Gastroenteritis, Haemorrhagic

Signalment

Middle-aged, small-breed dogs such as:

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.