Gastric Dilatation-Volvulus

What is it?

• GDV is when the dog’s stomach bloats and twists.

• This is a life threatening disorder.– Fatality rate ranges from 10% - 60%

• The bloating could come from:– Accumulation of:

• Air• Gas • Food• Liquid• Any combination of these

• When the stomach accumulates too much of one of these, it can start to distend.

• If severe enough, the stomach will flip over on itself. – This is called torsion

• Bloat usually leads to torsion, although torsion can happen without a bloat.

• Since the stomach is securely fixed only at one spot near the top, when the stomach is dilated, it can rotate on that one fixed axis.

• The stomach generally rotates in a clockwise direction and can rotate up to a maximum of 360 degrees.

• A less common rotation is counter-clockwise direction and can rotate up to 90 degrees.

• If the rotation is severe enough, it could mean the displacement of both the stomach and the spleen.

– In other words, they will switch places.

• After the stomach has twisted, it will cut off both the stomach contents and the blood supply.

– Blood vessels that feed the stomach are kinked and stretched as the stomach twists.

• Where the stomach has twisted, toxins start to build up in the dying stomach lining.

• The liver, pancreas, and upper small intestines may be damaged also.

• Shock can occur from the low blood pressure and endotoxins rapidly develop.

– Endotoxins- potentially toxic, natural compounds found inside pathogens such as bacteria.

• Sometimes the stomach will rupture, leading to peritonitis.

– Peritonitis- an inflammation of the membrane that lines the wall of the abdomen and covers the abdominal organs.

Causes of GDV

• The exact cause is unknown; however there are many theories.

– Gulping food down• When the dog eats too fast and swallows a lot of

air at the same time.

– Eating large meals in one sitting

– Drinking large amounts of water immediately after eating

– Vigorous exercise/work after a full meal.• Due to the extra stomach contents and the belly

swinging while full.

– Eating food that swells excessively when soaked in water.

– Certain food types such as:• Peas• Onions• Beans• Beet pulp

• There are also some medical problems such as:– Gastric fermentation (digestive disorder)

– The speed in which the stomach empties itself.

– The pace of the stomach’s digestive contractions.

What are the symptoms?

• Abdominal distention

• Abdominal pain

• Restlessness

• Depression

• Anxiousness

• Respiratory dysfunction

• Hypersalivation

• Belching

• Retching

• Frequent attempts to vomit

• Vomit foamy mucous

• Mucousy foam around lips

• Pale mucous membranes

• Lethargy

• Weakness

• Whining for no apparent reason

• Thumping sound on abdomen

• Can’t get comfortable

• Excessive panting

• Prolonged capillary refill time– >2 seconds

• Rapid heart rate – Greater than 120 bpm

• Rush dog to the vet, this is an EMERGENCY!!

What we do for it

• Decompress by placing a large bore needle or trocar catheter through the skin and muscle directly into the stomach.

• Attempt to pass a stomach tube.

• Place one or two large catheters and pump them with fluids and steroids for shock.

• X-rays, ECG, and blood tests.

– Treatment will probably start before all test results are in.

Ways to prevent it

• Feed multiple, small meals throughout the day.

• Add liquid to food before feeding.

• Restrict exercise an hour before and two hours after eating.

• Consider a bloat kit.– Contains the essentials needed to deal with a

bloat. Usually includes a rubber hose for each dog, tools needed for an emergency, and even a large bore needle to puncture your dog’s stomach, should help not be available in time.

• Use lubrication on the tube, if none available use water.

• Pass the tube down slowly and gently.

– Push it down an inch or so at a time, only after the dog has swallowed, without gagging, the section you have already pushed in.

• NEVER FORCE TUBE DOWN!!

– You can do severe damage to the internal organs.

• If the tube passage is unsuccessful due to internal obstruction, then it means that the stomach has probably twisted

• Improperly used may harm your dog even more.

• DON’T TAKE THIS LIGHTLY!!

• Gastropexy– This is a surgical procedure, but should be

done anytime a dog bloats or even preventively for breeds that are predisposed:

• The stomach is attached to the body wall to prevent twisting, or future episodes of volvulus.

• Recurrent volvulus can be pretty effectively managed with a gastropexy, but dilatation can still occur.

Just to know

• All the female working dogs leaving Lackland Air Force Base have had a gastropexy done. They do this during the spay surgery.

• People used to say that elevating the food bowl would help prevent GDV. Raising the bowl may actually increase the chance.

Case Study

• Dec 2006: Joop B021– Returned from deployment to Iraq one month

earlier (survived numerous IEDs)– Presented on emergency late at night with

severe bloat/GDV– Last check on dog was 4 hours prior to

presentation, MWD was fine at that time– CAN HAPPEN QUICKLY!!!!

Any Questions?