Hemorrhagic Gastroenteritis (HGE) in Dogs
Overview of Canine Hemorrhagic Gastroenteritis
Hemorrhagic gastroenteritis, commonly referred by the letters “HGE”, is a disease syndrome seen in dogs, characterized by the acute (sudden) onset of bloody diarrhea, usually explosive, accompanied by high packed cell volumes (red blood cells).
Below is an overview on HGE followed by detailed information about Hemorrhagic Gastroenteritis in dogs.
Causes of HGE in Dogs
The true cause of HGE is unknown but there are some suspected causes.
- Endotoxic shock, or poisons produced from bacteria causing shock
- Immune mediated destruction of the intestinal lining
- Infectious agents, possibly Clostridium
Predisposing Factors for HGE
This is a syndrome seen in dogs only. All breeds can be affected, although the incidence is greater in small breed dogs. Schnauzers, Dachshund, Yorkshire terriers, and miniature poodles are the most commonly affected.
HGE usually occurs in adult dogs, with the mean age of 5 years, and there is no sex predilection. HGE is most often seen in city dogs, or dogs housed in urban areas.
What to Watch For
- Acute vomiting
- Bloody diarrhea
Clinical signs are variable in both the course and severity of the disease. The onset of HGE is usually very quick/immediate, with no previous warning signs or health problems reported in the affected individuals. Signs progress rapidly and become severe within a few hours. Signs of shock, collapse, and sudden death have been reported.
Diagnosis of Canine Hemorrhagic Gastroenteritis
- Complete blood count (CBC)
- Biochemical profile
- Fecal examination
- Elisa for parvovirus
- Bacteria cultures and cytology of the stool
- Coagulogram, or clotting profile
- Abdominal radiographs (X-rays) should be obtained to eliminate a foreign body or other disease process
Treatment of Canine Hemorrhagic Gastroenteritis
Patients suspected of having HGE should be hospitalized and treated aggressively because clinical deterioration is often rapid and can be fatal. Treatment includes:
- Aggressive fluid therapy is the mainstay of therapy.
- Antibiotics are recommended in most cases.
- The patient should be kept off food and water until signs are clearly resolving, and the PCV is within normal range. A bland, easy to digest diet should be given for several days, and then your pet can be weaned back to a regular diet if his condition has improved.
Home Care and Prevention
The prognosis for patients with HGE is excellent if it is caught early and treated aggressively. If you suspect your pet may have HGE, seek veterinary attention immediately. Administer all medication and recommended diet as directed by your veterinarian.
Because there is no known cause of the syndrome, there are no preventative measures that can be recommended in these patients.
In-Depth Information on Hemorrhagic Gastroenteritis (HGE) in Dogs
Many conditions result in hemorrhagic diarrhea, although the hemorrhagic gastroenteritis (HGE) syndrome of dogs appears to have unique clinical features that distinguish it as an entity separate from other causes. Although HGE can affect any breed of dog, it is seen most commonly in small breeds.
HGE is considered a common clinical condition, especially in dogs that live in urban settings. There is no way to prevent the syndrome, as we do not know with certainty what causes it. Most affected animals have been previously healthy, have no concurrent illness, and receive the best of care. Clinical findings are variable in both the course and severity of the disease.
The most common sign seen is an acute onset of bloody, often projectile diarrhea. The bloody stools have been likened to dark raspberry jam. The prognosis for patients with HGE is generally excellent if caught early and treated aggressively. Most often hospitalization with intensive fluid therapy and support is necessary.
There are many other diseases/disorders that can appear similar to HGE. These include:
- Parvovirus is a contagious virus that can affect any age or breed of dog, although it is most common in the young, unvaccinated pup. The most common signs associated with parvo are vomiting, diarrhea (often with blood), and loss of appetite.
- Bacterial enteritis, which is inflammation/infection of the intestinal tract with salmonella, clostridia, is commonly associated with signs that may mimic HGE.
- Conditions resulting in endotoxic or hypovolemic shock, often associated with the movement of certain bacteria or toxins, or other overwhelming systemic infections, need to be ruled out.
- Intestinal obstruction or intussusception, which is the telescoping of one part of the bowel into another, secondary to foreign bodies, tumors, or parasites can cause similar gastrointestinal signs.
- Hypoadrenocorticism (Addison’s disease) is an endocrine disorder in which there is a hormonal deficiency, most often corticosteroids and mineralocorticoids, due to a problem with the adrenal glands. These individuals often present with signs extremely similar to HGE.
- Uremia is when toxins or poisons are not excreted from the body associated with kidney failure. It is not uncommon for these patients to present with gastrointestinal ulceration, vomiting, and bloody diarrhea.
- Pancreatitis, an inflammation of the pancreas, often presents for some combination of vomiting, inappetence, and/or bloody diarrhea.
- Coagulopathies, or bleeding disorders, including thrombocytopenia (decreased platelets), warfarin ingestion, disseminated vascular coagulation (DIC), and bleeding secondary to liver disorders may present with bloody diarrhea.
- Toxins including arsenic, thallium, Amanita mushrooms, and certain household cleaning products cause bloody diarrhea.
Diagnosis In-depth of HGE in Dogs
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 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.
- 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.)
Therapy In-depth of HGE in Dogs
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.
Home Care of HGE in Dogs
- Administer all prescribed medication and diet as directed. Alert your veterinarian if you are experiencing problems treating your pet.
- Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve.
Prognosis for HGE in Dogs
- Most patients, especially when HGE is recognized and treated aggressively, have an excellent prognosis and a full recovery is expected. Patients whose signs are not recognized early, or whose treatment is not terribly aggressive, may have complications, some of which may be life threatening. Acute death has been seen with this syndrome.
- Reoccurrence is seen in approximately 10 percent of the cases.