Plasma urea:creatinine ratio as a biomarker of gastrointestinal bleeding in dogs with anaemia.

BACKGROUND: Gastrointestinal bleeding is a cause of anaemia in dogs. A reliable, non-invasive biomarker to differentiate gastrointestinal bleeding from other causes of anaemia would be advantageous to direct clinical decisions in anaemic patients. Plasma urea:creatinine ratio is an accepted biomarker of upper gastrointestinal bleeding in human medicine. OBJECTIVES: The objective of this study was to evaluate plasma urea:creatinine ratio as a biomarker of gastrointestinal bleeding in a population of dogs with anaemia. METHODS: This was a prospective cross-sectional study of dogs with anaemia presenting to referral centres for the investigation of anaemia. Cases were categorised as having overt gastrointestinal bleeding (melena on presentation), occult gastrointestinal bleeding (historical and diagnostic findings consistent with gastrointestinal bleeding without melena at presentation) or anaemia of other cause (confident diagnosis other than gastrointestinal bleeding reached, normal diagnostic imaging of gastrointestinal tract). Urea:creatinine ratio at presentation was calculated by dividing urea (mg/dL) by creatinine (mg/dL). RESULTS: Ninety-five dogs were included. Plasma urea:creatinine ratio was not significantly different between dogs with overt or occult gastrointestinal bleeding or those with anaemia of other cause (median urea:creatinine ratio 25.8, 20.7 and 22.5, respectively). No significant difference in urea:creatinine ratio was found between dogs with upper and lower gastrointestinal bleeding (median urea:creatinine ratio 19.4 and 24.6, respectively). CONCLUSIONS: Plasma urea:creatinine ratio was not helpful in differentiating between dogs with anaemia resulting from gastrointestinal bleeding (overt or occult) and those with other causes of anaemia.

[Neuroendocrine carcinoma of the gallbladder as a rare cause for melena and hematemesis in dogs]. / Neuroendokrines Karzinom der Gallenblase als seltene Ursache für Meläna und Hämatemesis beim Hund.

A 9-year-old male Malinois was presented for further workup of acute melena, hematemesis and chronic weight loss for a duration of one month. Clinically, the patient presented with a mildly reduced general condition. Blood tests revealed mild non-regenerative anemia as well as a mild elevation of alanine aminotransferase (ALT). Ultrasonography showed signs of an early mucocele. Treatment with gastroprotectants failed to lead to clinical improvement and the dog developed progressive anemia. Gastroduodenoscopy was unremarkable. Due to persistent clinical signs, exploratory laparotomy was performed. An ulcerated bleeding mass was detected at the gallbladder neck. Histopathological examination led to the diagnosis of a neuroendocrine carcinoma. There was no evidence of a mucocele on histopathology. Melena and hematemesis subsided postoperatively and 13 months after cholecystectomy, the dog remains without clinical signs. Neuroendocrine carcinomas of the gallbladder should be considered as a rare cause of melena and hematemesis in dogs.

Jejunal arteriovenous malformation and multiple acquired extrahepatic portosystemic shunts in a juvenile dog, presenting with melena.

A juvenile dog referred with a 1-month history of persistent melena and severe anaemia, was diagnosed with a jejunal arteriovenous malformation, and multiple acquired extrahepatic portosystemic shunts. A midline coeliotomy was performed, the jejunal arteriovenous malformation was localised intraoperatively and was successfully removed via an enterectomy. Histopathology confirmed a true arteriovenous malformation. Despite the initial improvement, the patient developed seizure episodes secondary to hepatic encephalopathy 8 months after surgery. Fifteen months after surgery, the owner opted for euthanasia due to the ongoing seizure episodes. Post-mortem histologic examination of the liver showed features consistent with portal vein hypoplasia. A congenital arteriovenous malformation should be considered as a differential diagnosis in juvenile patients with a chronic history of haemorrhage from the gastrointestinal tract. In addition, acquired portosystemic shunts may occur in patients with portal vein hypoplasia and jejunal arteriovenous malformations.

Double-blinded placebo-controlled clinical trial of prophylactic omeprazole in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion.

