|
A Case of Hemorrhagic Gastroenteritis
Our presumptive diagnosis of Pepper’s disease, based on clinical signs and laboratory results, was hemorrhagic gastroenteritis (HGE). HGE is a disorder of dogs which is usually fairly abrupt in onset. The significant signs of HGE are vomiting and/or diarrhea containing variable amounts of blood. The blood may be bright red (fresh blood) or dark (digested blood). The diagnosis of HGE is one of exclusion, meaning other possible causes of bloody vomiting and/or diarrhea must first be considered. Some of these possibilities include ulcers, trauma, gastrointestinal tumors or obstruction, foreign bodies, infectious diseases and clotting disorders. Evaluation of these other causes might require such tests as a complete blood count, blood chemistries, urinalysis, radiographs, fecal testing, coagulation tests and possibly ultrasound of the abdomen.
Here we have a happy ending! Thankfully, due to her owner’s awareness and because of the aggressive treatment she received at our hospital, Pepper made a full recovery. Within 36-48 hours of being home from the hospital, Pepper was starting to play again and getting back to her “peppy” self. |
Pepper, a 6 year old female Dachshund presented to our hospital with a sudden onset of lethargy, vomiting and bloody diarrhea. The owners had recently picked her up from the boarding kennel when she started to act ill. All of these symptoms started suddenly within the preceding 12-16 hours and had progressively worsened. When we first saw Pepper, she was very lethargic and not her usual “peppy” self. She appeared to be dehydrated and her body temperature was slightly low and her pulses were weak. She did have copious amounts of watery, bloody and mucousy diarrhea coming from her rectum. She was gagging and dry heaving during her exam and was clearly nauseous. We hospitalized Pepper immediately and performed some tests on her blood and fecal material to try to determine the cause of her symptoms. Her bloodwork showed a severely high HCT (hematocrit) of 71%. A normal HCT for a dog is 35% to 55%. A HCT is actually a measurement of her red blood cell count. However, when animals are severely dehydrated, we can see this level increase dramatically. Her potassium was slightly low. Her fecal tests showed a overgrowth of a bacteria in her intestines, as well as a large amount of RBCs (red blood cells) and WBCs (white blood cells).
Pepper was placed on intravenous fluids to rehydrate her. She was also given medications to treat the nausea/vomiting. She was started on intravenous antibiotics for her bacterial overgrowth in her intestines. Pepper’s vomiting and diarrhea resolved after a few hours of therapy. Pepper was hospitalized for 36 hours and was discharged the following day on a bland prescription food and oral antibiotics.
HGE is most common in small breed dogs. The blood count of affected dogs is frequently seen with an elevated hematocrit. The elevated HCT provides the best information that the dog may have HGE. Unfortunately the cause of HGE remains unknown. Dogs with HGE will appear profoundly ill, and left untreated, may die. In most cases, the disorder appears to run its course in a few days if the animal is given appropriate supportive care. Intravenous fluid therapy provides the cornerstone of therapy for HGE. Antibiotics and anti-ulcer and anti-vomiting medication are also often given. If intravenous fluid therapy is not given, the dog’s red blood cell count will continue to elevate due to dehydration. Eventually, the blood may become so thick that it flows very slowly through the blood vessels. In this situation, the dog is a prime candidate for a potentially fatal clotting disorder called disseminated intravascular coagulation (DIC). Once DIC begins, it is often reversible and may result in death.