Canine Health, the Labradoodle blog

When is canine vomiting and diarrhea something serious?

My dog threw up, is he really sick, or is this just something minor?  It is always best to ask your veterinarian this question and let the doctor make the judgment as to if a visit is necessary.  Here are some simple at home tests. 

1. Is the dog still interested in eating, will they eat their favorite treat, even a small one?
2. Do they have diarrhea?
3.  Is there any blood in their vomit or diarrhea?
4. Do they have a temperature, always have a thermometer for your dog and know that a dog’s temperature should be 101.  A dog can be very sick and NOT have a fever, but it is a warning sign.
5. Is the dog dehydrated? Grasp the skin between the shoulder blades; it should bounce back upon releasing the skin almost immediately. Skin that takes more than 2 seconds to bounce back or stands up in the position grasped is a sign of dehydration and in need of immediate veterinary attention.
6. Does the dog have good blood circulation and oxygenation? Check the color of your pet’s gums. Lift your pet’s upper or lower lip and observe the color of the inner lip and gums. A healthy animal should have a pink color to the gums. Brick red or brown, pale light pink, white, yellow or blue colors of the mucous membranes are colors indicative of an emergency (shock, loss of blood, or anemia). Some breeds have dark pigmentation in their inner lips and gums making observations difficult and misleading, know the color of your dogs gums when healthy. For these dogs check for color by gently pulling down on the skin just below the eye with your thumb and observe the color in the inner eyelid.
7. Will the dog play? Grab their favorite toy and see if they will play.
8. Will the dog stand? Move them to their feet and see what their reactions are.
9. Call your veterinarian and tell them the answers to these questions.  If you vet is closed and any of these questions are of concern, go immediately to an emergency room.

What is Hemorrhagic GastroEnteritis, HGE?

The onset of HGE is usually very quick/immediate, with no previous warning signs or health problems reported in the affected dog. Signs progress rapidly and can become severe within a few hours. First vomiting, then bloody diarrhea, followed quickly by dehydration, shock, collapse, and sudden death.

Hemorrhagic gastroenteritis (HGE) is a fairly common disorder of dogs that is characterized by the sudden development of vomiting and/or diarrhea.  The vomitus and the diarrhea may contain variable amounts of bright, red blood or dark, digested blood.

Contributing Factors

There are no known contributing factors.  Most dogs appear healthy prior to the onset of clinical signs. Dogs with sensitive stomachs are believed to possibly be prone to HGE.

Affected Animals

Dogs of all ages and breeds can be affected by hemorrhagic gastroenteritis. Young adult dogs of toy and miniature breeds, may be affected more frequently.

Causes/Transmission

The exact cause of HGE remains unknown.

Clinical Signs

There is some variability in the both the severity and course of this disease but, generally, signs are very sudden in onset.  Vomiting is followed by the onset of bloody diarrhea.  The rapid onset of profound dehydration is one of the hallmarks of HGE.  The continuing loss of bodily fluids can progress so rapidly that hypotension (low blood pressure) and shock develop.   

There are many causes for bloody diarrhea and vomiting in dogs. Hemorrhagic gastroenteritis, or HGE, refers to a specific syndrome usually seen in young adult dogs. In HGE, fever is usually NOT present, and the main laboratory abnormality is a marked elevation of the hematocrit (concentration of blood cells) due to fluid shifts and intestinal fluid loss. There is no diagnostic test that confirms the presence of HGE. Its diagnosis is made mainly on clinical grounds.

Just as there is no unique diagnostic test for HGE, there is no established cause for the illness. Treatment is similar as that for other causes of vomiting and bloody diarrhea in dogs. However, relatively large amounts of fluid are usually needed to replace the fluid lost into the intestinal tract, and to reverse shock, if present. Antibiotics are also given because bacteria may play a role in causing HGE. Although the signs are sudden and severe, and some dogs do not survive, most animals with HGE recover fully with prompt treatment. Prompt veterinary attention is VITAL for any dog with severe gastrointestinal signs and depression, whether due to HGE or other causes.

Canine hemorrhagic gastroenteritis, or HGE, is a syndrome characterized by the sudden onset of vomiting, bloody diarrhea, depression, no fever, a normal white blood cell count, and an elevated hematocrit on bloodwork.

Changes in the mucosa, or lining tissue, of the intestine result in fluid shifts from the vascular system and changes in fluid secretion into the intestinal tract. These changes appear to cause the symptoms of HGE. Animals can become extremely ill in a very short period of time.

Treatment requires prompt and aggressive fluid administration, and shock-level doses are usually needed at first. Steroids are given to animals that are in shock, and dogs with severe blood loss may require blood transfusion. Antibiotics are also given as part of the supportive treatment for HGE. Most dogs recover with appropriate treatment, although some may have additional bouts of the same signs after the initial episode resolves.

Prevention

Because the cause is unknown, there is no recommended preventive therapy. A bacterium called Clostridium perfringens has been isolated from cultures of intestinal contents in dogs with HGE, but its exact role in the syndrome has not been identified.

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.

Written by Krista at Rainmaker Ranch Labradoodles www.labradoodle-breeder.com, editted by Dr. Sandy Fink VDM of West Orange Animal Hospital