Bleeding in dogs and cats. Stomach bleeding

Bleeding- this is the release of blood from the lumen of blood vessels or cavities of the heart due to a violation of the integrity of their walls.
Blood can be released drop by drop, flow in a trickle, or beat in a powerful pulsating stream. Volume lost blood can vary from a few drops to several liters. And all this will be called bleeding.

Depending on the type of damaged vessel, bleeding is distinguished between arterial, venous, capillary and mixed. Bleeding may coincide in time with the onset of exposure to a damaging factor ( primary bleeding), and may open after a few hours or even days (secondary).

If blood flows freely outward, it is called external bleeding; if it rushes into any natural cavity of the body, it is called internal bleeding. It can also forcibly make its way into the surrounding tissues, forming so-called extravasates, bruises and hemorrhages.

External bleeding is clearly visible even with minor injuries, but internal bleeding is dangerous because it is not visible.
Important! Consult a doctor in a timely manner, determine the cause of the bleeding and provide timely assistance to the animal. They will help you with this alarming symptoms, characteristic of internal bleeding.

So, internal bleeding there are:

obvious(gastric, intestinal, pulmonary, uterine, etc.).
They can be suspected when scarlet foamy blood is released when coughing, vomiting of “coffee grounds”, liquid tarry stools, stools streaked with scarlet blood are noted; bloody discharge from the loop, blood in the urine, and in all its portions;
hidden, intracavitary, invisible to the eye.
Typically characteristic external signs is shortness of breath, pallor of the mucous membranes, sudden fatigue and a rapidly increasing volume of the abdomen.

Why are bleeding dangerous?

The body of any animal contains a certain amount of blood: freely circulating and deposited in various organs. Any bleeding leads to the loss of some amount of blood from the bloodstream.

The animal body has a powerful mechanism for regulating and redistributing the volume of circulating blood, which allows maintaining effective work vital important organs in conditions of blood loss. But everything has its limit. Minor blood losses, if they are infrequently repeated, pass without a trace for the body. Heavy bleeding in case of rupture of large blood vessels(For example, carotid arteries, chest and abdominal aorta, vena cava), entail instant death. Damage to smaller vessels and internal organs, especially through which the body passes every minute a large number of blood (spleen, liver, kidneys, lungs), also represent great danger for the life and health of animals.

After significant blood loss, the mechanics of blood circulation are disrupted due to insufficient filling of blood vessels and the heart and a drop in blood pressure. Acute anemia develops, which is expressed in a sharp decrease in the number of red blood cells in the blood and a decrease in hemoglobin levels. As a result, the process of oxygen delivery to organs and tissues is disrupted. Hypoxia occurs ( oxygen starvation) tissues, local metabolic processes, cell death occurs and, as a consequence, the death of the entire organism. The maximum amount of blood loss that leads to death depends on age, type and individual characteristics animal. Animals that have lost 2/3 - 3/4 of their total blood mass, as a rule, cannot be saved.

When you need to see a doctor urgently?

External bleeding could not be stopped on its own, and the blood has been flowing or oozing for more than 15 - 20 minutes
External bleeding has stopped, but your pet has lost a lot of blood and his condition remains severe (shortness of breath, poor mucous membranes, lethargy)
You notice that the animal is emitting blood from a natural orifice or the stool/discharge is colored red or dark red: scarlet foamy blood when coughing, vomiting “coffee grounds”, liquid tarry stools, stools streaked with scarlet blood, bloody discharge from loops, blood in the urine, and in all its portions, blood from the nasal passages
Blood is not released from the wound or from natural orifices, but the animal’s condition is deteriorating, shortness of breath, pale mucous membranes, lethargy are noted, or you notice a rapidly increasing volume of the abdomen
Your pet has a very red eye or both eyes
Hematomas (elastic, voluminous swellings) appeared under the skin on the paws (can be on the thigh, lower leg, shoulder, i.e. over the entire surface of the limb), on the outer ear, hemorrhages on the mucous membrane oral cavity or skin.

Pulmonary hemorrhage

For car and other injuries chest(in old dogs), as well as with heart disease, dogs experience bleeding from the mouth and nose, often accompanied by a cough with bloody discharge.

First aid: The dog must be calmed down, barking and moving should be prohibited. Then give the animal medications that stop the cough (for example, codeine at a dose of 0.01-0.1 g, depending on the breed of dog), then wrap it in a sheet, a towel dampened cold water. The dog should only be given something to drink cold water, preferably with pieces of ice.

Bloody vomiting

At acute diseases in dogs of the esophagus, stomach and liver, vomit may be bloody, the color of meat slop or coffee grounds. Vomit may also contain dark blood clots. In diseases of the esophagus, vomit is bright red, and in diseases of the stomach, vomit contains blood that has changed under the influence of gastric juice until dark.

