Page 501 - Problem-Based Feline Medicine

23 – THE BLEEDING CAT 493

● Bleeding into or from skin, underlying tissues, Tests of hemostasis (platelet count, BMBT, ACT,
ears and footpads with lacerations, puncture aPTT, PT) are either normal or not sufficiently abnor-
wounds, blunt trauma, ruptured cat bite abscesses mal to account for the hemorrhage.
and bleeding tumors (see The Cat With Skin Lumps
and Bumps, page 1067 and The Cat With Non-Heal-
Differential diagnosis
ing Wounds, page 1081). Vasculitis usually results in
edema, but may rarely cause local bleeding. If a local lesion is not apparent, a hemostatic defect is
● Bleeding from oral cavity due to lacerations and likely.
puncture wounds, periodontal disease, and oral
neoplasms (see The Cat With Bad Breath or Oral Local lesions and hemostatic defects may be concurrent.
Lesions, page 602). Systemic hypertension may cause retinal hemorrhages
● Epistaxis from nasal trauma, rhinitis and neo- and epistaxis.
plasms (see The Cat With Upper Respiratory Tract
Signs of Chronic Nasal Disease, page 19).
● Ocular hemorrhage from corneoscleral lacera- Treatment
tions, severe uveitis, and ocular neoplasms (see The
Treat the local lesion – see the appropriate chapters
Cat With Eye Problems, page 1165).
listed above.
● Hematuria from major trauma to the kidney or
bladder, idiopathic lower urinary tract disease, neo- Use fluid therapy and/or whole blood transfusion
plasms of the kidney or bladder (see The Cat With (10–20 ml/kg) to correct acute hypovolemia and
Urinary Tract Signs, page 173). Clot formation in anemia.
the bladder may cause or exacerbate signs of lower
urinary tract disease.
● Vaginal bleeding from pyometra, spontaneous abor- MOTOR VEHICLE AND OTHER MAJOR
tion or lochia (see The Infertile Queen, page 1145). BLUNT TRAUMA***
● Melena from intestinal neoplasia, which may cause
iron-deficiency anemia (see The Cat With Signs of Classical signs
Gastrointestinal Tract Disease, page 578).
● Shorn nails, fractured mandible, fractured
● Hematochezia from colitis (and rarely acute enteri-
pelvis, dyspnea.
tis), and colonic and anorectal neoplasms (see The
Cat With Signs of Gastrointestinal Tract Disease,
page 578). Clinical signs
● Hemoptysis from major blunt trauma, acute heart
failure and less commonly lung lobe torsion and External signs of trauma include shorn nails, and
primary lung neoplasms (see The Dyspneic or bleeding from skin and oral cavity lacerations.
Tachypneic Cat, page 47). Internal signs of trauma include palpable fractures,
● Hemothorax from major blunt trauma, penetrating non-palpable bladder, hemoperitoneum and dyspnea
trauma and spontaneous bleeding from the thymus from pneumothorax, hemothorax, diaphragmatic her-
(see The Dyspneic or Tachypneic Cat, page 47). nia, pulmonary contusions, neurogenic pulmonary
● Hemopericardium from major blunt trauma, pen- edema, shock and pain.
etrating trauma or neoplasia (rare) (see The Dysp-
neic or Tachypneic Cat, page 47). The cat may be in shock with pale mucous membranes
● Hemoperitoneum from major blunt trauma, pene- and weak pulses.
trating trauma, liver disorders (especially hepatic
amyloidosis and peliosis hepatis), and bleeding
Diagnosis
neoplasms (see The Cat With Abdominal
Distention or Abdominal Fluid, page 443). Diagnosis is facilitated if the event is witnessed, e.g. hit
by motor vehicle, fall from a height, kicked by a horse.
Diagnosis
Physical examination findings consistent with trauma
See the appropriate chapters listed above. are supportive evidence.