Canine Bloat or Gastric Dilatation-Volvulus (GDV)

The stomach enlarges dramatically from gas, fluid, or both causing the stomach to twist itself, sealing off the entry and exit of the stomach.  Regardless of the initialing cause, swelling of the stomach with swallowed air, intestinal gas and fluid most likely precedes twisting of the stomach. Distention of the stomach by gas and fluid may be associated with air gulping (aerophagia), diffusion of dissolved gas from the bloodstream, release of carbon dioxide after the reaction of stomach acids with certain substrates, or bacterial fermentation. As the stomach swells and twists, gastric outflow becomes obstructed, resulting in even more swelling and twisting.  The spleen enlarges and causes torsion of the major vein bringing blood to the heart. Dogs are uually in considerable pain as they cannot clear trapped gas.  Rapid deterioration and death can result.  Immediate relatives of dogs which have suffered from GDV are also at a greater risk.

A dog with GDV will have a distended abdomen and may appear restless and depressed and have dry heaves. Owners often report that affected dogs were initially observed to be drooling excessively, belching, and making repeated, mostly unsuccessful attempts to vomit.  Bloat requires  immediate medical attention. It is usually seen in male dogs between 4 and 7 years of age who eat large quantities of dry kibble, exercise vigorously after eating, and drink lots of water after eating. One possible way to prevent bloat is to crate the dog (or keep calm) for at least an hour after eating, feed smaller meals more often and limit the amount of water consumed after exercise.  Dogs that gulp food quickly or are stressed are at a greater risk of GDV.

With GDV, owners need to get the dog to a veterinarian immediately. Successful emergency treatment involves relieving the pressure within the stomach and treatment for shock. In most cases, treatment will also involve emergency surgery to untwist the stomach and "tack" it in place to prevent future reoccurrence of the stomach twisting,"

Bloat in a dog
Torsion - Fred Lanting
Gastric Dilation Volvulus (canine bloat)
Gastric Dilation Volvulus
Bloat, Torsion, Gastric Dilation-Volvulus (GDV)

BLOAT IN A DOG

Also known as

GASTRIC DILATATION
GASTRIC VOLVULUS
GDV

The x-ray on the right demonstrates the extreme distension of the stomach that occurs with bloat.

Tail to the left 
Head to the right 

Bloat in the dog!  There are very few challenges in veterinary medicine that rival an emergency presentation of bloat in the dog.  Known by various terms, some more accurate than others, a dog with a bloating stomach has a short time to live without emergency veterinary intervention.  Once the stomach is unable to expel gasses produced from fermentation within the stomach,  a series of events occur that result ultimately in such intra abdominal pressure that the dog is unable to survive.  Circulatory collapse and heart failure ultimately result, after extreme stretching of the stomach wall, constriction of intra abdominal blood vessels, widespread death and destruction of the stomach wall, and release of intestinal toxins.  Let's explore what is known about canine bloat and actually see an unusual and  relatively uncomplicated case of bloat in a dog.

CLICK on an image to see a larger version of the image.
X-rays are helpful to establish the presence of abnormalities other than the obvious distended stomach.  Plus some evidence of Volvulus (twisting) can be seen if present.  This dog did not have a volvulus of the stomach.	Carefully an incision is made in the midline abdomen.  The stomach wall will be pushed tightly to the inside of the abdomen due to the high pressure inside the stomach; incising the stomach at this point is not desired.	The stomach wall is located and a small stab incision is made to relieve gastric pressure... unless a gastric tube can be safely inserted through the esophagus and into the stomach.  In this case the stomach was not incised.
The stomach wall pushes up through the incision and is carefully examined for any perforation or tearing of the stomach.  Once pressure is neutralized the stomach can be evaluated for twisting or malposition.  In this case the stomach wall looks healthy and is not extremely stretched thin.  Dark bruising is not visible, the stomach wall has been oxygenated.	The patient, lying on his back, has the stomach gas and semi-liquid food removed via a stomach tube.  The pulse monitor is seen attached to the tongue, the endotracheal tube is just below the tongue and delivers the gas anesthetic, and the stomach tube is seen draining the brownish stomach contents.  The stomach is flushed through the tube at the end of surgery.	The abdominal tissues are examined, especially the spleen and its vessels seen in this image.  In some cases the spleen is severely congested with blood due to the twisting of the stomach on the supporting tissues... which also contain the blood vessels to and from the spleen.  Occasionally the spleen needs to be removed at this time.  The stomach is often sutured in place to the abdominal wall if necessary.