BACKGROUND: Proton pump inhibitors are administered prophylactically in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). However, their efficacy in decreasing gastrointestinal (GI) complications is unknown. HYPOTHESIS: Omeprazole does not decrease the frequency of GI complications compared to placebo in dogs treated surgically for acute TL-IVDE. ANIMALS: Thirty-seven client-owned dogs undergoing hemilaminectomy for acute TL-IVDE. METHODS: Randomized double-blinded placebo-controlled prospective clinical trial. Dogs received PO placebo or omeprazole at 1 mg/kg q12h for 5 days during hospitalization. Development of GI signs (e.g., diarrhea, vomiting, regurgitation, hematochezia, melena) was recorded daily. Clinicopathologic testing performed during hospitalization and at 2 and 4-week re-evaluations included: fecal occult blood, PCV, blood urea nitrogen/creatinine ratio, fecal calprotectin, canine pancreatic lipase immunoreactivity and fecal alpha-1 proteinase inhibitor concentrations. Omeprazole and placebo groups were compared using chi-squared or Fisher's exact tests. RESULTS: Gastrointestinal signs developed in 10/20 (50%) dogs in the omeprazole group and in 7/17 (41%) dogs in the placebo group (P = .59). Diarrhea was common (8/20 omeprazole, 5/17 placebo), hematochezia was rare (1/20 omeprazole, 1/17 placebo); melena was not observed. Clinicopathologic evidence suggestive of bleeding was present in 9/20 dogs treated with omeprazole and in 11/17 dogs that received placebo (P = .23). Fecal occult blood positivity was more common in dogs with GI signs (P = .03). Canine pancreatic lipase immunoreactivity was higher during hospitalization compared to re-evaluations (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE: Short-term, prophylactic omeprazole treatment did not decrease clinically detectable GI complications in dogs with acute TL-IVDE.

Prevalence and characterization of hypoadrenocorticism in dogs with signs of chronic gastrointestinal disease: A multicenter study.

BACKGROUND: Dogs with hypoadrenocorticism (HA) frequently show signs of gastrointestinal disease (SGD). The prevalence of dogs presented for chronic SGD with HA is unknown. OBJECTIVES: The aims of this study were to determine the prevalence of HA in dogs with chronic SGD and to identify clinical and laboratory variables for HA in this population. ANIMALS: One hundred fifty-one dogs with chronic SGD. METHODS: In this multicentered prevalence study a standardized workup was performed in prospectively enrolled dogs with SGD > 3 weeks duration. Basal serum cortisol concentration was measured in every dog with ACTH stimulation test (ACTHST) if basal serum cortisol concentration was <3 µg/dL. RESULTS: Basal serum cortisol concentration was <3 µg/dL in 80/151 (53%) dogs, <2 µg/dL in 42/151 (28%) dogs, and < 1 µg/dL in 9/151 (6%) dogs. In 6/151 dogs HA was diagnosed based on ACTHST (stimulated serum cortisol concentration < 2 µg/dL), a prevalence of 4%. There was no difference in history, physical examination, and laboratory variables between dogs with HA and those with other causes of chronic SGD. In 4/6 dogs with HA, there was melena or hematochezia indicating gastrointestinal blood loss. Hyperkalemia, hyponatremia, or both was not observed in any dog. CONCLUSION AND CLINICAL IMPORTANCE: The prevalence of HA among dogs with chronic SGD is higher than in the general population. Based on these results, testing adrenal function should be performed as a standard screening test in dogs with chronic SGD to differentiate between HA and chronic enteropathies.

A case of canine hypoadrenocorticism needing blood transfusion for severe acute anemia due to gastrointestinal hemorrhage.

A 3-year-old male Rottweiler presented with the chief complaint of recurrent vomiting, diarrhea, hypothermia, and lethargy. Hypovolemic shock was noted with abnormal electrolytes (Na/K ratio, 27.9) and anemia (hematocrit, 17.3%). Since the hematocrit was 49.2% four days earlier when the primary veterinarian examined the dog, acute anemia was diagnosed. Melena was observed on the next day. The general condition and hydration improved with treatment, and an adrenocorticotropic hormone stimulation test identified hypoadrenocorticism. However, the hematocrit decreased further to 9%, necessitating blood transfusion. The cause of severe acute anemia was thought to be gastrointestinal hemorrhage. It should be noted that hypoadrenocorticism can lead to potentially fatal anemia with gastrointestinal tract bleeding, and blood transfusion may be required.

