n 11-year-old female spayed Golden Retriever was A presented to the refemng veterinarian because of a 1-day onset of lethargy and black tarry stools that had progressed to dark bloody diarrhea. The dog had vomited bile and mucus once during the proceeding 24 hours. The dog had not been exposed to toxicants; however, the dog occasionally received 1 Ascriptin (Rorer Pharmaceutical Corp, Fort Washington, PA) (325 mg aspirin and 150 mg magnesium-aluminum hydroxide) a day for arthritis. During the prior 2 weeks approximately 5 doses had been administered. Physical examination identified pale mucous membranes. Thoracic and abdominal radiographs were taken and were within normal limits. A CBC, serum chemistry panel, platelet count, prothrombin time, and activated partial thromboplastin time were submitted to a local veterinary diagnostic laboratory. Abnormalities in the CBC included a hematocrit of 17% (reference range 37-%%), red blood cell (RBC) count of 2.45 X 106/pL (reference range 5.5-8.5 X 106/pL), hemoglobin 5.8 g/dL (reference range 12-18 g/dL), and platelet count of 112 X 103/pL (reference range 200-500 X 10VpL). The coagulation times were normal. Relevant abnormalities on the serum chemistry profile included increased blood urea nitrogen (BUN) concentration (51 mg/dL; reference range 7-28 mg/dL), hypoproteinemia (3.5 g/dL; reference range 5.4-7.4 g/dL), hypoalbuminemia (2.0 mg/dL; reference range 2.7-4.5 mg/dL), and hypoglubinemia (1.5 mg/dL; reference range 1.9-3.4 mg/ dL). A tentative diagnosis of gastrointestinal ulceration was made based on the clinical and clinicopathologic findings and the dog was treated with sucralfate and doxycycline PO.Twelve hours after her release the dog was represented for acute collapse. On physical examination the mucous membranes were very pale, and the hematocrit had decreased to 9%. The patient was referred to a veterinary internist for diagnosis and therapy of the gastrointestinal ulceration, where she received 2 units of packed RBCs, 500 mL of hetastarch, lactated Ringer's solution, ranitidine, and sucralfate. During the blood transfusion the dog vomited bile-tinged fluid with no evidence of either digested or undigested blood. On hospital day 2 the dog had improved clinically, and the PCV had increased to 19% and the total protein to 4.4 mg/dL. Rectal examination revealed gross melena. An abdominal ultrasonogram and upper gastrointestinal barium contrast study were performed in an attempt to identify a source of gastrointestinal bleeding; both were interpreted as normal.On hospital day 3 the hematocrit was 28% and upper gastrointestinal endoscopy was performed under general anesthesia in the attempt to identify a source of gastroin- The clinical and hematologic findings supported a diagnosis of gastrointestinal bleeding. The lack of historical hematemesis and the failure of upper gastrointestinal endoscopy to demonstrate a definitive site of active bleeding suggested a lesion distal to the proximal duodenum.A scintigraphic study using labeled RBCs as a minimally invasiv...
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