WHAT IS BLOAT?
Canine bloat occurs when there is gas production in the stomach and that gas buildup is unable to be expelled via belching or vomiting, or passed through the intestines and out of the dog as flatulence.  Some bloat cases occur very rapidly when fermentation of grains in the wet and warm stomach environment create gas.  The influence of grain in creating an environment conducive to bloat seems even more plausible in that it is very rare for dogs that consume meat-based diets to develop bloat.  Generally, bloat is the extreme dilation of the stomach as a result of gas buildup that cannot escape the stomach.

WHAT TYPES OF BLOAT ARE THERE?
GASTRIC DILATATION... is simply the expansion of the stomach due to the buildup of gas or material in the stomach.

GASTRIC VOLVULUS (TORSION)... is the condition where the stomach rotates (flips on its long axis) and thereby twists the esophagus and small intestine closed so there is no passage of stomach contents or gas in or out of the stomach.

HOW DOES BLOAT HAPPEN? 
Scientists have tried to decades to learn about how bloat occurs by setting up bloating conditions in the laboratory with laboratory dogs... and consistently have failed in producing the spontaneous bloating that occurs with canine house pets.  The usual history is of a dog of a large breed that has recently eaten a meal of dry dog food and then exercises or engages in some physical  activity.  On occasion, though, there is no history of physical activity and the dogs is suddenly seen trying to retch and vomit unsuccessfully.  The dog paces, becomes uncomfortable, attempts to pass stool and repeatedly makes retching, gagging noises.  Salivation is common.  At this stage it is impossible to determine what type of bloat is occurring.   In the photos above, the fortunate Malamute had a simple Gastric Dilatation with no torsion or volvulus.  Once the stomach contents and gas were eliminated via a plastic stomach tube, and the stomach was flushed and antibiotics administered to prevent further bacterial fermentation and gas production, the surgery was over and the dog recovered rapidly and successfully.  With Torsion or Volvulus present, far greater damage occurs to internal blood vessels and stomach tissues, plus the spleen gets caught up in the twisted mess of tissues and becomes starved for oxygen along with the stomach.  Eventually the heart is affected due to the major interruptions in blood flow and heart rhythms;  plus the pressure on the heart and diaphragm prevents normal cardio-pulmonary function. When the blood supply in the abdomen’s major arteries is compromised, blood flow to the heart and the cardiac output decrease, leading to low blood pressure, and eventually, shock.

The production of gas in the stomach sometimes overwhelms the dog's ability to belch it away or pass it through the bowel as flatulence.  There are various theories about the gastric chemistry that occurs to produce this sudden buildup of gas.  Plus, many dogs that become uncomfortable as the gas builds up will begin to swallow air, compounding their dangerous condition.

HOW IS BLOAT TREATED?
Treatment needs to be undertaken immediately.  Time is a very decisive factor in the success or failure of correcting bloat.  Once presented to a veterinarian, a dog with bloat will become the center of attention and all other activities at the animal hospital assume a lesser priority.  Supportive medications such as cortisone, antibiotics and intravenous fluids are started immediately.  The veterinarian may need to decompress the stomach initially (before surgery) by inserting a large diameter needle into the stomach right through the abdominal wall.  An audible hiss is heard as the gas passes through the needle.  Once this is performed the doctor administers intravenous anesthetic in very small amounts because the patient in this state of affairs requires very little intravenous anesthetic to facilitate the passing of the endotracheal tube through which the gas anesthetic is administered.  Some veterinarians skip the intravenous anesthetic and, via a face mask, administer gas anesthesia such as Isoflurane... once the patient is unconscious the endotracheal tube is passed into the trachea to allow continuous control of anesthesia.

Once anesthesia is at the proper level, a stomach tube (see the photo above) is gently inserted down the esophagus in an attempt to gain entry into the stomach.  If there is a Volvulus present and the twisting of the esophagus/stomach junction prevents passing the stomach tube into the stomach, the doctor will need to incise the stomach to dissipate the gas and bring the stomach back to a reasonable state of size and pressure.  If no volvulus (twisting or rotation of the stomach on its axis) is present such as in the case presented here, with careful and gentle manipulation by the surgeon within the abdominal cavity the stomach tube can be directed into the stomach and the gas and stomach contents can be drained by gravity out of the dog.

Once the intra-gastric pressure is lowered the presence or absence of rotation of the stomach can be ascertained.  Also, if a volvulus is present, the spleen is also involved and often its blood supply becomes strangulated.  Occasionally, the doctor will elect to remove the spleen at this time.  The health of the stomach is established... in cases where the gastric dilatation has been present for hours and the pressure is very high, the stomach wall will be very thin and stretched and there may be areas of necrosis (cell death).  In the photos above a well vascularized stomach wall is evident... that a god situation.  In severe bloat where the stomach is stretched for long periods, the blood supply is shut down and the stomach wall appears bluish or blackened.  This blackish coloration suggest permanent cell death and damage.  Any time there is necrosis of the stomach wall the prognosis for a successful resolution of the case is very poor.  The massive cell death and absorption of toxins through the stretched stomach wall creates severe cardiovascular damage and blood pressure problems.  Once a state of shock begins, the chances of recovery for the patient are slight.  Even dogs that survive surgery and seem to be recovering often succumb to endotoxic shock hours and even days after the procedure.