Help needed comes down to urgently delivering the dog to a veterinary hospital. A dog with such signs must be transported in a resting position and should not be fed under any circumstances. You can give a very limited amount of cold drink (water) with pieces of ice.

Intestinal bleeding

At various diseases intestines - chronic and acute - bleeding may occur in dogs. If the bleeding is minor, it can be determined by the tarry stool when the animal defecates. If there is heavy bleeding, the animal often “sits down” bloody issues have a dark color.

With hemorrhoids in older dogs, bleeding from the dilated venous vessels of the rectum can also be observed. Such bleeding is usually small and the blood is dark in color.

First aid: rest, ice pack or cold compress on the belly, sacral area. Do not feed the dog, do not give an enema, or give laxatives. After providing first aid, call a veterinarian or send the animal to a veterinary hospital.

The appearance of blood in the urine

Various injuries to the kidney area, urinary tract, Bladder, as well as diseases of the urinary system in dogs can be accompanied by bleeding. In such cases, blood may be excreted along with urine in the form of impurities or clots, as well as in pure form.

First aid: peace, with heavy bleeding- ice or cold compresses on the lumbosacral region or on the lower abdomen. After providing first aid, you should contact a specialist.

Nosebleed

With trauma to the nasal area and certain diseases, dogs may experience nosebleeds. Blood may flow in a trickle or flow from the nose in separate drops.

First aid: calm the dog down, keep it from running and barking, stroke it affectionately, call it by its nickname. It must be remembered that any movement of the animal increases bleeding. A cold pack or ice should be applied to the dog's nose and forehead area.

You can also try to insert cotton wicks soaked in a solution of hydrogen peroxide into both nostrils (if bleeding is from both nostrils).

Bleeding after tooth damage

When the jaw is injured, teeth are often damaged or knocked out, which often accompanied by bleeding. If the bleeding does not stop, measures should be taken to stop it.

First aid: Having made a small roll of gauze or cotton wool (according to the gap between the jaws), you need to lay it between the upper and lower jaws dog so that it lies on the site of a knocked out or damaged tooth. The roller should apply pressure to the area of the knocked out or damaged tooth. To fix the clenching of the dog's jaws, it is necessary to put on a muzzle or tie its jaws with a bandage, improvising a muzzle.

Vaginal (uterine) bleeding

Tumors of the uterus, various inflammatory processes, retained placenta and other diseases of the genital organs of bitches may be accompanied by bleeding.

First aid: complete rest, a cold compress or ice should be placed on the area of the uterus, lower part of the peritoneum. You can give your dog cold water, preferably with some ice cubes added. After providing first aid, urgently take the animal to a veterinarian.

The digestive tract in dogs begins in the mouth and ends anus. Each section of this “tube” plays its role in the process of efficient food consumption, digestion, absorption, movement and removal from the body. Each section of this “tube” also has its own, unique set of pathological processes, which emphasizes its functional features. This amazing path must be covered from beginning to end: given the considerable distance, there is not much time to overcome it!

Cricopharyngeal dysphagia

Clinical signs canine dysphagia include repeated swallowing, gagging, belching, and nasal discharge during feeding or drinking. Clinical consequences may include halitosis, cough, chronic nasal discharge, and recurrent aspiration pneumonia. Breeds likely to be predisposed to dysphagia include: Golden retriever, Cocker Spaniel, Springer and King Charles Spaniel, Bouvier des Flanders, Boxer and Miniature Dachshund.

Anamnesis(including onset, duration, progression, possible exposure to poisons) and physical examination (dental diseases, anatomical defects, function cranial nerves, vomiting reflex, oral tumors, tongue lesions) are critical, but the starting point is simply observing how the dog tries to drink and eat. It is quite common practice for the owner to report to the doctor about significant problems with drinking water or food of a certain shape or consistency. Through careful observation, the problem may be located in the mouth (grasping), the larynx (repeated attempts to swallow), or the esophagus (odynophagia).

Diagnostic examination starts with UAC, biochemical analysis blood, urinalysis and total T4 concentration analysis, which helps to exclude systemic diseases, anemia, hypoglycemia, increased creatine kinase levels and disorders electrolyte balance.
A plain radiograph of the neck reveals anatomical changes, including volumetric formations, but the method does not have sensitivity and dynamic characteristics. Videofluoroscopy of dogs after ingestion of liquid barium (5-10 ml, 60% w/v) and barium-impregnated granules is a key imaging study in the diagnosis of cricopharyngeal dysphagia.

Dr. Stan Marks of the University of California, Davis, developed a scheme that specifically analyzed the timing and movement patterns of swallowing, using the ratio of maximum contraction of the pharyngeal muscles to their contraction at rest to determine the force of contraction of the pharyngeal muscles (Pollard RE, et al Vet Radiol Ultrasound 2007;48:221-226).

