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Causes of Blood in a Dog's Abdomen (Hemoabdomen)

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Blood in a Dog's Abdomen

There are various causes of blood in a dog's abdomen and the majority of them are quite serious. The underlying causes of blood in a dog's abdomen can be divided into two main categories: hemoabdomen caused by trauma (as it may happen as a result of a car accident) or hemoabdomen as a result of underlying conditions that make dogs prone to bleeding internally, filling the abdomen with blood. If you suspect your dog has hemoabdomen, please see your vet at your earliest convenience as this may be suggestive of a life threatening situation requiring prompt veterinary intervention.

Dog with ascites Image from page 150 of "Canine distemper, its complications, sequelae, and treatment" (1922)

Dog with ascites Source: "Canine distemper, its complications, sequelae, and treatment" (1922)

Definition of Hemoabdomen in Dogs

The medical term ascites refers to the accumulation of fluid in the dog's belly. Depending on the type of fluid present, the collection of fluid may adopt a different name and the term hemoabdomen is a perfect example.

The definition of hemoabdomen in dogs is "the collection of blood within the peritoneal cavity which is located between the parietal peritoneum, which lines the abdominal wall, and the visceral peritoneum, which surrounds the abdominal organs. " In a normal, healthy dog, blood should never be present in the abdominal cavity freely.

When a significant amount of blood accumulates in the belly, dog owners will typically notice some level of abdominal swelling. The dog's belly area may appear enlarged; however, mild cases may not produce a significant amount of blood filling the cavity enough for the enlargement to become apparent enough to prompt a vet visit. Veterinarians upon palpation may detect a palpable fluid wave which is recognizable only when the amount of fluid present is greater than 40 ml/kg .

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On top of the visible abdominal swelling, dogs with hemoabdomen may also manifest discomfort associated with the swelling such as trouble breathing. Increased breathing effort in this case is caused by the fluid in the belly compressing the diaphragm preventing the lungs from being able to expand completely, explains veterinarian Dr. Altman.

Dogs with a significant amount of blood in the abdomen will typically also manifest weakness, pale gums, increased heart rate and other signs of internal bleeding in dogs.

Causes of Blood in a Dog's Abdomen

High-grade ascites in a Chavalier King Charles Spaniel Source: Uwe Gille

High-grade ascites in a Chavalier King Charles Spaniel Source: Uwe Gille, Wikimedia Commons

As mentioned, blood in a dog's abdomen in dogs may be caused by several underlying conditions. The blood may be leaking from several internal organs such as the spleen, liver, adrenal glands and kidneys and occasionally, may derive from vessels in the abdomen or the dog's abdominal muscles.

If you notice an enlarged abdomen in your dog, see your vet promptly. Your dog's belly may filling up with fluids such as blood or your dog's stomach may have filled with air causing a potentially life-threatening condition known as gastric dilatation volvulus. 

It is therefore important to see the vet promptly as hemoabdomen in dogs can be indicative of some life-threatening conditions that require quick treatment.

Dogs bleeding internally are prone to develop severe anemia, which is a low blood count that can quickly turn out being deadly. Following are some of the most common possible causes of blood in a dog's abdomen, but there may be several more.

 Hemoabdomen in Dogs Due to Trauma

Dogs with traumatic causes of hemoabdomen have a history of sustaining some type of trauma and presence of concurrent injuries. The most common cause of blood in the dog's abdomen due to trauma is the dog being victim of a car accident. Another possible cause may be penetrating trauma causing injuries to solid organs such as the liver and spleen as it may happen with gunshots, stick impalement and bite wounds.

Dogs with potential hemoabdomen due to trauma are usually x-rayed. Chest x-rays can help assess and rule out other potential injuries. Treatment-wise, dogs bleeding in their abdomen due to trauma can be managed conservatively (when feasible) by providing supportive care, but some cases may require surgical intervention to halt the bleeding at its source.

When it comes to the prognosis of dogs who have developed hemoabdomen due to blunt trauma, the good news is that the survival rate is close to 70 percent, whether treated surgically or medically, explains Dr. Lori Ludwig, a board-certified veterinary surgeon working in a private small-animal referral practice located in Charleston, South Carolina. In these cases, the dog's body usually reabsorbs the free blood that has accumulated in the abdomen.

Hemoabdomen in Dogs Due to Cancer

The tissue sample taken from the liver is checked under a microscope.

The tissue sample taken from the liver is checked under a microscope.

Unfortunately, the majority of non-traumatic causes of blood in the dog's abdomen are due to some type of cancer rupturing. According to a study involving 39 dogs with acute non-traumatic hemoabdomen, the spontaneous occurrence of blood in the dog's abdomen is due to cancer 80 percent of the time, with the most common diagnosis being canine hemangiosarcoma which was found in 70 percent of cases.

