Update

My Dachshund patient turned out to have a rather large gastric mass. He was scoped, and his stomach found to be full of blood with 2 actively bleeding sites. Endoscopically obtained biopsies were inconclusive. He would not survive surgery, because he was very, very ill, and he had few platelets to clot with. The owners elected to euthanize.

I feel like a moron moron moron. An older (7) dog with vomiting, melena, and thrombocytopenia - I should have had gastric cancer on my list. It occurred to me, but I didn't put it on my "official" differential list in the chart. I'm not sure why, entirely. It was an odd case, and now, we'll never know the answer. Was the mass cancer? Was it something else - something infectious like pythiosis? Was it an embedded foreign body that had set off a systemic DIC?

What I found interesting and confusing was the low platelets with a NORMAL PCV (measure of red blood cells in circulation). The internal medicine specialist attributed the low platelet count to ongoing bleeding in the stomach, however the dog wasn't anemic. We had no explanation for that other than perhaps a "consumptive coagulopathy" - the platelets were just being used up too fast.

Guess we'll never know. It was however, an excellent reminder of why we should refer. When something is above us...get help from the specialists! I never, ever hesitate to refer.