When the stomach contents are emptied through the stomach incision, the stomach wall is finally sutured closed.  If a volvulus is present the surgeon will rotate the stomach (and spleen) back into the normal anatomical position.  Then the stomach tube is inserted through the mouth into the stomach and additional flushing and antibiotic administration is done.  Before closing the abdominal incision the surgeon usually will tack (affix with sutures) the stomach wall against the inner abdominal wall (actually just inside the rib area) to prevent future episodes of gastric dilatation/volvulus.  This tacking procedure is excellent insurance against a volvulus happening again.

WHAT CAN BE DONE TO PREVENT BLOAT?
The best suggestions are to feed the dog two small meals a day instead of one large meal.  Do not allow the dog to drink large quantities of water at one time... have water available at all times.  Do not allow exercise or other vigorous activity for at least two hours after a full meal.  Feed a diet composed of more meats and less grain.

Below are photos of a dog that had repeat episodes of gastric dilatation.  Luckily, under anesthesia, a stomach tube was able to be passed and the gas and pressure was relieved.  The stomach was flushed, appropriate medication was given to help prevent cardiovascular shock, antibiotics were administered to prevent infection and to eliminate gas forming bacteria in the stomach.  Usually the stomach is sutured or anchored to the abdominal wall to prevent subsequent bloat episodes.

Click on an image to view larger rendition in a new window.
Arrows point to the distended abdomen.  This dog is normally very thin.	This view is of the dog laying on its side under anesthesia.  The ballooning of the abdomen is apparent.	This is the x-ray image of the dog prior to the procedure to relieve the gas distension.

BREEDS AT MOST RISK...

EXCERPT from FRED LANTING's BOOK

Torsion - Commonly called bloat, sometimes described as gastric dilation/volvulus, this is a terrifying and frequently fatal disorder that German Shepherds and many other deep-chested dogs experience. A twisting of the entrance and exit to the stomach traps the food and gas, and as the stomach swells, the twist is more unlikely to be relieved with-out veterinary help. Great strides in surgical treat-ment have been made, but the key to reducing the high mortality is still time. Recognize the symptoms and get the dog to a veterinary surgeon, preferably an emergency or trauma oriented hospital. Simple dilation (swelling due to gas) may not be serious as long as the dog is able to pass food into the duodenum, but it has been estimated that 80 percent of all dogs that experience simple dilation will someday also have torsion.

Symptoms of torsion include a swollen, turgid abdomen; the sluggish action of the dog; his white, frothy, unsuccessful attempts at vomiting; and perhaps his scratching in the dirt to make a cool hole in which to lie down. Also, the spleen will feel like a hard lump. The spleen is normally wrapped around some of the stomach and therefore splenic torsion accompanies gastric torsion. When this happens, the return of the blood that flows through the spleen is shut off causing shock, the "immediate" killer.

The first thing your vet is likely to do is attempt to push a tube down the throat into the stomach so the gas pressure can be relieved. If he cannot get past the twisted part of the alimentary canal, he may opt for immediate surgery so he can un-twist the organs. One emergency veterinary service in the Detroit area uses a different kind of lavage tube in their treatment of acute torsion. The large diameter, stiff, black polyethylene pipe has a smaller, flexible tube inserted into it. This smaller tube is for warm water so that the stomach contents can be flushed out of the larger one for about fifteen minutes. In either case, once the dog has been stabilized, decisions can be made about whether to operate, or untwist a stomach or spleen still in volvulus.

Follow up surgical techniques are numerous, but the one with the most success in preventing future torsion is a tube gastrostomy. In this procedure, a rubber or vinyl tube is put into the stomach through the abdominal wall, and in a week the stomach wall at that point becomes attached with scar tissue to the peritoneum and abdominal wall. The tube is then pulled out. The surgical opening seals off in a few days, and since the stomach is fused to the abdominal wall, it is prevented from again twisting out of position. Regular gastroplexy, which is suturing the stomach to the abdominal cavity, is also widely performed. Because of these and other techniques, especially the rise of emergency clinics, the mortality rate among those that make it to the clinic while still alive has plummeted to about 15 percent. Another 15 percent or so die without being seen by the vet first.