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Hemangiosarcoma is a cancer of the spleen that often goes unnoticed for some time, hence why it's often nicknamed "the silent killer." One of the first signs dog owners may notice is the abdomen enlarging due to it filling up with blood following a rupture. Eventually, affected dogs developing an acute rupture lose so much blood, they cannot keep up good circulation which may lead to collapse.

However, should the hemoabdomen be caught before the dog decompensates, affected dogs would need to undergo surgery to remove the spleen, but even with surgery, we are talking about average survival times of just about one to two months, explains veterinarian Dr. Kelly Jones. 

Other forms of cancer that may cause bleeding in the abdomen include hepatocellular carcinoma and carcinomatosis and certain benign tumors affecting the dog's liver or adrenal glands.

"The medical records of 39 dogs with acute non-traumatic hemoabdomen were identified and reviewed. When a definitive diagnosis was obtained, malignant neoplasia was diagnosed most frequently and occurred in 24/30 (80%) dogs. Hemangiosarcoma accounted for 21/30 (70%) diagnoses."~ Journal of the American Animal Hospital Association: November/December 2003, Vol. 39

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Hemoabdomen in Dogs Due to Hematomas/Hemangiomas

It's unfortunate that too many dogs are put to sleep at the time they are diagnosed with hemoabdomen because inexperienced vets assume they are dealing with the worse-case scenario, that is, a malignant cancer, observes Dr. Irene Flickinger, a veterinarian specializing in oncology.

Instead, in some cases (especially in small and medium-sized dogs and in some fortunate cases involving larger breeds) the bleeding is due to a harmless hematoma in the spleen which causes strikingly similar symptoms to hemangiosarcoma. The only definite way to distinguish the two is through examination of the surgically removed spleen sent out to a pathologist for microscopic evaluation.

Statistically, when we look at numbers, it's estimated that about 2/3 of cases of hemoabdomen deriving from a mass on the spleen are malignant, while about 1/3 can be a result of benign causes. Benign causes such as hematomas or hemangiomas won't spread anywhere else and complete resection can be curative.

Hemoabodomen Due to Coagulopaties 

Sometimes, blood in a dog's abdomen may be due to coagulopaties which are conditions affecting how efficiently the dog's blood clots. Common coagulopaties causing hemoabdomen may arise from ingestion of toxins that interfere with proper blood coagulation such as rodenticide poison (rat poison) or dogs accidentally ingesting Coumadin, a drug often prescribed to human heart patients.

Affected dogs may develop pale gums and presence of surface bleeding (petechiae and ecchymosis) but bleeding within cavities is more common and this includes hemoabdomen. Treatment entails administration of prescription vitamin K and possible blood transfusions.

Did you know? Hemoabdomen, blood in a dog's abdomen, may also occur as a result of organ torsion, as seen in gastric dilatation-volvulus, spleen torsion and splenic liver lobe torsion.

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life expectancy of addison disease in dogs

Blood in a dog's abdomen requires careful investigation.

At the Vet's Office 

Once your dog is at the vet, the vet will likely perform a quick physical exam looking for signs of trouble (pale gums, slow capillary refill time, abnormal heart rate, changes in mentation etc.). Further diagnostic tests may be conducted. Such tests may include complete blood count (particular attention to packed cell volume), biochemistry profile (to check the status of organs), x-rays, ultrasound (to see where the blood originates from) and CT- scan (to check for signs of tumor spread).

An abdominocentesis is a procedure that may be carried out in the case of hemoabdomen in dogs. In this procedure, a hollow 22-gauge needle is used to aspirate a sample of the fluid, or alternately, this procedure may performed using ultrasound guidance. The fluid sample is then evaluated under a microscope for presence of neoplastic cells (cancerous) or bacteria.

If the dog presents with signs of shock, an intravenous catheter will be placed to deliver fluids (crystalloids or colloids) and/or important life-saving drugs. Severe cases, where the dog's packed cell volume is low, may require a blood transfusion once the dog's blood type has been identified. More and more veterinary hospitals are likely to start offering autologous transfusions using a red blood cell salvage system in the near future.

Placing a compressive bandage around the dog's abdomen can help decrease the rate of blood loss increasing the chances for a dog's survival. Once the dog is stabilized, the bandage should be gradually and carefully removed by veterinary staff one piece at a time every few minutes as removing it too quickly can lead to rapid lowering of the dog's blood pressure.

Exploratory laparotomy may be carried out when the underlying cause or origin of the bleeding hasn't been identified precisely. Often, this surgery leads to a splenectomy (removal of spleen).

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References:

  • DVM360: Surgery STAT: Emergency management of hemoabdomen
  • Jason Pintar, Edward B. Breitschwerdt, Elizabeth M. Hardie, and Kathy A. Spaulding (2003) Acute Nontraumatic Hemoabdomen in the Dog: A Retrospective Analysis of 39 Cases (1987–2001). Journal of the American Animal Hospital Association: November/December 2003, Vol. 39, No. 6, pp. 518-522.

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