Sensitivity of fecal occult blood testing in the cat.

Objectives The impact of dietary factors on fecal occult blood (FOB) testing has been previously evaluated in cats, but the analytical sensitivity of this point-of-care test remains unexamined. The primary goal of this study was to assess the analytical sensitivity of the FOB test in cats. Methods Five cats were used in a repeated measures study. Following oral administration of blood, feces were collected and tested every 12 h for FOB and melena. All cats were fed an animal protein-free diet starting the week before entry into the study. Blood was administered on a milligram of hemoglobin per kilogram of body weight basis, and dosed at 1.5, 3, 15, 30 and 45 mg/kg hemoglobin in series with a wash-out period between each trial. Results FOB was detected in one cat at 1.5 mg/kg hemoglobin, three cats at 3 mg/kg hemoglobin and in all five cats at 15, 30 and 45 mg/kg hemoglobin. Melena was noted in one cat at 30 mg/kg and four cats at 45 mg/kg, but not at lower doses. Conclusions and relevance Administration of 15 mg/kg hemoglobin (equivalent to about 1.5 ml blood) was sufficient for positive results in all cats. However, detection occurred with as little as 1.5 mg/kg hemoglobin. Thus, FOB has good analytical sensitivity in cats under appropriate clinical situations.

Haemorrhagic diathesis in neonatal calves: an emerging syndrome in Europe.

In 2008 and 2009 a large number of cases of haemorrhagic diathesis (HD) in neonatal calves were reported in different European countries. In Flanders, 84 cases of neonatal HD in 30 herds were reported in this period. The disease typically affects calves younger than 1 month old from different breed and gender. Prominent clinical signs are cutaneous bleeding, petechiae on all mucosae, melena and often high fever. Early in the disease, the mental state of the animals is uncompromised. The typical haematological finding is pancytopenia, with severe to complete thrombocytopenia being the cause of the increased susceptibility to bleeding. In seven of the affected herds blood samples of calves of the same age group as the clinical case were collected and on six of those farms at least one subclinical case could be identified. Necropsy findings were generalized petechiae, ecchymoses or haemorrhages and variable lymphadenopathy. Histopathology of haemorrhagic lesions revealed multifocal extravasation of red blood cells (haemorrhage) with preservation of tissue architecture and absence of other abnormalities. Total bone marrow aplasia and depletion of all lymphoid tissue was the most prominent finding on histology. Activated macrophages and haemophagocytosis were seen on bone marrow cytology from two live calves. Polymerase chain reaction for bovine viral diarrhoea virus, bluetongue and epizootic haemorrhagic disease virus was negative. Several attempts to isolate a viral agent were unsuccessful.

Hemangioma of the ileum in a dog.

An 11-year-old, castrated male beagle dog was presented with a sudden onset of clinical signs of depression, abdominal discomfort, anorexia and melena. Radiography and ultrasonography revealed a well-circumscribed mass lesion with a size of 5 cm in diameter at the hypogastrium. A complete blood count and blood chemistry revealed severe anemia, hypoproteinemia and hypoalbuminemia. Through celiotomy, a large tumor mass involving the ileum was resected. The inside of the mass was irregular and sponge-like structure with multiple cavitated structures. On histology, the lesion was diagnosed to be hemangioma of the ileal wall. To the best of our knowledge, this unusual case is the first clinical report on the ileal hemangioma in non-human animal species.

Life-threatening hemorrhage from enterotomies and anastomoses in 7 horses.