Groups of scientists at many locations have been studying bloat for a long time, partly with help from such as Morris Animal Foundation, the GSDCA, and many others. So far, they have identified a number of likely causative factors, including behavioural traits.  Breed susceptibility is pretty obvious, with 25 percent or more of Great Danes, Saint Bernards, Weimaraners, and Irish Setters expected to suffer from bloat sometime during their lives. German Shepherd Dogs, Standard Poodles, Collies, and Gordon Setters are fairly high on the incidence lists, also. Some of the characteristics seen most often in dogs that had bloated include some stressful event, even minor, in approximately the eight hours prior to the incident, a fearful temperament, and consumption of fairly large quantities of non food material. The only dogs I've had direct contact with that bloated were of impeccable character, but those may have been in the minority. Purdue researchers found no pattern in pre soaking dry food or not, but a slight correlation between several smaller meals and less bloat. Others found no relation to soybean meal in the food, an early target of breeders looking for a primary cause. Adding vegetables and canned or meat scraps appears to help lower incidence. Most dogs (60%) bloated not immediately after vigorous exercise soon after a meal, but in mid- to late evening when resting or sleeping.

There is a familial element in torsion/volvulus in many, similar to the way cancer "runs in families", but most cases don't give a clue to hereditary factors. As in "toxic gut syndrome" which is also seen a lot in some GSD lines, it is almost impossible to tell which came first, the presence of abnormal bacterial populations and irritated intestinal or stomach linings, or the bloat itself.  Which is cause and which is effect is not going to be easy or even possible to determine. Some investigators suspect that breeders may be stuffing their small, young puppies' stomachs too much, with results that show up only later in life. Work goes on.

Less likely are other types of torsion, but they can be as life threatening.  Splenic torsion can occur without gastric twisting, and an even rarer disorder is mesenteric root torsion. The mesentery is the white, fibrous, web-like or film like tissue that connects the various sections of intestines to each other and to the abdominal wall.

Blood vessels travel through the mesentery, and if there is a twisting  there, regardless of whether the intestine itself is closed off, the blood supply can be halted and the intestinal tissue can become necrotic.
Bloody diarrhoea, vomiting, abdominal swelling and/or pain, and shock or general collapse can be symptomatic. It may be the same as what some call "twisted intestines". So few dogs survive that it is impossible to prevent recurrence or conclusively predict whether those are at greater risk for another attack than any other dog is.


COPYRIGHT 1999, Fred Lanting  May be reprinted with permission of author,  with this statement:
This is an excerpt from Fred's revised "The Total German Shepherd Dog" (http://www.hoflin.com)  Fred is a long time breeder and judge with international exposure, and also gives seminars on HD, as well as Gait & Structure.

Fred Lanting, Canine Consulting.    mailto:mrgsd@hiwaay.net   Seminars: Canine HD & Other Orthopaedic Disorders;     Gait & Structure (Analytical Approach); more

Gastric Dilatation-Volvulus (Canine Bloat)

GDV (the canine bloat) can be frightening to any dog owner. It can be lethal to dogs, though many dog owners know very little about it. GDV is a very dangerous disorder of the canine digestive system. Below is some information about the disorder and the symptoms that may be helpful for dog owners. Observation and how well you know your dog’s behavior is the key. We all must learn to read canine body language because they can’t express themselves verbally.

Section: Overview
Gastric Dilatation-Volvulus (GDV) often referred to as “bloat,” is a serious condition caused by abnormal dilatation and twisting of the stomach. The condition is initiated by abnormal accumulation of air, fluid or foam in the stomach (gastric dilatation). Bloating of the stomach is often related to swallowed air, although food and fluid also can be present. Bloat can occur with or without volvulus, or twisting. As the stomach enlarges, it may rotate 90 degrees to 360 degrees, twisting between its fixed attachments at the esophagus (food tube) and at the duodenum in the upper intestine.

This Dog with Bloat has a very hard and Distended Abdomen

Volvulus can completely obstruct emptying of the stomach. The twist also prevents burping, so the dog cannot obtain relief of air or stomach contents by belching or vomiting. In fact, a hallmark symptom of torsion is nonproductive attempts at vomiting.

The bloated stomach obstructs the return of blood from the veins in the abdomen leading to low blood pressure, obstructive shock and associated complications. The dog also may seem short of breath due to pain and the physical compression of the chest and diaphragm caused by the expanding stomach.

Radiagraphic view of Gastric Dilation.  The greatly distended stomach is the black area

The combination of bloating and torsion seriously reduces the blood supply to the stomach (gastric ischemia) and this can lead to necrosis (death) of the stomach wall. Shock and lack of blood supply to abdominal organs break down the integrity of the gastrointestinal tract lining and permit toxins and bacteria to enter the blood stream. Abnormal blood clotting – disseminated intravascular coagulation (DIC) – may develop. The spleen can be damaged or begin to bleed because it is attached to the stomach by a membrane, and it becomes twisted and rotated abnormally as the stomach turns. Heart function is compromised due to lack of venous blood return. Irregular heart rhythms often develop such as ventricular tachycardia. Shock and death follow if the condition is left untreated or if treatment is initiated too late in this devastating sequence.

