Hemoabdomen & Hemoperitoneum: Abdominal Bleeding in Dogs
Dr. Douglas Brum
Abdominal radiographs are a good test to see if fluid is present in the abdominal cavity. Although they are a good initial diagnostic, they cannot discern the type of the fluid type. Abdominal radiographs also may identify mass lesions (tumors or hematomas). Unfortunately, a large volume of fluid in the abdomen will often make the radiographic visualization of masses more difficult.
The order of diagnostic tests depends on the clinical condition of the pet. In an emergency situation, the pet would be stabilized prior to significant 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Abdominocentesis - A small sample of fluid is withdrawn from the abdominal cavity and the fluid submitted for microscopic analysis. The bloody fluid withdrawn should not clot, since blood in the peritoneal space rapidly becomes defibrinated (loses it's ability to form a clot). When a hemorrhagic (bloody) fluid is obtained that does clot, it usually means that a blood vessel was inadvertently aspirated. The fluid analysis will show mainly red blood cells with some white blood cells, in quantities similar to peripheral blood. The hematocrit (red blood cell count) should be similar to that of the peripheral blood.
The complete blood count - The CBC is an important test since it evaluates the red and white blood cell lines. When a hemoperitoneum is suspected, a hematocrit is used to evaluate the degree of blood loss (anemia). The CBC also provides information on if the bleeding was acute or chronic. Red blood cell morphology (shape) changes may suggest that hemangiosarcoma or other malignancy is present.
The biochemical profile is a useful test to evaluate if any other organ systems are affected. Animals with traumatic injuries (and sometimes, cancer) will often have elevated liver enzymes. Kidney function is also evaluated.
Full clotting tests are especially important in young animals with no trauma history. If trauma and intra-abdominal (within the abdominal cavity) tumors are ruled out, or if the bleeding is not stopping, a clotting panel is indicated.
An abdominal ultrasound is used to determine if there is an abdominal tumor or hematoma present. Unlike radiographs, fluid in the abdomen does not inhibit the visualization of masses. An ultrasound- guided biopsy may be considered if a mass is found; however, many times the biopsy is non-diagnostic since some masses are mostly blood. Care must be taken when these masses are biopsied, as they do tend to bleed. Animals with splenic masses have the highest incidence of these potential problems.
CT or MRI - Rarely a mass may be too small to be visualized on ultrasound. A CT or MRI available at specialty hospitals may identify these difficult to visualize masses.
One or more of the diagnostic tests described above may be recommended by your veterinarian. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following nonspecific (symptomatic) treatments may be applicable to some, but not all pets with hemoperitoneum. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for treatment of the underlying disease responsible for your pet's condition.
If possible immediate veterinary care should be sought. A hemoperitoneum may be a life threatening condition requiring immediate intervention.
Intravenous fluids are given if there is significant or rapid blood loss. Intravenous fluids maintain blood pressure and improve tissue perfusion. With trauma or bleeding abdominal masses, animals are commonly in shock, and may have multiple organ systems affected. Fluid therapy is critical in these patients, and animals often respond to treatment dramatically.
Blood transfusions may also be required if there is a significant amount of blood loss causing anemia. Blood loss may be only within the abdomen, or be present elsewhere in the body.
A belly wrap is a pressure bandage placed around an animal's abdomen. It causes an increased intra-abdominal pressure that will sometimes slow or stop an abdominal bleed.
Oxygen therapy may be needed in animals that have lost a large volume of blood. It is especially useful early in treatment, while initial fluids or blood products are being administered. Oxygen is administered via oxygen cage, mask or nasal oxygen canula.
Analgesic medication - Keeping the patient still and calm is very important. If an animal is painful, they will have increased stress and be more likely to re-injure themselves. Bleeding that has previously stopped may start again. Treatment with narcotics or other pain medications helps keep animals more comfortable, and potentially 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, an exploratory may be the only way to obtain a diagnosis and treat the condition. If the clotting panel is normal, and abdominal bleeding is continuing, an exploratory might be recommended to stop the bleeding surgically and to discover the cause of the problem.