OBJECTIVE: To report our experience with horses that presumptively had severe intraluminal hemorrhage from enterotomy or anastomosis. STUDY DESIGN: Clinical study. ANIMALS: Six adult horses and 1 adult donkey. METHODS: A retrospective study was conducted at the University of Illinois (April 1994 to December 2001) to determine the clinical course and outcome of horses with melena and/or anemia and evidence of life-threatening hemorrhage from intestinal incisions. Medical records of all horses that had colic surgery were reviewed to determine the proportion of horses with this complication. In addition, horses that fit the same criteria identified in 3 other veterinary clinics were included. RESULTS: Three horses (1.3%) of those that had enterotomy or anastomosis at the University of Illinois and 4 horses from other clinics had complications presumptively related to severe hemorrhage from these intestinal procedures. Melena became evident within 72 hours of surgery and lasted 12 to 96 hours. Six horses had an acute and severe drop in packed cell volume (PCV), increased heart rates, and other signs of acute hemorrhage, and 1 horse had signs of colic postoperatively. Horses were administered intravenous formalin (3 horses) and whole blood transfusions (4 horses). Repeat celiotomy was performed on 2 horses. In 1 of these horses, a bleeding artery was ligated in the edge of the original enterotomy, and, in the other, a 25-cm-diameter intraluminal blood clot was found occluding the pelvic flexure. A horse that had jejunocolostomy for cecal impaction was not treated for hemorrhagic shock but was euthanatized and necropsied. Necropsy revealed blood-filled bowel from the jejunocolostomy to the anus. One of the remaining 6 horses died of enterocolitis and 5 survived to discharge. CONCLUSIONS: Hemorrhage from incisional edges, particularly in the large intestine, should be considered a rare but possibly fatal complication of enterotomy or anastomosis in horses. CLINICAL RELEVANCE: To prevent fatal hemorrhage from incisional edges during enterotomy or anastomosis, large vessels should be ligated at the original surgery, and hemostatic effects of different closure techniques should be considered. No intraoperative or postoperative findings were useful to predict this complication, and response to supportive medical therapy was favorable.

Ultrasonography of canine gastric epithelial neoplasia.

Signalment, clinical and ultrasonographic findings from 16 dogs with histologically confirmed gastric epithelial neoplasia were reviewed. The most common clinical findings were vomiting, anorexia and weight loss. Hematemesis and melena were uncommon findings. Ten (10/16) dogs were female and there were four Chows. The most common ultrasonographic findings were transmural thickening of the gastric wall associated with altered wall layering. A poorly echogenic lining often was noted on the innermost and/or the outermost portions of the gastric wall, separated by a more echogenic central zone. The distribution of these changes was variable. This ultrasonographic feature, called pseudolayering, was present in 14 dogs. It was believed to most likely correlate to the unevenly layered tumor distribution noted histopathologically. The maximum wall thickening ranged from 1 cm to 2.7 cm. Regional lymphadenopathy was identified ultrasonographically in 15 dogs. Ultrasound-guided fine-needle aspiration biopsy or automated microcore biopsy, endoscopic biopsy, surgical biopsy or necropsy resulted in the diagnosis of carcinoma in 15 dogs and of carcinoid tumor in one dog. The results of this study suggested that ultrasonography was a useful tool for the detection and diagnosis of canine gastric epithelial neoplasia. Furthermore, ultrasonography can assist in obtaining diagnostic samples and in clinical staging of the tumor.

Complications associated with high-dose prednisolone sodium succinate therapy in dogs with neurological injury.

A retrospective study of 105 dogs with neurological injury was conducted to evaluate the type and prevalence of complications encountered when treatment consisted of a high-dose corticosteroid protocol. All dogs were treated with high-dose prednisolone sodium succinate (HDPSS) (30 mg/kg body weight, administered intravenously [i.v.] q 6 hrs for 36 hrs). Thirty-five (33.3%) cases developed complications including diarrhea (n = 11), melena (n = 11), vomiting (n = 6), hematochezia (n = 3), hematemesis (n = 1), anorexia (n = 1), or a combination (n = 2). Most complications resolved without additional treatments after termination of the HDPSS therapy. None of the complications were considered serious, and none prolonged hospitalization.

Primary IgG secreting plasma cell tumor in the gastrointestinal tract of a dog.

A mixed-breed dog, evaluated because of a chronic history of diarrhea and intestinal bleeding, was found to have a multilobular mass involving the intestine. Surgical resection of the mass necessitated an ileocolic anastomosis. On the basis of histologic and electron microscopic appearance and staining characteristics, a tentative diagnosis of intestinal carcinoid was made. Recovery was uncomplicated; the owners declined further diagnostic tests or treatment. Eight weeks later, the dog was reexamined because of signs consistent with hyperviscosity syndrome and hyperproteinemia. At the owner's request, the dog was euthanatized. At necropsy, extensive metastases to liver and lymph nodes, but not to bone, were seen. Reevaluation of the intestinal mass supported classifying the tumor as an IgG-secreting extramedullary plasmacytoma. This case underscores the need for additional histologic techniques, especially when confronted with an unusual manifestation of hyperproteinemia.