GDV is most common in deep chested or large to giant breed dogs between two and ten years of age. GDV can also occur in other breeds, but this is comparably rare. GDV can sometimes be associated with eating or drinking before or after exercise.

What to Watch For

Drooling
Nausea
Restlessness
Abdominal distension
Vomiting leading to nonproductive retching
GDV is life-threatening. See your veterinarian immediately if you suspect bloat or GDV.

Diagnosis
The diagnosis can usually be made based on the history and physical examination.

Physical examination should include abdominal palpation and auscultation of heart and lungs.

After your dog has been stabilized and initial treatment begun, radiographs may be taken. A lateral abdominal view in right lateral recumbency with dog lying on the right side, is the view of choice for differentiation of simple dilatation from dilatation-volvulus.

After initial stabilization and treatment, a complete blood count and blood biochemical tests may be performed. Blood tests help to define concurrent abnormalities that may influence the choice of anesthesia.

Treatment
Initial treatment of GDV will include emergency treatment for shock with intravenous fluids, drug therapy, and decompression of the stomach.

Placement of an intravenous cathether for fluid therapy is part of the emergency  treatment.

Surgery is the recommended treatment to untwist and stabilize the stomach. To prevent recurrence, the stomach must be attached to the abdominal wall, known as gastropexy. If the spleen is badly damaged, it may need to be removed (splenectomy).

Surgery is recommended to evaluate the stomach and perform a procedure to reduce the risk of future occurrences of bloat.  This dogs abdomen is being shaved in preparation for surgery

Home Care and Prevention
If you observe signs of GDV at home, see your veterinarian immediately. There is no recommended home therapy for GDV. Remember that giant-breed and deep-chested dogs are at increased risk.

Feed small frequent meals and limit water intake for one hour after eating, and avoid large volumes of water intake. Limit exercise after eating.

Section: Information In-depth
Gastric dilatation-volvulus (GDV) is a condition that is centered initially in the stomach, but eventually can affect the entire body. Some problems that can result are:

Shock and cardiovascular complications
Bleeding disorders
Injured spleen
Secondary infection Heart arrhythmias (irregular heartbeats. The arrhythmias are caused by poor oxygenation to the heart (myocardial ischemia), release of toxins, electrolyte abnormalities, acid-base abnormalities, and gastric receptor stimulation.

These problems can persist even as the GDV is successfully resolved. Other medical problems can lead to symptoms similar to those encountered in GDV, and it is important to exclude these conditions before establishing a definite diagnosis.They are:

Gastric dilation without volvulus
Aerophagia, which is swallowing air due to difficulty breathing (dyspnea)
Ascites, or fluid accumulation in the abdomen

Section: Veterinary Care In-depth 
Veterinary care should include diagnostic tests and subsequent treatment recommendations.

This is an intraoperative photo of GDV.  The long tubular tissues are the intestines.  The stomach is distended and located to the left of the intestines.

Diagnosis In-depth
Diagnostic tests are needed to recognize GDV, and exclude all other diseases, including:

Complete medical history and physical examination.

Clinical response to gastric decompression (passing a stomach tube or inserting a needle into the abdomen to relieve gas pressure).

Your veterinarian should assess your pet for shock. It is important to monitor vital signs, airway, breathing, heart rate and to identify bleeding disorders.

If the diagnosis is not clear, abdominal radiography (X-rays) is the first diagnostic test performed. An abdominal X-ray may reveal a large air-filled stomach with a soft tissue fold that appears to compartmentalize the stomach. This suggests that the stomach is twisted (volvulus).

After initial stabilization of the patient a complete blood count (CBC) and blood biochemical test may be performed. Electrolyte abnormalities may be present.

An electrocardiogram (EKG) is often needed to monitor for cardiac arrhythmias.

Additional diagnostic tests may be recommended on an individual pet basis, including:

Arterial blood gas determinations may be needed to identify complications of shock.

Repeat biochemistries if initial tests are abnormal.

Blood lactate. This test may be prognostic as a higher level indicates a worse prognosis.

Coagulation studies should be done and fibrinogen levels should be tested to identify disseminated intravascular coagulopathy.

Treatment In-depth
Treatments for GDV may include one or more of the following:

Initial therapy directed at treatment of shock and alleviation of gastric distension
Rapid administration of intravenous fluids
Administration of flunixin meglumine to decrease prostaglandin synthesis for shock (controversial)
Monitoring of urine output
Antibiotic therapy to prevent complications of gastrointestinal injury
Corticosteroids such as methylprednisolone sodium succinate or dexamethasone to treat endotoxemia and shock
Sedation or anesthesia to perform gastric decompression and lavage

Decompression is a procedure in which a large, flexible rubber or plastic tube is passed through the mouth into the stomach. This is done to relieve pressure and to remove the stomach's contents. Decompression does relieve gastric dilatation, but does not correct a volvulus (twisting) if that is also present. Decompression also decreases pain and discomfort, improves venous blood return to the heart and helps reduce further injury to the stomach lining.

