteritis publications

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.