Gastric dilatation volvulus (GDV), commonly referred to as “bloat,” is a rapidly progressing, dangerous condition that results when the stomach twists on itself.
• GDV causes major blockage of blood flow to organs and requires immediate medical attention
• GDV is a multifactorial condition and possible risk factors include old age, genetics, eating a single large meal, stressful events, and trauma
• Symptoms are not always noticeable and might vary
• Initial symptoms include an anxious look, drooling, unproductive retching (dry heaves), and abdominal distension
• Diagnostics involve a complete physical evaluation, bloodwork, urinalysis, and diagnostic imaging (X-rays) of the abdomen
• Treatment involves emergency surgery to decompress the stomach, and patient stabilization prior to surgery
• GDV is often rapidly fatal, making mortality rates relatively high, but dogs who survive emergency surgery have a good prognosis
GDV is commonly referred to as “bloat.” Although abdominal distension (ie. bloating) is one of the symptoms, GDV should not be confused with non-urgent swelling of the abdomen. GDV occurs when the stomach twists over on itself, cutting off blood supply to itself and surrounding tissue.
Volvulus (turning of the stomach on its axis) might occur either before or after dilatation. The dilated stomach compression on the blood supply returning to the heart can potentially lead to fatal circulatory collapse. Death may also result if the stomach wall ruptures, leading to peritonitis and septic shock.
As the condition progresses, symptoms become more obvious. The bloated belly is often visible, the patient begins to pant more frequently, and weakness and possible collapse might occur. Death can occur in a matter of hours. Further complications might arise even after treatment; the blood supply might have been cut off for too long resulting in irreversible tissue death.
GDV is a rapidly progressing medical emergency. The only possible chance of survival is emergency surgery. Preservation of life is most likely in cases where medical intervention begins as soon as possible after symptoms are noticed.
It is advisable for owners of at-risk animals to decide in advance whether treatment will be pursued in the event of this emergency condition, as prompt therapy and surgical correction must begin as soon as possible for the best prognosis. It may be recommended for some dogs to have their stomach tacked to the abdominal wall as a preventive measure during other routine surgery, such as spay or neuter.
GDV is most commonly seen in large, deep-chested dogs but in rare cases can also affect younger, smaller dogs. It is an immediate life-threatening emergency.
GDV is an extremely aggressive disease and time is paramount as it rapidly degenerates. Without immediate treatment GDV is always fatal. The chances of survival even with treatment are limited. Surgical correction is required and complications are common.
Risk factors for GDV are:
• Genetics (first-degree relatives with a history of GDV)
• Advanced age
• High thoracic depth-to-width ratio
• Stressful events
• Gastric motility disorders
• Behavioral disorders (such as anxiety or aggression)
• Eating a single large meal
Large or giant breed dogs are more prone to GDV, especially Great Danes.
There is no specific cause of GDV. It is a multifactorial condition and a subject of ongoing research. There is speculation that certain precipitating events or contexts may influence the likelihood of GDV occuring, including
• Weather extremes
• Fast eating
• Aerophagia (swallowing air)
• Not drinking water after a meal
• Eating from an elevated bowl
• Inflammatory bowel disease (IBD)
• Feeding small-cut kibble
• Low body condition
GDV does not always present with straightforward, noticeable symptoms. The bloated stomach might not be apparent within the rib cage. Dogs do not always appear to be distressed, and symptoms do not always progress at the same fast pace. Possible initial clinical signs include:
• An anxious look
• Looking towards the abdomen
• Distending abdomen
• Retching without producing vomit (dry heaves)
The diagnostic process often involves a full physical evaluation, and bloodwork to evaluate metabolic functions and to help stabilize the patient before treatment. Abdominal X-rays are necessary to confirm the diagnosis.
Treatment is complex, and most patients require stabilization before undergoing surgery. Intravenous fluid therapy and gastric decompression are often necessary.
Surgery involves correction of the volvulus and assessing the abdomen for any compromised or dead tissues. Splenectomy (removal of the spleen) might also be performed. Once the stomach is returned to its normal position it is affixed to the abdominal wall (also called gastropexy, or “pexy”) to prevent it from rotating again.
After surgery, intensive nursing care includes medications such as antibiotics, analgesics, antiarrhythmics, and gastroprotectants. The patient must be monitored for some time to avoid further complications that are commonly associated with the condition.
GDV lasts until it is surgically corrected. The faster treatment is initiated, the better the chances of survival. The mortality rate for GDV is between 10 to 45%. Excluding euthanized dogs, around 80% of patients survive after surgery. The mortality rate is higher in patients who show clinical signs for more than six hours, and/or require removal of the spleen or part of the stomach.
GDV is not contagious. Tacking the stomach during other routine surgery (such as spay or neuter) is suggested for at-risk, large, deep-chested dogs as a form of prevention.
Selective breeding is also recommended, by avoiding using dogs who have survived GDV for breeding.
Other forms of prevention have not been confirmed but might be effective in decreasing the risk. These include: eating two or more small meals per day, avoiding heavy exercise, and living in a calm, stress-free environment.
GDV is more common in deep-chested, large dogs. It Rarely occurs in smaller or younger dogs.
• IV fluid therapy
• Gastric decompression
• Volvulus correction
• Removal of dead tissues
• Splenectomy (if necessary)
• Supportive care
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