Once the tube is placed into the stomach, the stomach is flushed with warm water to remove fluid and food debris. This is called gastric lavage.

If the tube does not advance, a procedure called gastrocentesis may be needed. This procedure involves clipping hair over the side where the stomach is located and inserting a needle through the wall and into the stomach to remove air. This removal of air and pressure will often allow a tube to be inserted.

A temporary pharyngostomy tube, which is a tube that goes from behind the jaw to the stomach, can be placed if the dog is too unstable for surgery due to cardiac arrhythmias or other complications. However, in most cases of GDV, the next step is abdominal surgery.

Surgery is the definitive treatment for GDV. While tubing can effectively treat this disease, surgery is the best treatment and follows shock therapy, gastric decompression and arrhythmia stabilization.

If volvulus is present, surgery is needed to return the stomach to its normal position. Surgery should not be delayed unnecessarily. Surgery is also essential to allow visual inspection of the stomach wall because this tissue may not be viable if it has been deprived of blood supply for very long. During surgery, the stomach is repositioned, the spleen examined (and untwisted), devitalized (dead) stomach wall can be removed, and the spleen can be removed if it does not become normal after untwisting.

This is a picture of a "gastropexy" in which the stomach has been returned to its normal position and sutured to the body wall to try and prevent the reoccurance of "bloat"

If the patient is stable after these procedures, a gastropexy is usually performed, which is a procedure to attach the stomach to the abdominal wall and help to prevent recurrence of GDV. There are several surgical techniques for gastropexy such as tube gastropexy, circumcostal gastropexy, belt loop gastropexy and muscle flap (incisional) gastropexy. Each of these techniques has proponents. In a comparison between the different surgical types, all were found to have similar effectivenss. The tube gastrotomy was found to have the most complications. The best technique is the one that your veterinarian is familiar with and can perform.

Unfortunately, some dogs suffer extensive injury to their stomach such that the bulk of muscle is devitalized or dead, especially if the GDV has been prolonged and care was not sought quickly. In such cases, euthanasia may be the only course as removal of the stomach is not a practical option.

This is a photo of a compromised stomach.  The dark red section held by the surgeon's right hand is bruised stomach.  The spleen is the dark organ to the right.

After surgery, post-operative care by your veterinarian may include:
Monitoring for 2 to 4 days that includes observation for arrhythmias. Severe arrhythmias may be treated with drug therapy.

Post-operative pain treatment
Fluid therapy to ensure that an adequate blood potassium level is maintained 

Post-operative wound care

Antibiotics are usually continued. Even with the sterile procedures employed during surgery, there is the risk that devitalized stomach tissue or intestine injured by shock (low blood flow) may allow bacteria to move into the circulation.

Reduction of stomach inflammation can be treated with cimetidine (Tagamet®) or famotidine (Pepcid®).

Enhancement of gastric motility can be treated with metoclopramide HCl. Gastric motility is often abnormal post-operatively due to gastric distension, lack of blood flow to the tissue, and the surgery itself.

Most dogs that die from complications of GDV will do so within the first four days post-operatively.

Section: Follow-up
Optimal treatment for your pet requires a combination of home and professional veterinary care. Administer prescribed medication as directed and be certain to contact your veterinarian if you are experiencing problems treating your pet. Observe your pet's general activity level, appetite, and interest. Keep your pet in a supervised area of the home.

Antibiotic therapy is usually continued for seven to ten days. Drug therapy for ventricular arrhythmias (such as procainamide), is sometimes needed if arrhythmias are very severe.

Feed small frequent meals, often using a bland diet. Your veterinarian will discuss diet with you. Limit water intake for one hour after eating and always prevent your pet from ingesting large volumes of water. Avoid any exercise after eating.

Re-evaluation by your veterinarian is often recommended in seven to ten days with suture or staple removal and examination of the heart rate and rhythm.

(www.petplace.com), the definitive online source for pet news, health,
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Bloat, Torsion. Gastric dilatation-volvulus (GDV)

Becky Vaughan-Curran
Garwood Kennels  www.garwoodkennels.com

Bloat is a serious, life threatening disease in dogs. Bloat is actually two conditions that come under the heading of one syndrome. First there is "simple" bloat or gastric dilatation; second is bloat with twisting of the stomach or gastric dilatation and volvulus. Veterinarians use the abbreviations GD and GDV to describe these clinically. You could think of these as two syndromes in which one becomes the other; gastric dilatation becoming gastric dilatation and volvulus. So the line between the two is not exactly clear.

