What is it?
Gastric Dilatation and Volvulus (GDV), commonly known as bloat, is a swiftly advancing and life-threatening condition in dogs. Several predisposing factors, discussed below, can lead to the expansion of the stomach with gas (gastric dilatation). This can progress to a rotation and twisting of the stomach onto itself, ranging from 180 to 360 degrees (volvulus). In this situation, there is no outlet for the accumulating gas, contained fluid, or food to escape. To visualize, think of tying a balloon animal, where the twisted section represents the stomach and the two ends symbolize the esophagus and the small intestine.
This condition is life-threatening and requires surgery immediately. There is no other successful treatment plan.
Surgery involves decompressing, untwisting and replacing the stomach to its normal position, as well as anchoring the stomach to the body wall to prevent future recurrences (gastropexy). The entire abdominal cavity and its contents are also explored.
What are the consequences of a GDV and the risks of surgery?
Hypoxia (low oxygen) occurs due to the large, gas-swollen stomach preventing adequate blood return to the heart and therefore loss of blood flow to the lining of the stomach and other vital organs. The cells of the gastrointestinal tract die and slough off, the stomach may rupture, and toxins may gain access to the blood stream and cause multi-organ (kidneys, liver, lungs) damage, failure and/or sepsis. This can occur even after life saving measures to deflate and correct the GVD has occurred.
Cardiac arrhythmias (irregular heart beat) due to buildup of toxins and hypoxia. These may persist for up to 3 days following surgical correction.
Aspiration pneumonia (from food and fluid content travelling up the esophagus and into the throat, mouth and eventually the lungs when breathing in) after untwisting the stomach.
The spleen and/or stomach may be badly damaged from the GDV, and, as such, the spleen and part of the stomach may need to be removed (splenectomy, partial gastrectomy, respectively). A repaired stomach may still dehisce and perforate contents into the abdomen several days after surgery. A damaged spleen may be actively and profusely bleeding and blood loss can be a major concern requiring blood transfusion(s).
Waiting to decide on surgical intervention can increase the chances of complication and even patient death. Anesthetic deaths can occur due to being in shock (low blood pressure, high then low heart rates).
PREDISPOSING FACTORS
- Breed/Genetic predisposition: Great Danes, Weimaraners, St. Bernards, Irish setters, Gordon setters
- Deep chested dogs
- Are fed a single large meal once daily
- Eating quickly followed by intense physical exercise
- Geriatric patients
Clinical Signs
Increased risk of surgical complication and mortality is seen the longer a patient waits to have a GDV corrected. Seek veterinary care immediately if your dog is experiencing these signs (even just one!):
- An anxious look or looking at the abdomen/painful abdomen
- Excessive salivation
- Frequent standing and stretching
- Distending (larger), possibly firmer feeling abdomen
- Retching without producing anything
Aftercare
- Patients recovering from a GDV surgery will spend on average two to five days in hospital before being discharged.
- Restricted activity for 14 days. Short leash walks only to go to the bathroom. No running, jumping or rough plays during this time.
- Patient is monitored closely for the first week for reduced appetite, abdominal pain and swelling, lethargy, fever and vomiting.
- Pain medications and a more frequent, smaller volume feeding schedule will be implemented during recovery.
- An Elizabethan (E) collar (“cone”) is provided and must be worn at all times to prevent self-trauma of the surgical site. A loose fitting breathable T-shirt or post-surgical onesies may also be considered.
- Daily monitoring of the surgical site. Complications include oozing, a foul smell, swelling or pain at the surgical site. A bandage may be applied to the surgical site to be kept on for the first day (and removed thereafter) after surgery to minimize leaking from the incision.
Prognosis:
- Mortality (death) rates are approximately 15%.
- Mortality and morbidity (complication) rates increase as disease severity and time to surgical intervention increase.
- Negative prognostic factors for survival include patients: 1) with clinical signs for more than 6 hours, 2) with cardiac arrhythmias prior to surgery, 3) requiring removal of a portion of the stomach (gastrectomy) due to loss of blood supply/ necrotic tissue and 4) requiring removal of the spleen.