| Abstract | Sindrom akutnog hemoragijskog proljeva (eng. Acute haemorrhagic diarrhoea
syndrome, AHDS) često je hitno stanje u maloj praksi koje se najčešće javlja u pasa malih i
srednjih pasmina. AHDS je definiran kao perakutno nastajanje hemoragijskog proljeva koje
dovodi do dehidracije, hemokoncentracije i/ili hipoproteinemije te hipovolemijskog šoka.
U posljednje vrijeme, smatra se da netF toksin, kojeg proizvodi Cl. perfringens,
uzrokuje nekrotizirajuće lezije crijeva u pasa oboljelih od AHDS-a. Patuljaste i male pasmine
pasa (jorkširski terijer, pinčer, malteški psić i patuljasti gubičar) su predisponirane. Bolest traje
u prosjeku 48h te je samoograničavajuća.
Od promjena u krvnim nalazima može se očekivati: hemokoncentracija, lekocitoza /
leukopenija sa skretanjem u lijevo, hiper- i hipoproteinemija, povišene vrijednosti CRP-a,
povišene vrijednosti CK, dok elektroliti ostaju stabilni što ukazuje na očuvanu funkciju crijeva
u vidu resorpcije iona.
Potporna terapija koja se koristi u liječenju AHDS-a uključuje intravensku tekućinsku
terapiju, antiemetike, gastroprotektante, opioide, antimikrobnu terapiju te probiotike.
Tekućinska terapija se koristi zbog dehidracije i hipovolemije pacijenata. Antiemetik,
maropitant, koristio se kod većine pacijenata. Inhibitori protonske pumpe, esomeprazol i
pantoprazol, korišteni su za zaštitu želučane sluznice, ali ako se koriste u kraćem vremenskom
periodu, nemaju utjecaj na ishod bolesti. Analgetici, posebno opioidi, korišteni su za kontrolu
boli i usporavanje crijevnih kontrakcija. Antimikrobna terapija bila je prisutna kod 60%
pacijenata, iako se njihova upotreba smanjuje zbog mogućih negativnih efekata. Ampicilin i
metronidazol bili su najčešće korišteni antibiotici. Uloga probiotika, poput Fortiflore, je
istraživana, ali nije bilo dovoljno uzoraka da bi se utvrdila njihova učinkovitost u liječenju
AHDS-a. Generalno, terapija je prilagođena stanju pacijenta, s posebnim naglaskom na
prevenciju i liječenje dehidracije i bakterijske infekcije.
AHDS nije smrtonosna bolest i unatoč teškoj kliničkoj slici, pacijenti ozdrave uz pomoć
simptomatske terapije. |
| Abstract (english) | Acute Hemorrhagic Diarrhea Syndrome (AHDS) is a common emergency condition in
small animal practice, primarily affecting small to medium-sized dog breeds. AHDS is
characterized by the sudden onset of hemorrhagic diarrhea, leading to dehydration,
hemoconcentration, hypoproteinemia, and/or hypovolemic shock.
Recently, it has been suggested that the netF toxin produced by Clostridium perfringens
causes necrotizing lesions in the intestines of dogs with AHDS. Small and toy breeds, such as
Yorkshire Terriers, Pinschers, Maltese dogs and Miniature Schnauzer, are predisposed to this
condition. The disease typically lasts around 48 hours and is self-limiting.
Bloodwork changes commonly observed in AHDS include hemoconcentration,
leukocytosis or leukopenia with a left shift, hyper- or hypoproteinemia, elevated CRP (Creactive protein), increased CK (creatine kinase), while electrolyte levels remain stable,
indicating preserved intestinal ion absorption.
Supportive therapy for AHDS includes intravenous fluid therapy, antiemetics,
gastroprotectants, opioids, antimicrobial therapy, and probiotics. Fluid therapy is essential due
to the dehydration and hypovolemia seen in patients. Maropitant, an antiemetic, was used in
most cases. Proton pump inhibitors, such as esomeprazole and pantoprazole, were used to
protect the gastric mucosa, but their short-term use did not impact the disease outcome.
Analgesics, especially opioids, were administered to control pain and slow intestinal
contractions. Antimicrobial therapy was used in 60% of patients, although its use is decreasing
due to potential negative effects. Ampicillin and metronidazole were the most commonly used
antibiotics. The role of probiotics, like Fortiflora, was also explored, but there were insufficient
samples to confirm their effectiveness in treating AHDS. Overall, treatment is tailored to the
patient's condition, with a focus on preventing and treating dehydration and bacterial infections.
AHDS is not a fatal disease, and despite the severe clinical presentation, patients
typically recover with symptomatic therapy. |
