Hemorrhagic Gastroenteritis (HGE)
Dr. Bari Spielman
A complete blood count (CBC) most often reveals profound hemoconcentration with a PCV of greater than 60 percent, and sometimes as high as 75 percent. There is most often an elevation in white blood cell count consistent with a stress response.
Certain diagnostic tests must be performed to diagnose HGE and exclude other disease processes that may cause similar symptoms. Obtaining a complete history, description of clinical signs, and thorough physical examination are all an important part of obtaining a diagnosis. In addition, the following tests are recommended to confirm a diagnosis:
A biochemical profile is usually within normal limits, although it may reveal elevations in kidney and/or liver enzymes, and/or electrolyte abnormalities that may suggest other disease processes.
A urinalysis helps assess the kidneys and level of hydration of the patient.
Abdominal radiographs (X-rays) are usually within normal limits, although they may reveal fluid and gas in the intestinal tract. They also help rule out other causes of bloody diarrhea, such as tumors, foreign bodies, and changes in the liver, for example.
A thorough fecal evaluation should be performed, as there are certain intestinal parasites (whipworms) that can cause explosive bloody diarrhea.
A platelet count and full coagulation (clotting) profile should be obtained, as thrombocytopenia and other clotting abnormalities are very often seen responsible for similar clinical signs.
Your veterinarian may recommend additional tests to exclude or diagnose concurrent conditions. These tests are not necessary in every case, although they may be of benefit in certain individuals, and are selected on a case by case basis. These include;
A fecal Elisa test for parvovirus in suspect dogs
Fecal cytology and bacterial culture in selected cases
An ACTH stimulation test should be performed in individuals suspect of having hypoadrenocorticism. It consists of a pair of blood tests that can be drawn at your local veterinary hospital.
Abdominal ultrasound may be recommended in certain cases. It is very helpful in evaluating all of the abdominal organs, including the liver, kidneys, lymph nodes and spleen. It is equally important to rule out other disorders or diseases that may initially be difficult to differentiate from HGE. Abdominal ultrasound is a noninvasive test that often needs the expertise of a specialist and/or referral hospital.
An electrocardiogram may be recommended as cardiac arrhythmias (abnormal heart rhythms) may be associated with HGE.
Colonoscopic examination (evaluation of the colon through an endoscope) is generally not necessary or even recommended in patients with HGE. The reason for it's mention is so that other disorders can be ruled out. Examples include colonic cancer, foreign bodies, etc.)
Patients suspected of having HGE should be hospitalized and treated aggressively, because clinical deterioration is often rapid and can be fatal. This is a syndrome in which out patient therapy most often is not enough, and certainly may put the patient at great risk, increasing the potential for complications. Successful treatment depends on managing fluid and electrolyte abnormalities and minimizing bacterial invasion of the body. Dietary management is important during the recovery period.
Rapid volume replacement with appropriate fluid and electrolyte therapy is imperative.
The patients PCV should be monitored closely during the initial stages of treatment.
Injectable antibiotics are given due to the potential for septicemia (systemic infection).
Dogs with evidence of shock may benefit from corticosteroids. They should be used with caution, however, as they do potentiate gastrointestinal ulceration.
Affected individuals should be held completely NPO (nothing given orally) for the initial part of therapy. Once vomiting has ceased, and blood in the stool has resolved, a very bland, low in fiber and fat, easy to digest diet should gradually be offered. After 1 to 2 weeks of tolerating the bland diet, the patient can be weaned back onto their original diet.