Gastric Dilatation-Volvulus (GDV), also referred to as bloat, is a life-threatening condition in dogs. GDV is commonly associated with a dog’s consumption of large meals, which can cause the stomach to expand due to food and gas, ultimately twisting (volvulus) and not allowing either to be expelled from the body. As the stomach begins to expand, pressure begins to increase, which can lead to several severe consequences, including prevention of adequate blood return to the heart from the abdomen, loss of blood flow to the lining of the stomach, rupture of the stomach wall, and pressure on the diaphragm that prevents the lungs from adequately expanding, which makes it difficult to maintain normal breathing.
Left untreated, the body begins to show signs of shock and can lead to sudden death. The treatment of this condition involves stabilization of your pet, decompression of the stomach, and surgery to return the stomach to its normal position. Additionally, during surgery a procedure called a gastropexy, which permanently attaches the stomach to the body wall, can be performed to minimize risk of recurrence. Abdominal organs will need to be evaluated for damage and treated appropriately as determined at the time of surgery.
Several studies have been published that have evaluated risk factors and causes for GVD in dogs; however, this condition is still not completely understood. To date, it is known that there is an association for canine bloat in dogs that have a deep chest, are fed one large meal per day, are older, and are related to other dogs that have had the condition.
It has also been suggested that elevated feeding, dogs that have previously had their spleen removed, large or giant breed dogs, and stress may result in an increased risk of developing this condition. A 2006 study also determined that dogs fed dry dog food that contain oils (e.g. sunflower oil, animal fat) among the first four label ingredients may be at higher risk.
Nearly all breeds of dogs have been reported to have had canine bloat with or without the stomach rotation, but some of the more common breeds with GVD are Great Danes, Weimaraners, St. Bernards, Irish setters and Gordon setters.
Signs and Symptoms:
Initial signs of GVD are often associated with pain in the dog’s abdomen. These can include, but are not limited to, an anxious look or looking at the abdomen, standing and stretching, drooling, a bloated abdomen, and dry heaving. Many will show signs of vomiting, but do not produce vomitus.
As the condition progresses, your pet may begin to pant, have a bloated belly, be weak, or collapse and remain lying down. Upon a physical exam, pets tend to have elevated heart and respiratory rates, and have poor pulse quality and capillary refill times.
Many secondary complications may occur, including diminished respiration and cardiac output, which leads to poor oxygen delivery to the body’s tissues and may result in abnormal heart beats. This also leads to cell death in the liver, kidneys, and other vital organs. Further, the lining of the entire gastrointestinal tract is also at risk of cell death and sloughing.
As the condition progresses, toxins may increase and circulate through the body resulting in additional cardiac arrhythmias, acute kidney failure and liver failure. Bacteremia (bacteria in the blood) may also occur.
Stabilization and surgery are most successful when performed early as mortality rates tend to increase with the severity of disease. If your pet has exhibited any of the above signs, they should be evaluated by a veterinarian immediately. If the stomach is rotated and surgery is needed, your pet may be referred to an ACVS board-certified veterinary surgeon for treatment.
Most veterinarians will recommend initial bloodwork that includes a complete blood count, serum chemistry, blood electrolytes, and a urinalysis. This allows your veterinarian to rule out certain diseases that may mimic the clinical signs of gastric dilatation. Additionally, abdominal x-rays are used to confirm a diagnosis and an electrocardiogram (ECG) is used to evaluate the presence of cardiac arrhythmias, which are commonly seen in this condition. Blood gas analysis may also be performed to evaluate the nature and severity of the respiratory compromise. Additional tests may be recommended by your veterinary surgeon.
The most important initial step for a dog with GVD is stabilization, which often begins with IV fluids and oxygen therapy. Gastric decompression often follows, which includes the passing of a tube down the esophagus into the stomach to release the air and fluid accumulation. In some cases, a needle or catheter may be placed into the stomach from outside the body to release air and aid in the passing of the tube. The need for general anesthesia and surgical stabilization will be determined by the stability of your pet and at the discretion of the veterinary surgeon.
Surgery involves a full exploration of the abdomen and de-rotation of the stomach. The viability of the stomach wall, the spleen, and all other organs will be determined, and removal of part of the stomach wall or the spleen will be performed if necessary. Once the stomach is returned to the normal position in the abdomen, it is permanently fixed to the abdominal wall to prevent rotation from happening again if canine bloat reoccurs.
Aftercare and Outcome:
Most dogs will be hospitalized and given fluids through an IV for several days as well as evaluated for cardiac arrhythmias and other postoperative complications. Immediate postoperative care includes exercise restriction for a few weeks to allow the incision to heal. Long term, dietary management will likely include multiple small meals (2-3) per day rather than a single large meal and continued monitoring for recurrence of symptoms.
Mortality rates associated with GVD have been reported to be approximately 15%. Mortality and complication rates increase as disease severity and time increase. Factors that have been shown to increase mortality rate include dogs with symptoms for more than 6 hours, cardiac arrhythmias prior to surgery, dogs that require removal of a portion of the stomach due to loss of blood supply and patients that require removal of the spleen.
General anesthesia remains the most important risk to dogs affected by canine bloat. Following the procedure, cardiac arrhythmias are common, although relatively few are life-threatening and require treatment. Further loss of organs may occur because of the toxins released when the stomach is returned to its normal position. Additionally, many dogs will have some degree of gastric bloat; however, gastropexy, the surgery that de-rotates and pins the stomach in place, serves to prevent this life-threatening complication. Surgery always carries a low risk of infection or breakdown of suture line, leading to a second surgery.
As a preventative measure, gastropexy is currently being recommended by many veterinary surgeons for breeds at risk for development of the condition or in dogs that have relatives that have had this condition. Preventative gastropexy can often be done at the same time as sterilization surgeries (spay/neuter). Minimally invasive techniques such as laparoscopic-assisted gastropexy, endoscopically assisted gastropexy and grid (limited approach) gastropexy are possible methods of preventative gastropexy.
If you have concerns about your dog and need to locate a board-certified surgeon, use the VetSpecialists.com search tool on the website’s homepage. The tool allows you to search for a veterinary specialist and then select the type of animal along with your location by zip code or city name. Contact the hospital of your choice to discuss your pet’s symptoms and to review whether there is a need for a referral from your primary care veterinarian.