Cricopharyngeal dysphagia is characterized by either dyssynchrony (functional) or achalasia (structural); It is critical to differentiate between these two categories to guide treatment options and prognosis.
Dyssynchrony is likely the result of neuropathy leading to muscle weakness and incoordination, and unless the cause is identified, these dogs have a poor prognosis compared to dogs with achalasia. In the early stages of the disease, attempts are made to select a specific feed consistency that will be best tolerated; After this, enteral nutrition through a gastrostomy tube is often switched to, but there is still a possibility of repeated episodes of aspiration pneumonia and malnutrition. Dyssynchrony is not surgical disease.
Achalasia- a structural lesion in which the hypertrophied cricopharyngeal muscle does not open the lumen sufficiently for the normal passage of the food bolus. Executed surgical methods myotomy or myectomy is the most preferred (and often effective) treatment in these dogs.

Megaesophagus

Regurgitation is the main symptom of megaesophagus, although inflammatory lesions of the esophagus or its obstruction and strictures are also accompanied by regurgitation.

Megaesophagus can be congenital or acquired, and although there is a significant list of diseases for differential diagnosis that should be excluded, the most common diagnosis is idiopathic megaesophagus.

Idiopathic megaesophagus is hereditary in Wire Fox Terriers and Miniature Schnauzers, and German Shepherds, Great Danes, and Irish Setters are likely predisposed to the disease.

Differential diagnosis of acquired megaesophagus:

Myasthenia gravis
Systemic lupus erythematosus
Dermatomyositis
Dysautonomia
Botulism
Canine distemper
Neoplasms
CNS diseases
Lead poisoning
Thallium poisoning
Hypocorticism
Hypothyroidism
Pituitary dwarfism
Timoma
Polymyositis
Polymyopathy
Polyneuropathy
Other?

When diagnosing megaesophagus in dogs, these diseases should be taken into account and prescribed specific treatment if the etiology of the disease is established. However, most often the cause is not identified, and treatment is based on nonspecific changes in the dog's therapy, particularly related to nutrition.

And again key characteristic consistency: liquid or semi-liquid food is usually better tolerated than solid food. Every effort should be made to ensure that the dog receives food in an elevated position (and remains in this position for some time after eating) (Bailey chair), and it should also be remembered that it is better to feed the animal in small portions and often than to give large portions.

A gastrostomy tube may be placed to reduce aspiration (although this method does not completely eliminate aspiration).

Stomach ulcer

Differential diagnosis of gastric ulcers in dogs:

Clinical signs of gastric ulcer may be nonspecific or as obvious as hematemesis and melena associated with cranial abdominal pain. The owner may not notice melena (hence the importance of a rectal examination), and the absence of melena does not exclude gastrointestinal bleeding, since for macroscopically visible melena to appear in a dog weighing 30 kg, its blood loss must be approximately 100 ml. Anemia, general weakness, increased drowsiness, weight loss, delayed gastric emptying, and deterioration in coat quality may occur depending on the duration of the ulceration.

History and physical examination should focus on application medicines(NSAIDs) and possible exposure to toxins (household chemicals with cauterizing properties), as well as signs indicating any potential causing appearance ulcer disease (polyuria, polydipsia, weight loss, increasing and decreasing gastrointestinal symptoms, etc.). A blood test is used to rule out many possible reasons, assessing coagulation and platelet count, determining the nature and severity of anemia (chronic gastric ulcers can lead to non-regenerative hypochromic microcytic anemia) and in order to identify electrolyte disturbances(in particular, the Na+/K+ ratio), as well as assess the acid-base status of the dog.
Dr. Tvedt from State University Colorado has demonstrated that a blood urea nitrogen/creatinine ratio greater than 30 indicates gastrointestinal bleeding. At the University of Colorado, we frequently measure serum gastrin levels in older dogs with signs of ulceration and weight loss. Radiographic examination is insensitive, although double-contrast radiographic examination may be helpful. Ultrasonography organs abdominal cavity allows you to determine the thickness of the stomach wall and the location of defects, as well as identify possible perforation of the gastrointestinal tract.

Treatment of stomach ulcers in dogs aimed at a specific cause, if one is identified. Otherwise, it is nonspecific and supportive in nature, including infusion therapy, maintenance of electrolyte and acid-base balance, antiemetic and painkillers. In some cases, the need for surgical intervention is obvious (gastrinoma, gastric neoplasm, peritonitis, etc.).
Omeprazole demonstrates superiority over other histamine H2 receptor antagonists in reducing the formation of of hydrochloric acid in the stomach (Tolbert et al, 2011), and sucralfate is used to protect the gastric mucosa from hydrochloric acid already present in the stomach. The feed should contain a low amount of fat to reduce the transit time through the stomach.

