Gastric volvulus and dilatation (GDV) is a true emergency! The distension and rotation of the stomach, typically seen in deep-chested dogs, tends to be rapidly life threatening.
Signs include unproductive attempts to vomit, abdominal distention, discomfort, and collapse.
Diagnosed with an x-ray, rapid treatment for shock, decompression, and emergency surgery to untwist the stomach is key to a good outcome.
What is GDV?
It is distension of the stomach with gas and/or fluid, accompanied by the rotation of the stomach out of its normal position.
The rotation of the stomach may be accompanied by a rotation of the spleen from its normal position.
The distension and rotation causes the circulation of blood to the stomach (and spleen) to be impaired.
The distension may also impede venous return of blood to the heart by compression of the great vessels.
Sufficient damage may be caused that multiple organs fail, a rapidly life-threatening situation.
To view animation to the right press play. Take note that the stomach first becomes distended, then twists and finally becomes very distended.
Pertinent Anatomy
The esophagus is a tube that courses from the back of the mouth to the stomach.
The stomach empties through the pyloric region into the duodenum under the ribs on the right.
The duodenum is the first part of the small intestine that is attached to the lower part of the stomach
Clinical Signs
Large and giant breed dogs are most susceptible to GDV: Akita, Great Dane, Bouvier, Irish Setter, Boxer, Labrador Retriever, Doberman Pinscher, St. Bernard, English Sheepdog, Standard Poodle, German Shepherd, Wolfhound, Golden Retriever, and Mastiff, Bull Mastiff. Other breeds can also develop bloat.
Risk factors that have been identified: drinking large amounts of water immediately after eating, single large daily meals, eating from elevated bowls, exercising on a full stomach, gulping food quickly, increasing age, first-degree relative affected, deep thorax, aerophagia (swallowing air), fearful temperament, stressful events.
Owners may see the following signs at home: swollen abdomen, non-productive retching, salivating, restlessness, rapid breathing, difficulty breathing, weakness, collapse, pale tongue/gums, depression, lethargy and rapid heart beat.
A veterinarian may find: signs of shock, pale/tacky mucus membranes, decreased capillary refill time, difficulty breathing, rapid breathing, arrhythmias, changes in heart rate, abdominal distension, enlargement of the spleen and rapid or thready weak pulses.
Diagnosis
A single radiograph in the right lateral position can be diagnostic for GDV. See photos right - black arrows outline the bloated twisted stomach
Other tests may be done to monitor your pet’s condition, including: ECG, blood pressure, complete blood count, serum biochemical profile, packed cell volume, total solids, urinalysis, electrolytes, blood gases, pulse oximetry, activated clotting time, other tests for clotting factors.
Treatment
Intravenous fluids are administered at shock doses (some dogs need two intravenous catheters placed to deliver the appropriate amount of fluids over a short period of time).
Decompression of the stomach may be achieved by inserting a large bore needle or trochar through the body wall and into the stomach to relieve pressure, or by passing a tube down the esophagus and emptying the stomach of gas, fluid, and ingested food. This procedure will likely require anesthesia.
Abdominal exploratory surgery is the recommended next step; the abdomen is opened and the internal organs are examined.
The stomach is untwisted and examined for dead or dying tissue, the presence of which is a bad prognostic factor. The affected portion of the stomach is removed. If there is very extensive necrosis of the stomach, successful surgery may not be possible.
If the spleen is unhealthy due to the twist of the stomach, a splenectomy (removal of the spleen) is performed.
A gastropexy(stomach tack) is then performed to prevent the stomach from twisting again. The stomach is attached to the body wall so that it will lie in the correct anatomical position. There are many ways to perform a gastropexy and the veterinarian performing the surgery will use the method that they prefer. All techniques are highly successful.
After surgery, your pet is monitored during recovery. Monitoring may include: ECG, blood pressure, pulse oximetry, packed cell volume, total solids, electrolytes, blood gases, activated clotting time.
Your pet may need to stay in intensive care for 1 to 3 days, depending on their initial state, response to surgery, and development of complications.
Medications may include, but are not restricted to, antibiotics (to treat gut wall compromise), antacids (to promote stomach wall healing), and anti-ulcer medication.
Potential Complications
Detection of gas within the stomach wall (seen on radiograph) indicates compromise of the stomach wall and suggests a poor prognosis.
Free gas within the abdomen (seen on radiograph) means stomach rupture and indicates a poor prognosis.
Abnormal heartbeats (arrhythmias) may be seen after surgery – this is monitored with an electrocardiogram, and treated with medication as they can very rarely be fatal.
Blood pressure may be low after surgery due to fluid losses and protein losses. This is monitored closely during and after surgery, and is treated with artificial plasma (Hetastarch) or real plasma in some cases.
Repeat bloodwork monitors for development of disseminated intravascular coagulation (DIC), where the patient has hyperactive clotting of blood. This can cause small blood clots to lodge in internal organs, causing multi-organ failure and death. Rapid and early treatment is the patient’s best chance if this disorder develops.
Breakdown of gastropexy – this occurs very rarely, and can allow the stomach to twist again and necessitate another surgery.
Chronic bloat – a very small percentage of dogs will go on to experience repeat dilation episodes (but not twisting of the stomach). This may again become life threatening, in which case, a low profile gastrostomy tube may be placed to allow air to escape whenever the stomach becomes distended with air. We have found that the excess air will usually leak around the tube, thus the owner may not need to manually decompress the stomach with a syringe.
Your pet may be treated with antacids, antinauseants, and antibiotics, depending on your veterinarian’s assessment of the situation.
Home Care
3 to 4 weeks of restricted activity is recommended to prevent the breakdown of the attachment of stomach to body wall. This means no running, jumping, or rough-housing, with short leash walks outside for bathroom duties only.
By 10 to 14 days post-operatively, most patients are feeling well.
Patients should be fed two to three small meals per day, dividing up the daily ration appropriately, for the rest of their lives.
Exercise is to be avoided for 2 hours after eating to decrease the chance of another dilation episode
Prognosis
Prognosis is grave without any treatment; an untreated GDV can be rapidly fatal.
Decompression alone may buy time to arrange an emergency abdominal exploratory surgery, depending on the patient’s state at time of decompression. For best outcome, surgery should be performed within 24 hours. Approximately 80 % of the dogs that are treated only with stomach decompression (no pexy) will have recurrence of the bloat.
Approximately 90% of dogs undergoing emergency abdominal exploratory surgery survive.
Preventative Surgery
A preventative surgery is available for dogs that are in the suspect breed group. This is in essence a form of "insurance" as it has been shown to prevent the problem before it happens.
Our surgeons perform a laparoscopic prophylactic gastropexy, which results in less pain for the patient than traditional open surgery, and allows that patient to go home the same day.
MVS Surgery Team
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Diagnosis