Hemorrhagic Gastroenteritis or HGE

Question: Dr Richards,

I'm sure this will be another "hard to diagnose" type of letters but I'll try to fill in as many gaps as I can. There are many events leading up to the present maybe something will ring a bell. Oscar is our miniature dachshund. He's 22 1/2 months old, and weighs roughly 12 lbs. A year ago around this time of the year (actually the day after Thanksgiving) he had a bout of throwing up , and very black tar like stool. At the time we had rat poison out, thought that he came in contact with it some how or maybe a rat that had eaten some. We contacted our vet and he didn't seem to concerned figured he'd eaten too much Turkey, or maybe a stick and it had irritated him digestional tract. Said to give him some pepto and call him if he didn't improve. Gradually he did improve and things were looking better.

Couple months later after the first of the year we had him neutered, and on his return checkup it was time for his 1 year shots (boosters or whatever there called), and we took him in and got the shots. That night he started swelling up in soft lumps all over his body. Started at his head and worked its way down his back. (After the initial shock and worry about his breathing being affect he was a rather amusing sight!) Another call to the vet said to give him a couple small doses of benydrl and this brought the swelling down eventually. Not long after he began throwing up blood, and had a very loose uncontrollable black tar stool. (VERY strong odor) He stopped eating and drinking during this time. We took him into see our vet, and he stayed there 2-3 days with fluids until we could get him started eating and drinking again. During his stay some blood work came back with what the vet called high AST levels of like 280. He said that normal was 45ish. And that Oscar had serious liver problems. He thought maybe it was cause from pancretitis or sensitivity to something. He put Oscar on KD can food, and slowly moved him over to dry, and some vitamin tonic. Several weeks later we took him back for another blood screening and it had AST level has come down 30 points or so. Vet was still very Stern about the fact that if this didn't come down he would die. Safe to say we were crushed by all this. He seemed to be doing great getting stronger back to his normal playing and running and fighting routines. A month or 2 later we decided to have one more blood screen just to check it again, we felt for sure that it would be down by his actions. It had almost doubled to over 400 this time... He gave him some type of "liver" vitamin (sorry I can't give you more of an explanation). well here we are waiting for him to get worse and worse over all this, and he continues to do fine to this day.

He's had one other visit since all this for a hurt back he received somehow. We took him to another vet, and explained all the other stuff to him. The other vet seemed to believe that is the dog is acting well usually he is. And that maybe the original vet hadn't made the right diagnosis with his liver.

Now over the last several months he's been slowly losing hair over his underside and behind his ears. His chest is almost completely bare of hair just very fine thin hair remains, and this is how is ears are too. He's always been a thin hair dog. He was checked for mites at his first vet visit after we got him for thin hair on the top of his head. The thinning appears to be slowly going up his sides no, and several thinning spots have started appearing that seem light colored. some people have call white spots on him. The hair isn't completely gone in these spots just thinning.

He had no other symptoms... No itching, no fleas, no flaking or scaling. No abnormal behavior that we can tell, no excessive drinking or urination nothing outta the ordinary for him. His weight has stayed constant he seems to be sleeping more but I feel like he is getting out of his puppy stage and just likes to sleep. The sleep doesn't conflict with playing though. He's always ready to go chase a ball. So we're debating on whether to take him back for some type of testing (hormonal or something). He is a wonderful dog, Probably the best I've ever had and thats saying a lot since I grew up with never less than 7 dogs at my house. We're just at a loss of what to do. We have lost our confidence in our vet... thinking that he has been reluctant to help us figure out what's going on. Plus he's too busy to ever sit and talk to us. So we need some advice from someone who might can point us in the right direction as far as what to ask, or what to be checked on.

I know I've thrown a lot of garbage out there, but this is abot all I know. we never could get much information outta the vet. Anything you can suggest or think of we would appreciate it greatly.

Thanks again...for this site and the help you offer people.

M.T.

I've read your sight and come up with several things from cushings to nothing. Nothing really matches, and maybe its nothing at all. Any help you can offer... THANKS!! :)

Answer: M.T.-

I think that you asked three questions in your note. If I missed one or if this reply just makes you more confused, feel free to write again.

1) Hairloss in the areas you describe could easily be due to pattern baldness in a dachshund. This is a very common problem in this breed. There is some chance that this type of baldness will respond to melatonin administration but not much in a dachshund. If you want to confirm this diagnosis it is possible to do so by skin biopsy sent to a pathologist with a strong interest in skin disease. I'd lean towards this before doing a lot of hormonal testing in a dog this young.