Dosages medicines for the treatment of stomach ulcers in dogs:

Famotidine - 0.2 mg/kg orally, two to once a day daily for 6-8 weeks
Omeprazole (or lansoprazole) - 1 mg/kg orally 2 times a day for 3-4 weeks
Misoprostol (prevention) - 1-5 mcg/kg orally 3 times a day
Sucralfate - 0.5-1 g orally 3 times a day

Colitis

Colitis (inflammation of the colon) is the most common cause of colonic diarrhea in dogs.
Any disturbance in the normal functioning of the large intestine can lead to changes in fluid absorption, electrolyte balance, intestinal motility and imbalance intestinal microflora.
As with inflammatory diseases small intestine, colitis can be further characterized histologically as lymphocytic-plasmacytic, eosinophilic, granulomatous, or separate disease- histiocytic ulcerative colitis.

Emerging diarrhea - colonic diarrhea: frequent bowel movements small quantity with mucus, blood, tenesmus, pain or imperative urges to the bottom Weight loss is not usually expected with colonic diarrhea, although it is often observed in cases of histiocytic ulcerative colitis or fungal colitis (histoplasmosis). It is clear that in these cases a rectal examination is required.

Therapy of colon inflammation with 5-aminosalicylic acid:

Sulfasalazine (side effects include keratoconjunctivitis sicca) - 20-30 mg/kg orally, three times a day
Olsalazine - 10-20 mg/kg orally, three times a day
Mesalamine:
Suppository (hemorrhagic colitis) - Enema
Orally - 10-20 mg/kg orally, three times a day

Often, either tylosin (15 mg/kg orally twice daily) or metronidazole (10–20 mg/kg orally twice daily) is added to therapy. This approach appears to be effective, although the actual mechanism of this effect is poorly understood. In complex cases, immunosuppressive therapy may be required: prednisolone (1-2 mg/kg orally twice a day with a gradual dose reduction until complete discontinuation), budesonide (1-3 mg/kg orally once a day), cyclosporine (5 mg/kg orally once daily), azathioprine (2 mg/kg orally once daily), but these drugs are not recommended until the examination is completed.

Histiocytic ulcerative colitis- heavy inflammatory disease, first identified and most commonly diagnosed in young boxers. A similar or extremely similar condition is recognized in French bulldogs and is rarely observed in mastiffs, Alaskan Malamutes and Doberman Pinschers. The disease in these dog breeds is severe, accompanied by loss of body weight, mucous stool and hypoalbuminemia, that is, all clinical signs atypical for a classic case of colitis. At colonoscopy, PAS-positive staining is observed in tissues taken from colonic tissue biopsies, demonstrating the accumulation of macrophages and macroscopic signs of ulcerative lesions. For a long time, the treatment used was ineffective, leading to the use of euthanasia, until the condition began to be considered as a common inflammatory bowel disease. The identification of adherent and invasive E. coli as the cause led to the use of fluoroquinolones, particularly enrofloxacin (Baytril), for 4 to 6 weeks.

Diseases of the anus

Perianal fistulas occur mainly in German Shepherds(but can be observed in Irish setters, Labrador Retrievers, Bobtails, Border Collies, Bulldogs and mixed breed dogs) and may initially be misdiagnosed as an infection of the anal sac or glands. Clinical signs include tenesmus, mucopurulent discharge With unpleasant smell, self-mutilation and perianal licking, tail drooping, lethargy and weight loss. Although clinical picture diseases include superficially opening fistulas, pathological process extends into the deeper tissues of the rectum and may also include a component of food reaction disease, or inflammatory disease intestines. Perianal fistulas appear to be immune-mediated, although secondary ones are often present bacterial infections. The disease often recurs.

Conservative therapy can successfully control the disease in approximately 75% of dogs, although the high cost, effort involved, and side effects of treatment require owners to strictly follow prescriptions and dogs not to remain sexually intact.

Dietary interventions are provided in the form of a hypoallergenic or hydrolyzed diet, taking into account the immune-mediated inflammatory component of the disease.

The basis of therapy was local application tacrolimus (0.1% ointment). The mechanism of action is similar to oral cyclosporine (4-8 mg/kg twice daily, can be combined with ketoconazole to reduce cost), but with less side effects and at a lower cost (monitoring of liver and kidney functions). Thin film tacrolimus is applied to the affected area after gentle washing once a day; the owner is instructed to always wear gloves when doing this.

Tacrolimus therapy is traditionally combined with antibiotic therapy (cephalosporin group drug for 4-6 weeks) and prednisolone (1 mg/kg once a day for 4-6 weeks, followed by a gradual dose reduction until complete withdrawal) and lasts quite a long time (4-6 weeks) after resolution of clinical symptoms.

Surgical treatment is an option in cases where conservative therapy turns out to be ineffective.

Craig B. Webb, Colorado State University, Fort Collins, CO, USA