Hemorrhagic gastroenteritis, often abbreviated HGE, is a fancy way of describing inflammation of the gastrointestinal tract that results in bloody diarrhea. Despite its fancy name, know that HGE can result in severe clinical signs. Untreated, HGE can quickly be life threatening as it progresses to hypoglycemia (i.e., low blood sugar), electrolyte imbalances, severe dehydration, hypovolemic shock, and even sepsis.
Gastroenteritis in dogs
The term “gastroenteritis” typically means that there is an acute inflammation of the gastrointestinal tract (e.g., stomach, small intestines, and large intestines). There are numerous causes for gastroenteritis, including infections (e.g., bacterial, viral, parasitic), dietary changes, metabolic problems (e.g., pancreas, liver or kidney disease), immune-mediated causes (e.g., inflammatory bowel disease), obstructions (e.g., foreign bodies), stress, etc. Some of these conditions can even result in bloody diarrhea.
However, gastroenteritis is clinically different from the diagnosis of HGE.
The difference between HGE and gastroenteritis
With HGE, there are a few unique clinical features that make it different from gastroenteritis alone. These include:
- An elevated packed cell volume (see the diagnostic section below)
- An acute nature (signs occurring within just a few hours)
- Bloody diarrhea
Another way to confirm HGE is to rule out any underlying causes. With HGE, there is no underlying cause (i.e., parasitic infections, metabolic problems, etc., must be ruled out).
What dogs are at risk for HGE?
HGE is more often seen with certain breeds including small dogs1 such as:
Symptoms of HGE
Clinical signs of HGE can occur very quickly, within just a few hours. Symptoms include:
- Malaise
- Not eating
- Vomiting
- Bloody stool
- “Raspberry jam” appearance to the feces
- Drippings of blood-tinged fluid on the rear legs, feathers, or perineal area
- Painful abdomen
- Not moving
- Weakness/lethargy
- Dehydration
- Collapse
- Fever
Diagnosing HGE
The diagnosis of HGE is typically based on ruling out other medical causes. Blood work should be performed to rule out underlying problems and to monitor for the severity of dehydration. With HGE, the packed cell volume (PCV) – the number that represents the amount of red blood cells in the body - is typically very elevated. Normal PCV ranges from 35-45%, and for patients with HGE, the PCV is typically > 60%;1 This finding is classic for HGE.
Other tests that may need to be assessed include:
- A complete blood count to evaluate the red and white blood cell count, along with the platelet count
- A biochemistry panel to evaluate the protein, electrolytes, kidney function and liver enzymes
- A fecal sample to rule out parasitic infections or abnormal bacterial overgrowth
- A urinalysis to evaluate kidney function
- Abdominal x-rays to rule out a foreign body, obstruction, or abnormal fluid in the intestines or abdomen
Depending on the results of the initial tests, more advanced diagnostics may be necessary to rule out other underlying problems. These tests may include:
- Specific testing for viruses (e.g., parvovirus fecal tests, etc.), depending on the vaccine status of your dog
- Abdominal ultrasound (to look at the inside of the stomach, intestines, pancreas, liver, kidneys, etc.)
- A cPL (canine pancreas-specific lipase) test to rule out pancreatitis (Note: this test is not 100% accurate, and must be interpreted with care by your veterinarian)
Prognosis of HGE
Thankfully, the prognosis for HGE is quite good with aggressive supportive care and treatment. Typically, this requires hospitalization for a minimum of 24 hours, depending on how severe the clinical signs are. As HGE can result in severe dehydration, treatment focuses primarily on re-hydration with aggressive intravenous (IV) fluids. Anti-vomiting medication (e.g., Cerenia™), anti-diarrhea medication (e.g., metronidazole), a bland diet, and repeat blood work (to make sure that the PCV is improving).
While there’s no way to prevent HGE, make sure to seek veterinary attention as soon as you notice any clinical signs. With HGE, the sooner we diagnose the problem, the sooner we can treat it. Not only is this safer for your dog, but it may also cost less if the medical problem is treated sooner -- before the signs are severe!
If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.
References:
1. Twedt DC. Gastroenteritis, Hemorrhagic. In Blackwell’s Five-Minute Veterinary Consult: Canine & Feline. Eds. Tilley LP, Smith FWK. 2007, 4th ed. Blackwell Publishing, Ames, Iowa. pp. 532-533
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