2)There is a good chance that your dog suffers from a condition known as hemorrhagic gastroenteritis (HGE). This is a tendency to have really awful bouts of bloody diarrhea. This can be life threatening so it is important to treat each instance aggressively. Some dogs have one bout of this in their entire life and others have repeated incidences that seem to correspond with stressful situations. The causative factor may be Clostridium species bacteria but I don't think this has been proven. I am not aware of a proven preventative diet, vaccination or medicine for this problem. There are other possible problems that could lead to the signs you have seen, including bleeding disorders that show up when diarrhea is present (subclinical bleeding disorders), pancreatitis and other bacterial enteritis disorders.

3) I don't know what to make of an elevation in AST (used to be called SGPT) in the absence of rises in other liver enzyme values. The two liver enzymes that are most meaningful in dogs are the ALT and the AST. The levels of ALT rise whenever the cell wall of liver cells are damaged. The AST level rises when the mitochondria inside liver cells are damaged. This means that usually there is a rise in ALT before, or at the same time, as a rise in AST in the case of liver disease. Unfortunately, AST is NOT specific for liver disease. It also rises in situations in which muscle damage or red blood cell damage are occur. Due to this problem, it seems to me that it would be best to assess liver function with a more specific test, such as a bile acid response test or even a liver biopsy as long as blood clotting is shown to be normal prior to considering the liver biopsy. This is always important but in your dogs case it is more so, since blood clotting disorders are a rule out in TWO of the conditions that are affecting your dog. Bile acid response testing is not hard to do, poses no risk to the patient and is a good indicator of whether the liver is functioning well. It doesn't totally rule out liver disease but it makes it easier to take a "wait and see" attitude, which I am inclined to do when a patient appears to feel good despite rises in a blood chemistry value that doesn't necessarily indicate a life threatening condition.

Hope this helps some.

Mike Richards, DVM 11/17/99

Hemorrhagic Gastroenteritis (HGE)

Q: Dr. Mike, Our 2 year old male silky terrier has been diagnosed with HGE. Over an 18 hour period, beginning at 2am, he first vomited frequently in the night, then had bloody stools over the daytime period. He seemed increasingly subdued and would not eat. We took him to the emergency vet at about 6pm. After a blood test showed a 65% level of pcv, he was put on fluids and antibiotics IV.

Can you tell us more about where this comes from, what the problem is, what the treatments are, and how we might prevent it in the future. Thanks sincerely.

A: Hemorrhagic gastroenteritis (HGE) usually causes a very sudden onset of vomiting, bloody diarrhea, dehydration and depression. Dogs affected by this condition get very sick, very fast.

To the best of my knowledge, the exact cause of this disease is unknown. It appears that Clostridium species bacteria may be part of the cause. The disease is more frequent in small breed dogs but can occur in any dog. I am not sure what the general impression is among veterinarians, but dogs that have this problem seem to have a high risk of getting it again in our practice.

Most dogs respond very well to treatment with fluids to restore hydration. In some cases it is necessary to give plasma to correct loss of protein and antibiotics to combat the suspected Clostridium infection. In a few dogs, it is necessary to give fast acting cortisones to counter shock, which is a problem due to the very rapid onset of dehydration in dogs with HGE.

It is generally necessary to totally restrict oral food and water for one or two days when treating this problem. This makes hospitalization necessary for several days for most dogs with HGE.

The odds are very good that your dog will be OK. Follow your vet's advice carefully after discharge from the hospital.

Mike Richards, DVM

HGE in Schnauzer

Q: Dear Dr. Mike, My vet today diagnosed my 3-1/2 yr. old Miniature Schnauzer with Hemorrhagic Gastroenteritis. This is her second attack in just 2-1/2 months. The first happened over a weekend and I took her to an emergency clinic where they said she had Gastroenteritis. The second attack was much more severe and my regular vet saw her. My question is will her life span be shortened by this and are there any preventions I can take with her to help her from having another attack so soon. I would also appreciate any information you could share with me on HGE. Thank you, Frances

A: Frances- It is pretty likely that your schnauzer will have repeat attacks of HGE. While most of the time these attacks do not occur quite as closely as the two you have seen, it can happen. We had a dachshund patient who had three or four attacks in one year and has not had one that I can remember since.