Gastric Dilatation-Volvulus (GDV), often referred to as bloat, is a life-threatening condition most commonly reported in large-breed, deep-chested dogs. In animals with GDV, the stomach rotates on its axis, trapping air inside. As the stomach dilates and expands, the pressure in the stomach increases, which leads to several severe consequences in multiple organs. It prevents adequate return of blood flow to the heart as well as to the stomach wall. Pressure on the diaphragm also prevents adequate lung ventilation and decreases the body’s ability to deliver oxygen to all of the organs. The entire body suffers from the poor ventilation, leading to death of cells in many organs. Additionally, most pets are in shock due to the effects on their entire body.
What causes GDV?
The exact cause of GDV is still unknown. Purebred large and giant dogs such as Great Danes, German Shepherds, and Labrador Retrievers are at increased risks as well as deep-chested dogs and dogs with a family history of GDV. Other factors that have been correlated with GDV include: feeding one large meal per day, eating rapidly, aggressive or fearful temperament, small kibble size, and exercise or stress after a meal.
What are the signs to look for in affected dogs?
Initial clinical signs of GDV consist of abdominal distension, restlessness, hypersalivation (drooling) and unproductive vomiting or retching. As the disease progresses, panting may be noted, as well as weakness and collapse. If a dog exhibits any of the above clinical signs, he or she should be evaluated by a veterinarian immediately. Surgery is indicated once the diagnosis of GDV has been established.
How do you diagnose GDV?
Bloodwork, including a complete blood count (CBC), serum chemistry, and urinalysis should be performed to determine the metabolic disturbances that are happening. To confirm the diagnosis of GDV, an abdominal x-ray will be necessary and will reveal a severely distended stomach that is gas-filled and occupies almost the entire abdomen (see figure). Additionally, an electrocardiogram (ECG) will be used to evaluate for the presence of cardiac arrhythmia, which can commonly happen with this disease.
What is the treatment?
Stabilization and surgery are best when performed early in the course of the disease as mortality rates increase with the severity of the condition. Initial stabilization includes intravenous fluids and oxygen therapy. Gastric decompression is then performed to release the air that has accumulated in the stomach. This can be performed by either passing a tube down the esophagus and into the stomach or, when this is not feasible, by inserting a needle into the stomach through the body wall.
At surgery, a full exploration of the abdomen will be performed and the stomach will be de-rotated. The viability of the stomach, spleen and all other organs will be evaluated and when necessary, part of the stomach (partial gastrectomy) or the spleen (splenectomy) will be removed. Furthermore, the stomach will be permanently attached to the body wall (gastropexy) to prevent any future rotation. After surgery, most pets will be hospitalized for several days and evaluated for cardiac arrhythmias and other postoperative complications.
What is the prognosis/outcome?
Mortality rates associated with GDV have been reported to be approximately 15%. Mortality and complication rates increase with increased disease severity and time between the onset of clinical signs and treatment.
Can this be prevented?
Prophylactic gastropexy is currently being recommended as a preventative measure by veterinary surgeons for breeds at risk for development of the condition. Prophylactic gastropexy can often be done at the same time as sterilization surgeries (spay/neuter) and can be performed using minimally invasive techniques such as laparoscopic-assisted gastropexy. This is performed through small incisions and with the help of a small camera. This is therefore associated with less tissue trauma and post-operative pain.