Hemoabdomen & Hemoperitoneum: Abdominal Bleeding in Cats
Dr. Douglas Brum
Abdominal X-rays - A good test to see if fluid is present within the abdominal cavity. Although radiographs can confirm a diagnosis of fluid in the abdomen, they cannot determine the type of fluid present. Abdominal X-rays may also identify masses or lesions (e.g. tumors or hematomas). Unfortunately, a large volume of fluid in the abdomen often makes the radiographic visualization of masses more difficult.
The order of diagnostic tests depends on the clinical condition of the cat. In an emergency situation, the cat would be stabilized prior to any extensive diagnostic procedures. A rapid but thorough veterinary evaluation is critical to prioritizing appropriate diagnostic procedures.
Abdominocentesis – A small sample of fluid is withdrawn from the abdominal cavity and the fluid is submitted for microscopic analysis. The bloody fluid withdrawn should not clot, since blood in the peritoneal space rapidly loses its ability to clot. When a hemorrhagic (bloody) fluid is obtained that does clot, it usually means that blood was inadvertently drawn from an abdominal blood vessel. Fluid analysis shows mainly red blood cells and white blood cells in quantities similar to those in peripheral blood. The hematocrit (red cell count) should be similar to that of the peripheral blood.
Complete blood count – The CBC is an important test since it evaluates red and white blood cell numbers and morphology (shape/type). When a hemoperitoneum is suspected, a hematocrit is used to evaluate the degree of blood loss (anemia). The CBC also provides information on whether the bleeding is acute or chronic. Red blood cell morphology (shape) changes may suggest that hemangiosarcoma or other malignancy is present.
Biochemical profile - A useful test to evaluate whether organ systems are affected. Animals with traumatic injuries (and sometimes, cancer) often have elevated liver enzymes. Kidney function may also be evaluated.
Blood clotting tests - Important especially in young cats with no trauma history. If trauma and tumors within the abdominal cavity are ruled out, or if the bleeding has not stopping, a clotting panel is indicated.
Abdominal ultrasound - Used to determine if there is an abdominal tumor or hematoma present. Unlike radiographs, fluid in the abdomen does not inhibit visualization of masses. An ultrasound-guided biopsy may be considered if a mass is found. Care must be taken when masses are biopsied as they tend to bleed. Splenic masses are most likely to present this problem.
CT or MRI – Rarely, a mass is too small to be visualized on ultrasound. A CT or MRI, available at specialty hospitals, may identify these difficult-to-visualize masses.
Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of patient is required, especially if the problem is severe. The following nonspecific (symptomatic) treatments may be applicable to some, but not all, cats with hemoperitoneum. These treatments may reduce severity of clinical signs and provide relief for your pet. However, nonspecific therapy is not a substitute for treatment of the underlying disease causing your cat's condition.
If possible, seek immediate veterinary care. A hemoperitoneum may be a life-threatening condition requiring immediate intervention.
Intravenous fluids are given if extensive blood loss is suspected. Intravenous fluids maintain blood pressure and improve tissue perfusion. Following trauma and when bleeding abdominal masses are present, affected cats are commonly in shock and may have multiple organ failure. Fluid therapy is critical in these patients. Treated cats often respond dramatically to treatment.
Blood transfusions may also be required if there is a significant blood loss causing anemia. Blood loss may be only within the abdomen, or it may be elsewhere in the body as well.
A belly wrap is a pressure bandage placed around an animal's abdomen. It causes an increased intra-abdominal pressure that sometimes slows or stops abdominal bleeding.
Oxygen therapy may be needed in animals that have lost a large volume of blood. It is especially useful early in treatment while fluids or blood products are being administered. Oxygen is administered via oxygen cage, mask, or nasal canula.
Analgesic medication – Keeping patients still and calm is important. Cats that are in pain have increased stress, flail around, and are more likely to re-injure themselves. Bleeding that stopped previously may start again. Treatment with narcotics, or other pain medications, helps keep affected cats more comfortable and more stable.
Vitamin K is sometimes given if anticoagulant intoxication is suspected, even prior to getting test results back. The treatment has few side effects and rapid therapy improves prognosis.
Exploratory surgery – If there is an abdominal mass, exploratory surgery may be the only way to obtain a diagnosis and properly treat the condition. If the clotting panel is normal and abdominal bleeding continues, an exploratory laparotomy is indicated to surgically stem the bleeding and find the cause of the problem.