Page 424 - Small Animal Internal Medicine, 6th Edition

396 PART III Digestive System Disorders

Hematemesis/blood dripping from mouth
VetBooks.ir History/physical examination/PCV and total plasma solids

Animal in shock OR Animal does not need
animal has acute abdomen immediate therapy

First give supportive/symptomatic Must distinguish among
therapy, then...

Vomiting or Expectoration Blood spontaneously
regurgitation dripping from mouth

Look for coagulopathy with See Chapter 19 Oral examination
buccal mucosal bleeding time.
If not a coagulopathy ...

Look for obvious causes on history and physical
examination (NSAIDs, dexamethasone, hypovolemic
or septic shock, possible mast cell tumor, abdominal mass)

Do BOTH

Treat symptomatically CBC/serum chemistry profile/urinalysis serum cortisol (dogs)
with injectable proton pump inhibitor (looking for adrenal, renal or hepatic failure)
(Do not administer sucralfate Plain abdominal radiographs/abdominal
if endoscopy might be performed) ultrasonography (looking for mass, infiltrate, foreign object)

IF cause is still unknown OR animal
not responding appropriately to therapy...

Esophagogastroduodenoscopy
(looking for ulcer, foreign object, tumor,
infiltration)

If lesion not found in alimentary tract, consider
bronchoscopy and posterior nares examination

FIG 26.3
General diagnostic approach to hematemesis in the dog and cat. CBC, Complete blood
count; PCV, packed cell volume.

are occasionally helpful; however, endoscopy is usually more be reviewed. Diseases may be inappropriately ruled out (or
cost-effective. During endoscopy, the clinician should biopsy diagnosed) because the clinician does not understand the
the stomach and duodenum, regardless of normal gross mu- limitations of certain tests. For example, dogs with hypoad-
cosal appearance. In cats, endoscopic biopsy of the ileum and renocorticism may have normal electrolyte concentrations;
ascending colon may occasionally be required to find the inflammatory gastric and bowel disease may be localized
cause of vomiting. If laparotomy is chosen over endoscopy, to one area of the stomach or intestine and rarely causes
the entire abdomen should be examined. The stomach, duo- significant changes in the white blood cell count; hyperthy-
denum, jejunum, ileum, mesenteric lymph nodes, liver, and, roid cats may have normal serum thyroxine concentrations;
in cats, the pancreas should typically be biopsied. dogs and cats with hepatic failure may have normal serum
If the cause of vomiting is undiagnosed after biopsy, the bilirubin concentrations as well as normal serum alanine
basis for previously excluding the different diseases should aminotransferase and alkaline phosphatase activities; dogs