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In today’s blog I want to discuss the condition I most commonly see dogs present to me with for emergency euthanasia, hemoabdomen (blood within the abdominal cavity). Most commonly in my patients, this is caused by a tumor or mass (spleen, liver, gastrointestinal tract, etc) rupturing. I tell owners these masses are like ticking time bombs, because they may be grow quite large or for a long time without your pet showing physical symptoms, and if they rupture they can cause an acute, sudden decline, progressing to death within minutes to hours in severe cases. It is not a failure on your part, something you did not notice - there were literally no signs you would know to look for because you are not a trained veterinary professional! This is a reason why at a minimum, routine veterinary physical exams are recommended yearly for all pets, and in particular at least every 6 months for senior pets. Depending on the size and/or location, your veterinarian may be able to palpate (feel) a mass if one is present. Imaging (radiographs, ultrasound, etc), and in some cases bloodwork, are also helpful tools for identifying certain masses. If a mass is found, your veterinarian may need to perform surgery (+/- biopsy), refer you for consult with a veterinary oncologist +/-chemotherapy, or other treatments. A biopsy and histopathology testing are necessary to tell what the mass is, the prognosis, and the best course of treatment. It is a great day for your pet's veterinary team when they get to share news that a splenic tumor came back as a benign hemangioma, and the surgery has been curative!
Unfortunately, the majority of these tumors within the abdominal cavity, especially in senior pets, are malignant. And as they can grow and spread quickly, your pet may have had a normal physical exam and bloodwork, and then have a tumor develop and grow that causes hemoabdomen within a timespan of weeks to months. You may ask why do tumors rupture and cause internal bleeding? It actually makes sense when you think about the physiology behind it. Cancer cells do not create normal healthy tissue. They also do not listen to normal signals telling them to stop proliferating (hence why tumors appear). They can grow so large that the vessels supporting them, which are also often made up of unhealthy tissue, can be stretched or otherwise fragile, until a tear happens and a bleed occurs. They can also literally outgrow their blood supply, leave parts of the tumor that necrose (die), becoming a nidus or site for infection, further weakening the health of the blood vessels and nearby tissues.
So what might happen with your pet that would make you seek emergency assistance? (And for older, frail pets or severely affected ones, this emergency assistance may be absolutely reasonable as requesting humane home euthanasia, based on the severity of the symptoms and the inability to safely and comfortably transport them). The rupture of a mass or one of its' blood major vessels leads to internal hemorrhaging. Families may notice that their dog acutely becomes weak (such as they only walk a few feet before laying down), starts panting at rest, their abdomen appears swollen, and/or gums become pale. If hemorrhaging is severe, your pet will enter a state of shock, including low blood pressure, elevated heart rate, breathing changes, white mucous membranes (gums, eyelids), collapse, and even death.
In milder cases, your pet may have less severe bleeding, which may even resolve temporarily, then occurs again. This can be responsible for the “waxing and waning” of symptoms which is very difficult for pet owners, as in some cases it can go on for weeks giving hope with each episode that it will resolve again so there can be more good time together. This makes hemangiosarcoma one of my most challenging diseases as far as giving timelines for families on what to expect when I treat pets for it in my veterinary hospice program. I focus on providing education on what the family can monitor at home to gauge when a bleed is progressing from mild to moderate to severe, planning for what to do in each situation that we could expect may occur, and providing guidance and tools for what to do to help their pet best in case of crisis.
If you elect to treat your pet, when they are in a state of shock from hemoabdomen, they will need emergency care including fluid therapy, pain medications (hemoabdomen can be extremely painful), and maybe even a blood transfusion. You and your veterinarian will have to decide, after the source of the bleeding is identified, if surgery is an option or recommendation for your pet. Anesthesia is high risk and difficult for patients in shock, but veterinarians use excellent staff, equipment, and protocols to monitor your pet and do everything they can to support them during a procedure.
It is important to repeat that humane euthanasia is an option, sometimes the best one, for pets with hemoabdomen, especially if they are in a critical state or do not have the option for surgery. The tumor may have already metastasized to other organs (full body radiographs may be needed pre-operatively to try to rule this out, but there is no guarantee the mets would be visible). The possibility of an acute crisis is ever present from such a mass. You should learn to monitor your pet’s vital signs so you can understand what their “normals” are. There are even free apps available for you to track respiratory rates or even heart rates to note changes over time!
I hope the information in this blog has been helpful, thank you for reading!