Page 882 - Cote clinical veterinary advisor dogs and cats 4th

428 Hematuria

or neoplastic cause of hematochezia may TREATMENT PROGNOSIS & OUTCOME
have a hyperglobulinemia. Treatment Overview The prognosis for hematochezia is good if
VetBooks.ir ○ Evaluate for helminths and Giardia cysts; Successful treatment depends on the ability the underlying cause can be resolved. Other
• Centrifugation fecal flotation
empirical deworming is recommended if
to identify and address the cause of bleeding.
causes (e.g., metastatic neoplasia) may be
clinical suspicion exists.
• Activated partial thromboplastin time/ Acute General Treatment life-threatening.
prothrombin time Treatment depends on suspected cause. PEARLS & CONSIDERATIONS
○ Performed as initial diagnostic test if • Patients with severe blood loss or coagulopa-
clinical suspicion for hemostatic disorder thies may need supportive measures such as Comments
exists. intravenous fluids, blood transfusions, and • Abdominal ultrasound can be excellent for
• Abdominal radiographs/ultrasound: useful for correction of electrolyte disturbances. identification of colonic masses except those
identification of moderate to large colonic • Sucralfate slurry or barium administered per in the pelvic canal.
lesions unless in the pelvic canal rectum can be considered for patients with • Distal rectal masses may be associated with
○ Thickened colon (inflammation, infection, severe hematochezia, unless GI perforation additional masses orad, and colonoscopy is
neoplasia) is suspected. often warranted before removal.
○ Lesions suggesting infection or neoplasia • For stable animals with small amounts of
such as masses or lymphadenopathy blood, treatment with fenbendazole 50 mg/ Technician Tips
○ GI foreign bodies kg PO q 24h for 5 days may be attempted Advise clients to monitor for hematochezia
before more advanced diagnostic testing. when administering ulcerogenic drugs, platelet
Advanced or Confirmatory Testing inhibitors, or anticoagulants to their pets.
• Thoracic imaging: include in initial diag- Chronic Treatment
nostics if metastatic neoplasia or systemic Administration of iron dextran 5-10 mg/kg SUGGESTED READING
infectious disease is suspected. IM q 3-4 weeks may be indicated for patients Willard M: Hemorrhage (gastrointestinal). In
• Additional fecal testing, including fecal with evidence of iron-deficiency anemia (e.g., Washabau R, et al, editors: Canine & feline
sedimentation, fecal wet mount, Baermann, microcytosis, nonregenerative anemia) from gastroenterology, St. Louis, 2013, Saunders, pp
and Giardia ELISA, should be considered chronic blood loss. 129-134.
to evaluate for GI parasites.
• Rectal scrape for cytologic interpretation Possible Complications RELATED CLIENT EDUCATION
may be useful if rectal mucosal abnormal • If hematochezia is associated with GI ulcer- SHEETS
on digital palpation (p. 1157). ation, perforation and septic peritonitis are
• Specific infectious disease testing (e.g., possible. Consent to Perform Abdominal Ultrasound
Histoplasma capsulatum ELISA, entero- • Prolonged or severe hematochezia can cause Consent to Perform Endoscopy, Lower GI
pathogenic bacteria screening) recommended, severe blood-loss anemia necessitating blood (Colonoscopy)
depending on initial findings and the transfusions. How to Collect a Fecal Sample
prevalence of enteropathogens in the practice
area. Recommended Monitoring AUTHOR: M. Katherine Tolbert, DVM, PhD, DACVIM
• Colonoscopy/proctoscopy can be used Clinical signs of anemia (e.g., tachypnea, EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
to identify and sample the source of GI tachycardia, lethargy) and PCV/total solids
bleeding. (TS) monitored to assess severity of blood loss.

Hematuria Client Education
Sheet

BASIC INFORMATION RISK FACTORS CONTAGION AND ZOONOSIS
• Acquired or hereditary bleeding disorders • Transmissible venereal tumor usually causes
Definition (e.g., rodenticide intoxication, thrombocy- a mass effect but can cause hematuria.
The presence of blood (gross or microscopic) topenia, hemophilia) • Some infections can result in thrombocyto-
in the urine; encountered commonly in dogs • Upper or lower urinary tract trauma, penia and secondary hematuria.
and cats neoplasia, infection, or inflammation Clinical Presentation
• Urolithiasis
Epidemiology • Renal insult (e.g., acute kidney injury, DISEASE FORMS/SUBTYPES
SPECIES, AGE, SEX glomerulonephritis) • Macroscopic hematuria: grossly discolored,
Dogs or cats of either sex and any age may • Vascular malformation bloody-appearing urine
develop hematuria for a variety of benign or • Urinary parasites (Capillaria plica, Diocto- • Microscopic hematuria: > 5 erythrocytes/high-
pathologic reasons. phyma renale) power field without overt urine discoloration
• Cyclophosphamide administration
GENETICS, BREED PREDISPOSITION • Prostatitis HISTORY, CHIEF COMPLAINT
Welsh corgi (renal telangiectasia), Abyssinian • Proestrus Gross hematuria may occur at initiation of
cats (glomerular disease), Scottish terrier urination, throughout urination, or at the
(transitional cell carcinoma) end of urination.

www.ExpertConsult.com