Normal Stomach	Parts
	A - Pylorus B - Pyloric Antrum C - Esophagus D - Fundus E - Body F - Omentum

 
In bloat, due to a number of different and sometimes unknown reasons, the stomach fills up with air and puts pressure on the other organs and diaphragm. Filled with air, the stomach can easily rotate on itself, thus pinching off the blood supply. Once this rotation (volvulus) occurs and the blood supply is cut off, the stomach begins to die and the entire blood supply is disrupted and the animal’s condition begins to deteriorate very rapidly.

The signs of bloat can be subtle at first: restlessness being the most likely first indication of a problem as the distention and pain increases. Drooling, retching or gagging (but not vomiting up stomach contents) will occur and by the time you recognize that your dog's stomach is distended, you have a serious medical emergency on your hands. Now a complex chain of physiologic events begins. The blood return to the heart decreases, cardiac output decreases, and cardiac arrythmias may follow. Toxins build up in the dying stomach lining. The liver, pancreas, and upper small bowel may also be compromised. Shock from low blood pressure and endotoxins rapidly develops. Sometimes the stomach ruptures, leading to peritonitis. You need to seek veterinary care immediately!

Gastric Dilatation with Torsion	Descriptions
	1.  Clockwise Torsion of the stomach; the organ is greatly enlarged. 2. Torsion of the esophagus 3. Duodenum displaced to the left. 4. Hemorrhages on the stomach's surface. 5. The Greater Omnetum covers the Stomach's surface.

 
The faster the distention and/or twisting can be corrected, the better the dog's chances of survival. Also, these conditions are extremely painful! Even with treatment it is estimated that at least 35% of the dogs with gastric dilatation and volvulus die. Plus treatment can be extremely costly, usually $500 to over $1000.

GDV is a true emergency. If you know or even suspect your dog has bloat, immediately call your veterinarian or emergency service. Do not attempt home treatment, but do take the time to call ahead. While you are transporting the dog, the hospital staff can prepare for your arrival.

Please do not insist on accompanying your dog to the treatment area. Well-meaning owners are an impediment to efficient care. Someone will be out to answer your questions as soon as possible, but for now, have faith in your veterinarian and wait.

The GDV risk ratio of a Great Dane is 41.4 times more likely to develop GDV than a mixed breed dog. It seems the larger the chest cavity of the animal, the greater the risk of GDV. The following chart lists the risk ratio for many of the popular breeds of today.

Breed	GDV Risk Ratio	Risk Rank	Breed	GDV Risk Ratio	Risk Rank
Great Dane	41.4	1	Alaskan Malamute	4.1	14
Saint Bernard	21.8	2	Chesapeake Bay Retriever	3.7	15
Weimaraner	19.3	3	Boxer	3.7	16
Irish Setter	14.2	4	Collie	2.8	17
Gordon Setter	12.3	5	Labrador Retriever	2	18
Standard Poodle	8.8	6	English Springer Spaniel	2	19
Basset Hound	5.9	7	Samoyed	1.6	20
Doberman Pinscher	5.5	8	Dachshund	1.6	21
Old English Sheepdog	4.8	9	Golden Retriever	1.2	22
German Shorthaired Pointer	4.6	10	Rottweiler	1.1	23
Newfoundland	4.4	11	Mixed	1.0	24
German Shepherd	4.2	12	Miniature Poodle	0.3	25
Airedale Terrier	4.1	13

 Prevention of GDV is preferable to treatment. In susceptible breeds, feed two or three meals daily and discourage rapid eating. Also regulate the amount of water consumed before, during, and after meals. Do not allow exercise for two hours after a meal. As previously mentioned, some owners feel that certain bloodlines are at greater risk and choose to have gastroplexy performed as a prophylactic measure. While the genetics of GDV are not completely worked out, most breeders and veterinarians feel there is some degree of heritability. The incidence is closely correlated to the depth and width of the dog’s chest. Several different genes from the parents determine these traits. If both parents have particularly deep chests then it is highly likely that their offspring will have a deep chest and the resulting problems that may go with it. This is why in particular breeds we see a higher incidence in certain lines, most likely because of that line's particular chest conformation. Therefore, while prophylactic gastroplexy will probably help an individual dog, it makes sense not to breed dogs who are affected or who are close relatives of those suffering from GDV.

reprinted with kind permission from Becky Vaughan-Curran
Garwood Kennels, Garwood Web Design, CKC member, AWCA member
www.garwoodkennels.com

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BE WARNED!!!

