Definition

A peracute hemorrhagic enteritis of dogs characterized by a sudden onset of severe bloody diarrhea that is often explosive, with vomiting, hypovolemia, and marked hemoconcentration due to a dramatic loss of water and electrolytes into the intestinal lumen.

Pathophysiology

• Many conditions result in hemorrhagic diarrhea, but the acute hemorrhagic gastroenteritis (HGE) syndrome of dogs appears to have unique clinical features that distinguish it as a clinical entity separate from other conditions.
• HGE is characterized as a peracute loss of intestinal mucosal integrity with the rapid movement of blood, fluid, and electrolytes into the gut lumen. Dehydration and hypovolemic shock occur quickly. Translocation of bacteria or toxins through the damaged intestinal mucosa may result in septic or endotoxic shock.
• Histological examination of the intestinal tract shows superficial mucosal hemorrhagic necrosis without inflammation. Gastric mucosa is spared.

Systems Affected

• Gastrointestinal
• Cardiovascular

Genetics

Unknown; however, there appear to be specific small or toy breeds that may be overrepresented.

Incidence/Prevalence

A common clinical condition

Geographic Distribution

N/A

Signalment

Signs

Causes

• The etiology is unknown; allergic, autoimmune and infectious causes have all been implicated.
• There is increasing evidence to suggest that Clostridium perfringens (CP) type A enterotoxin is involved in the disease and has been identified in necrotic mucosal surfaces.

Risk Factors

• Unknown.
• Most dogs are previously healthy with no major concurrent illness.

Differential Diagnosis

• Parvovirus
• Circovirus
• Acute gastrointestinal ulceration
• Bacterial enteritis such as salmonellosis or Campylobacter
• Conditions resulting in endotoxic or hypovolemic shock
• Intestinal obstruction or intussusception
• Hypoadrenocorticism
• Heat stroke
• Pancreatitis
• Coagulopathy

CBC/Biochemistry/Urinalysis

• Hemoconcentration with the PCV generally >60% and sometimes as high as 75% with discordant plasma proteins that are normal to decreased due to protein loss into the GI tract. Usually a stress leukogram.
• Biochemistry profile may reveal secondary hepatic enzyme elevations and high BUN due to prerenal causes.

Other Laboratory Tests

Imaging

Abdominal radiographs or ultrasound show fluid- and gas-filled small and large intestine.

Diagnostic Procedures

Pathologic Findings

Changes in the intestine include gross congestion and microscopic evidence of autolysis that is devoid of marked inflammation.

Appropriate Health Care

Patients suspected of having acute HGE should be hospitalized and treated aggressively because clinical deterioration is often rapid and can be fatal.

Nursing Care

• Rapid volume replacement through a large-bore IV catheter is required in all cases.
• Balanced electrolyte solutions are given up to the rate of 40–60 mL/kg/hour IV until the PCV is <50%.
• A moderate rate of maintenance fluids is given to maintain circulatory function and correct any potassium or other electrolyte deficits during the recovery period.
• Continued GI fluid losses should be estimated and that volume added to the fluid requirements.
• Hypoproteinemic animals may require colloids or plasma.

Activity

Restricted

Diet

• NPO during acute disease.
• During recovery period a bland, low-fat, low-fiber gastrointestinal diet should be fed for several days before returning to the normal diet.
• Consider increased dietary fiber to alter the intestinal microbiota to reduce the likelihood of recurrence of C. perfringens-associated diarrhea.

Client Education

• Discuss the need for immediate and aggressive medical management. With appropriate therapy, mortality is usually low.
• Recurrence is reported in about 10% of the cases.

Surgical Considerations

N/A

Drug(s) Of Choice

• Parenteral antibiotics are generally recommended; however, their use in aseptic cases has been questioned. Antibiotics are used for potential septicemia. Amoxicillin/sulbactam (50 mg/kg q8h IV) is suggested prophylactically.
• An antiemetic such as maropitant (1 mg/kg q24h) is suggested to control nausea and vomiting.
• Antacids such as famotidine (0.5–1 mg/kg q12h) or pantoprazole (1 mg/kg q24h) given IV may be indicated.
• Excessive blood loss may require a blood transfusion (rare).

Contraindications

N/A

Precautions

Septic and or hypovolemic shock can occur quickly and consequently the animal should be monitored closely.

Possible Interactions

N/A

Alternative Drug(s)

• Oral antibiotics and intestinal protectants are of little benefit and generally not administered.
• Rectal administration of mucosal protectants such as sucralfate is of questionable value.
• Antidiarrheal drugs are contraindicated.
• Consider probiotics to alter the intestinal microbiota to reduce the likelihood of recurrence of C. perfringens-associated diarrhea.

Patient Monitoring

• Monitor the PCV and total solids frequently (at least every 4–6 hours).
• Modify the fluid replacement-based PCV, continued GI fluid losses, and circulatory function.
• If there is a failure of clinical improvement in 24–48 hours, re-evaluate the patient, as other causes of hemorrhagic diarrhea are probable.

Prevention/Avoidance

N/A

Possible Complications

• Occasionally DIC may develop. Neurologic signs or even seizures secondary to the hemoconcentration may occur.
• Cardiac arrhythmias occur from suspected myocardial reperfusion injury.
• A hemolytic-uremic syndrome may occur (rare).
• Most dogs recover. Mortality rate can be high in untreated dogs. Fewer than 10% of treated dogs die, and 10–15% have repeated occurrences.

Expected Course and Prognosis

• The course of the disease is generally short, lasting from 24 to 72 hours.
• The prognosis is good, and most patients recover with no complications.
• Sudden death is uncommon if adequately treated.

Associated Conditions

N/A

Age-Related Factors

N/A

Zoonotic Potential

Unknown

Pregnancy/Fertility/Breeding

N/A

Synonym

Acute hemorrhagic enterocolitis

See Also

• Diarrhea, Acute
• Vomiting, Acute

Abbreviations

• DIC = disseminated intravascular coagulation
• ELISA = enzyme-linked immunosorbent assay
• GI = gastrointestinal
• HGE = hemorrhagic gastroenteritis
• PCV = packed cell volume
• RBC = red blood cells
• WBC = white blood cells

Client Education Handout Available Online