Gastric Dilatation and Volvulus Syndrome in Dogs

Bloat in dogs is commonly known as Gastric Dilatation and Volvulus or more simply as ‘GDV’. Dilatation refers to the expansion of the stomach due to an influx of air. The stomach then becomes distended within the abdomen which also compromises the peripheral organs. Volvulus refers to the twisting motion of the bloated stomach causing the air to be trapped with no release.

Dilatation (bloat) occurs initially without volvulus (twisting). It can be visualised in dogs with a distended abdomen and an obvious display of discomfort. Without immediate decompression of the accumulated gas, twisting of the stomach can occur quickly. GDV is an emergency life-threatening condition.

The symptoms of bloat often have a rapid onset and dogs can deteriorate quickly. It is important to seek veterinary attention immediately if these signs are noticed.

• Non-productive retching
• Excessive salivation
• Restlessness
• Standing in a stretched position
• Reluctance to lay down
• Abdominal distension
• Pale gum colour
• Panting and respiratory difficulty
• Rapid heart beat
• Collapse

The exact cause of GDV is unknown however there are a few factors that make dogs more susceptible to the condition.

• Deep chested large breeds - Great Danes, German Shepherds, Saint Bernards, Setters, Weimaraners
• Older dogs
• Stressed and anxious dogs
• Dogs that are thin and underweight
• Feeding only one large meal each day
• Quick consumption of large amounts of food and water
• Dry food diets
• Exercise immediately after eating
• Hereditary predisposition

Initial diagnosis is based on patient history, signalment (breed, age), and presenting clinical signs. The veterinarian will perform a thorough physical examination including abdominal palpation to feel for distension and tympany (a hollow sound as a result of the gas-filled cavity). An enlarged spleen will sometimes be felt. The veterinarian will also look for clinical signs that are associated with shock such as pale gum colour, prolonged capillary refill time, fast heart rate, weak peripheral pulses, and difficulty breathing. Additional tests performed include radiographs, blood work, and electrocardiography.

Radiographs are performed to determine whether the stomach is rotated (and extent of rotation) or just dilated.

Blood parameters that are evaluated include a complete blood count, serum chemistry, and electrolytes. There are no ‘typical’ blood values that signal GDV so this is often performed to determine the severity of any metabolic disturbances occurring due to the condition. Common findings in GDV cases include mildly increased liver enzymes and modified serum electrolyte values.

An electrocardiogram is performed to check for any arrhythmias or problems with the electrical activity of the heart.

The initial blood values and electrocardiogram are especially valuable as pre-operative baselines.

There are several steps in the treatment of GDV. Firstly, it is important to stabilize the patient experiencing shock. GDV is an extremely painful condition so strong fast-acting analgesics (pain relief drugs) are administered. Simultaneously, it is important to restore the circulating volume and correct shock with intravenous fluid therapy. For GDV, this usually involves placing two large-bore IV catheters (one in each forelimb) and administering a bolus (large volume) of fluids. Once the patient is stabilized, the dilatation and volvulus of the stomach must be addressed.

For dilatation (bloat) the air in the stomach must be decompressed, and this is usually done by one of two methods. The preferred method is orogastric intubation (passing a stomach tube via the mouth) and lavage. The dog is sedated, and a large diameter tube is passed into the stomach to release the gas, the stomach is then lavaged (irrigated) with warm water that reduces the risk of the stomach refilling with gas. If orogastric intubation is not possible due to the nature of the twisted stomach, then trocarization is performed. This involves passing a large needle or catheter through the skin adjacent to the stomach to release the gas.

Releasing air from the stomach only fixes the dilatation, not the volvulus. Once the dog is stable, surgical correction is required to straighten out the twisting of the stomach. The most common technique is called ‘Gastropexy’ and involves suturing the stomach to the abdominal wall in order to prevent reoccurrence of twisting. Without surgery, the bloat is likely to reoccur within a few hours. Surgery is also important to assess any damage to the stomach due to GDV. Any necrotic (dead or dying) tissue must be removed to avoid sepsis, or it will remain fatal for the dog despite all previous treatment efforts.

GDV progresses quickly and the longer it is left untreated, the more internal damage there will be. Dogs displaying GDV symptoms should receive veterinary treatment as soon as possible.

Following decompression and surgery, the dog will be monitored for several days for sepsis, cardiac difficulty, and other ancillary complications. Dogs will be sent home with medications including pain relief, antibiotics, protectants for the gastric lining, and gastric motility modifiers. They will need a follow-up appointment to check for adequate healing of the wound site which usually takes two weeks to heal.

Food must be reintroduced slowly with a highly digestible bland diet fed in several small meals throughout the day. Exercise will be restricted in the period immediately following surgery and until the incision is fully healed.

Long-term management focusses on preventing a reoccurrence by feeding two to three small meals per day instead of one large meal, avoiding elevated food bowls, and limiting exercise too soon after eating.

GDV is an emergency condition, however if it is diagnosed and treated promptly the survival rate is high. Some estimates peg survival rate, if acted immediately upon by the owner, is upwards of 93%.

Treatment involves stabilization, decompression of the stomach, and surgical correction. Homeopathic remedies can be given to relieve the pressure of the stomach initially en route to a veterinary clinic, but it is a life-threatening condition that will always require veterinary attention. Initial stabilization will cost between $300 - $550. This will ensure the shock is treated that is associated with GDV. Gastric decompression wills tart at $200 and can be upwards of $450. This allows the stomach to be decompressed, either with orogastric intubation or trocarization. The surgical correction will cost between $1,000 and $3,600 depending on the anesthesia, state of the animal, amount of time in the hospital, IV requirements, and amount of dead tissue that needs to be removed. There are supplements available to help with instant pressure, although these are not substitute for veterinary attention and will cost between $30 - $85. These should be provided en-route to the hospital.