We were on the last day of a great caravan holiday and en route home spent one night in an area we didn’t know well.  Having been out all day we returned to the van to have our evening meal around 7.30 pm.  “We” are my husband and myself, plus our Border Collie and Shadow, our GSD, aged 10.  We noted something strange when having our meal because Shadow who usually kept an eye on the table (from the prescribed distance!) wasn’t the least interested in the food being served.  Within about 15 minutes he had to be rushed outside as he was about to be sick.  This quickly changed however to desperate retching accompanied by very laboured breathing and noticeable distension of his stomach, which felt very hard to the touch.  These symptoms quickly got worse over the next half hour with mounds of white froth (or foam) being spewed up and the dog gasping desperately.  A little alarm bell rang in the back of my head!  Gastric Torsion!!

GASTRIC TORSION in dogs  . . .
(Veterinary definition) “Torsion of the stomach in the dog is characterized by life-endangering distension of the stomach with gas; the stomach is usually found to be severely dilated and congested, and often to have rotated about an axis in the plane of the oesophagus.” 

(in layman’s terms)  “The stomach twists on itself cutting off both the entrance to and exit from the stomach with consequent build up of gas in the stomach.” 

Many veterinaries believe the distension or dilation of the stomach with gas is the real problem. 
(For a full discussion paper see web page: www.eclipse.net/~bobaloo/bloat.htm  )

Regardless of definition  - Urgent veterinary attention is essential

We therefore had to find a vet – and quickly.  By now it was 9 o’clock at night, the caravan site shop was shut, so where do you find a vet in a strange town?  Fortunately, a kind passer-by found us a Yellow Pages (bless that publication!) – we located the first vet listed for the area and phoned him in desperation.  He told us to get Shadow down to his surgery as quickly as possible and so we met him there around 10 pm.  By now, the poor dog was spewing up what seemed to us like mountains of this froth.

The vet gave him a full examination – and very obligingly Shadow spewed up again.  This confirmed to the vet that it was indeed a gastric torsion.  He gave him an injection to relieve  him slightly with the hope that the torsion might be corrected, but asked us to leave Shadow with him so that he could monitor the situation over the next couple of hours.  We had of course to sign a consent form for any possible operation.  And so we had to leave him in the vet’s capable hands.

We returned to the caravan but never slept a wink that night.  The vet had said phone first thing, so at exactly 8 am we did just that to find that Shadow had been operated on at 2 am and had come through the op. successfully.  Unfortunately, we had to get home that day (100 miles further north) so debated about one of us staying and the other heading home.  However, the vet advised that if we could leave collecting Shadow until around 1.30 pm and took it carefully en route home, he had no fears for him making the journey.  So we did just that – we carefully padded out the boot of the car and packed everything else inside, including our border collie who couldn’t quite understand why she was promoted to being a passenger (!) albeit sitting atop mountains of luggage.  The vet gave Shadow a sedative to help him over the journey and minimise pain so we took it slowly and got home without event.  Shadow slept the whole way and was none the worse after the long journey and  over the next few days he gradually got back to his old self.  In due course the stitches were taken out and he seems to be neither up nor down from the whole incident.  But his poor owners … I think we died a thousand deaths and certainly aged overnight!

We will never cease to be grateful that we located a vet ‘of the old school’ – one who gave his ‘all’ to complete strangers and saved our beloved pet.  (Mr McKenzie of A McKenzie & Son, Gilmour Street, Alexandria, Dunbartonshire.  Take a note in case you are ever in the area!)

We have no way of knowing what brought on the gastric torsion as our dogs are never walked before or after eating; are fed 2 smaller meals per day rather than one large meal; and always have drinking winter readily available  (all sometimes quoted as possible causes of gastric torsion), but as the vet said: “It was just one of these unfortunate things.”  My advice therefore to owners of all deep chested dogs in particular (who have a greater predisposition to torsion) – please be alert to any severe sickness, particularly retching, and get your dog to a vet WITHOUT DELAY.   You might not be as lucky as we were if you don’t.
Joy Watson

reprinted with kind permission from Joy Watson

 

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First Aid for Bloat	Case History	Risk Factors for Canine Bloat	Gastric Torsion in Dogs
Bloat	Time is of the essence	Bloat in Dogs	Surgery for GDV
Bloat Notes 1	Acute Gastric Dilatation Volvulus in Dogs	Elevated Feeders	Gastric Dilatation Volvulus
Bloat Notes  2	Gastric Dilatation Volvulus (GDV), Bloat and Torsion	Gastric Volvulus and Dilatation	Twisted Insides
Bloat-The Mother of all Emergencies	Bloat and Torsion-Is Nutrition a Factor	Comments on the Purdue Bloat Study	Prophylactic Gastropexy and Procedures
Brake-Fast Dog Bowls	Eat Better and Drink Better Bowls	Canine Bloat and Temperment

Dietary Risk Factors for Gastric Dilatation-Volvulus (Bloat) in 11 Large and Giant Dog Breeds: A Nested Case-Control Study

Bloat site

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