Hemorrhagic gastroenteritis is a disease characterized by bleeding and inflammation in both the stomach and intestinal system. It is very rare in humans, and is more often found in animals, particularly dogs, sheep and cattle. In humans, hemorrhagic gastroenteritis is not a primary condition, but rather a symptom or complication of some other underlying condition. Hemorrhagic gastroenteritis should always be considered a medical emergency.
In adult humans, hemorrhagic gastroenteritis is most often caused by poisoning, particularly heavy metal toxicity. Rarrely, toxicity occurs in patients taking the colchicine for gout. Any poison or prescription drug that blocks cellular reproduction in some way has the potential to cause hemorhagic gastroenteritis.
In young children, and especially infants, virulent infection is usually the cause. Rotavirus is most likely to cause hemorrhagic gastroenteritis. Very rarely, E. Coli O157:H7 is the cause, though E. Coli usually causes only enterohemorrhage.
Certain autoimmune diseases, such as Systemic Lupis Erythmatosis, has also been found to cause hemorrhagic gastroenteritis.
Clinical Signs & Symptoms
Symptoms depend on the severity of the hemorrhage.
A minor hemorrhagic illness can be very hard to detect. Early in the disease process, a minor hemorrhagic gastroenteritis produces non specific symptoms, which may be associated with many conditions. These are things like vomiting, nausea, diarrhea, and loss of appetite. Later on, pallor, weakness, and orthostatic hypertension set in. If undected, the hemorrhage may lead to circulatory collapse and death.
A virulent hemorrhagic gastroenteritis is dramatic in its appearance. It is charicterized by vomiting of blood, which may be red, or dark brown. Diarrhea is usually concurrent. The diarrhea most often associated with hemorrhagic gastroenteritis is watery and mucosy at first. Later, blood, sometimes quite a bit, will be noticeable. Symptoms of shock set in quickly due to volume depletion as a result of blood an fluid loss.
A diagnosis of hemorrhagic gastroenteritis is made based on blood work, and diagnostic imaging.
A CBC will show decreasing hematocrit. White blood count is almost always elevated. If Lupus is the cause, there will be a significant elevation in sed rate in most cases. A PT/PTT should be done to rule out a bleeding disorder.
Endoscopy is the diagnostic tool of choice when it comes to comfirming hemorrhagic gastroenteritis. An endoscopy will show diffuse bleeding of the gastrointestinal mucosa, and can rule out ulcers. If the patient is hemodynamically stable, and a bleeding disorder has been ruled out, a biopsy can be taken to rule out cancer.
If bleeding is severe, surgery is usually done to more quickly establish a diagnosis.
Treatment consists of supportive care for the hemorrhage, and treatment of the underlying condition. A minor hemorrhage can usually be managed with I.V. fluids, while a severe hemorrhage may result in the need for whole blood transfusion. Additional supportive care includes analgesics for pain, and vasopressors, such as metaraminol, to control hypotension.
Treatment for the underlying illness is what eliminates the hemorrhagic gastroenteritis. Lupus can be treated with high dose corticosteroids. In more serious cases, immunosuppressive drugs, like methotrexate, may be used. Treatment for poisoning is often purely supportive, with the exception of heavy metal toxicity, which is treated with chelation therapy. Bacterial infections can be treated with aggressive antibiotic therapy, while viruses can not be treated.