Arteriovenous fistula of the jejunum associated with gastrointestinal hemorrhage in a dog.

Hemorrhage from the gastrointestinal tract of a young dog resulted in melena with concurrent anemia. Exploratory laparotomy revealed the hemorrhage originated from an arteriovenous fistula in the jejunum. Resection of the abnormal part of the jejunum was curative. The arteriovenous fistula in the dog was probably congenital in origin, but may have been the result of gastrointestinal tract trauma.

Evaluation of two commercial test kits for detection of occult blood in feces of dogs.

To evaluate the sensitivity and specificity of 2 commercial test kits for detection of occult blood in canine feces, various volumes of blood were administered to 6 dogs via orogastric tube. Blood volumes tested were chosen on the basis of hemoglobin quantities of 5, 10, 20, 200, 350, and 500 mg of hemoglobin/kg of body weight. Fecal specimens were collected twice daily and analyzed separately by 2 observers for the presence of occult blood by use of modified guaiac and orthotolodine tablet tests, and for melena by visual inspection. Five dogs given blood at the rate of 500 mg of hemoglobin/kg and 1 dog given blood at the rate of 350 mg of hemoglobin/kg developed melena. Results of both occult blood tests were positive in 2 of 6 dogs given blood at the rate of 5 mg of hemoglobin/kg. Five of 6, and 4 of 6 dogs given blood at the rate of 10 mg hemoglobin/kg had positive test results by modified guaiac and orthotolodine methods, respectively. Results of both methods were positive in all dogs given blood at the rate of 20 mg of hemoglobin/kg. There was 86% agreement between the 2 observers' results for the modified guaiac method, and 78% agreement for the orthotolodine method. There was 77% agreement of results between the 2 test methods. Gastrointestinal transit time decreased with increasing volumes of blood. Occult blood testing was found to be useful for detection of blood in feces at volumes 20 to 50 times less than that required to cause melena.

Hematochezia attributable to cranial mesenteric arterial aneurysm with connecting tracts to cecum and ileum in a horse.

A cranial mesenteric arterial aneurysm with fistulous tracts to the cecum and ileum was discovered in a Missouri Fox Trotter stallion. The principal clinical sign was hematochezia, observed at 7- and 10-day intervals. The lesion may have been attributable to arteritis caused by fourth-stage larvae of Strongylus vulgaris.

[Neonatal thrombocytopenic purpura in a black and white male calf. Case report]. / Neonatale thrombozytopenische Purpura bei einem schwarzbunten Bullenkalb. Fallbericht.

A report is given on a newborn calf showing mucosal hemorrhage and melena. All blood clotting tests, except for prothrombin time (which proved to be initially prolonged), had normal results. The striking recurrent thrombocytopenia was successfully treated with prednisolone. Autoimmune idiopathic thrombocytopenia is suspected as a possible cause.

Ibuprofen toxicosis in a dog.

Acute renal failure, vomiting, and melena developed in a 10-month-old dog after ingestion of ten 600-mg tablets of ibuprofen. After 5 days of IV fluid therapy, clinical signs resolved and azotemia decreased. With increased availability of nonsteroidal anti-inflammatory drugs, similar complications may become more common in veterinary practice. If acute renal failure should develop, the prognosis for recovery is good, with rapid institution of appropriate therapy. However, renal dysfunction may not be completely reversed.

59Fe utilisation and excretion in anaemia of cattle caused by Pimelea trichostachya intoxication.

Experimental chronic Pimelea poisoning, with severe anaemia, was produced in 4 calves by daily oral dose rates of Pimelea trichostachya of between 20 to 60 mg/kg body weight of whole plant. Bone marrow function was studied before and during intoxication using 59Fe to determine plasma iron clearance rates, intraerythrocytic iron incorporation rates and percentage iron uptake, and faecal blood loss was measured before and during intoxication. It was shown that bone marrow activity was neither significantly depressed nor enhanced during intoxication. There was however, evidence of a slight increase in erythrocyte maturation rate. Reticulocytosis was not observed during the development of anaemia, but did occur in 3 of the calves shortly before death.