Hemoabdomen
What is Hemoabdomen?
Hemoabdomen means free blood in the abdomen.
It can further be divided into traumatic vs non traumatic: Traumatic cases are caused by blunt or penetrating trauma that directly injure abdominal organs. Traumatic hemoabdomen is most often due to motor vehicle accidents or penetrating wounds.
Non traumatic cases includes things like anticoagulant rodenticide toxicity, liver failure, congenital clotting disorders as well as bleeding from masses in the abdominal cavity (spleen, liver etc.). These masses may be benign or cancerous.
What are the clinical signs?
Signs can include a transient weakness if only a small amount of blood is lost. Some animals may not even show signs if only a small amount of blood is lost or may simply be less willing to play.
Large amounts of blood loss can cause abdominal distention, weakness, collapse, pale gums, shock, and finally death if left untreated.
How do we diagnose Hemoabdomen?
Bloodwork can show anemia and a low protein level due to blood loss.
Radiographs may show loss of abdominal detail and some abdominal masses.
Ultrasound can show fluid in the abdomen and any masses originating on abdominal organs. However, ultrasound cannot determine exactly the type of fluid, which is why an ‘abdominocentesis’ is need to make the diagnosis.
Abdominocentesis means placing a needle into the abdomen and pulling back into a syringe to remove any fluid that may be present. This procedure will reveal free blood in the abdomen in the case of hemoabdomen.
How do we treat Hemoabdomen?
Treatment will depend on the underlying cause (traumatic vs non traumatic) and degree of blood loss.
Traumatic bleeds may stop on their own with pressure applied to the belly. Severe blood loss may necessitate a blood transfusion. The patient will be monitored very closely for continued bleeding which may require surgery.
The treatment for non traumatic bleeds depends on the underlying reason. For example, liver failure requires fluids, liver supportive medications and plasma transfusions. Rodenticide toxicities require vitamin K supplementation and plasma transfusions. Splenic or liver masses require surgery to remove the source of the bleed and submission of the mass to find out what type of mass we are dealing with. .
Follow-up Prognosis
The prognosis will depend on the underlying cause and severity of the bleed.
The most common non traumatic cause is a splenic mass. Of these 1/3 are non neoplastic (meaning that surgery will cure your pet) and 2/3 are neoplastic. Of those that are neoplastic 2/3 are a cancer called hemangiosarcoma (that unfortunately has a fairly poor prognosis). Unfortunately, there is no good test to find out what type of mass we are dealing with besides submitting the tissue to a pathologist. We will perform radiographs of the chest (to look for spread of cancer) prior to surgery and other tests (such as obtaining a few cells with a needle may be performed) may be chosen, but these are not always correct.
Pets with liver failure have a guarded prognosis.
Rodenticide toxicities have a good prognosis if treated aggressively.
The prognosis for pets with a trauma induced hemoabdomen will depend on the extent of the pet’s injuries.
Once the stomach is in the correct position it will be sewn to the body wall to prevent recurrence. This is called a gastropexy.
Post operative care is extremely important. These patients are at risk for cardiac arrhythmias, electrolyte abnormalities, and severely affected animals can have clotting abnormalities.
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