Gastric Dilatation with Volvulus: “Bloat”

“Bloat” is a serious life threatening emergency in dogs. This term is often used to describe two similar conditions. The first is gastric dilatation and the second is gastric torsion or volvulus, also known as GDV. Gastric dilatation occurs when the stomach fills with fluid and gas and becomes distended, remaining in its normal position. Gastric dilatation with volvulus (GDV) occurs when the stomach fills with fluid and gas and becomes rotated on its axis anywhere from 180 to 360 degrees, and sometimes more. A gastric dilatation can also progress to a more severe state of torsion. Nonetheless, a bloat or a GDV are considered emergencies.

What are the most common signs of bloat?
Oftentimes, one of the first signs of bloat is a distended abdomen, although in some large breed dogs with deep chests (taller than they are wide) this can be difficult to determine. Another common complaint is that the pet is trying to vomit and they are unable to bring anything up. This is also known as “retching.” Other symptoms include:

• weakness
• acting anxious and unable to settle and lie down
• excessive salivation shortness of breath (which can look like panting) due to the large distended stomach pressing up against the chest
• pale gum or tongue color
• a rapid heartbeat
• collapse

Simple stomach bloat can look just like gastric dilatation and torsion. If you believe your dog may have bloat, don’t wait and immediately bring your dog to the veterinarian for further evaluation. A couple of hours can translate into a matter of life and death for your dog.

What causes bloat or GDV?
There is no single exact cause or series of events which ultimately leads to GDV. What we do know is that GDV is predominantly a problem of large and giant breed dogs, although it has also been documented in small dogs and cats as well. Some of the most common breeds include: Great Danes, Saint Bernard, Standard Poodle and Irish Setter. Nonetheless, any deep chested dog (the length from back to sternum is greater than the width of the chest) is at a greater risk due to the fact that this anatomy may limit normal eructation (belching) which leads to dilatation of the stomach. Older dogs and males also seem to be represented in higher numbers at emergency clinics in comparison to young and female. Other factors that may predispose a pet to developing bloat include: having a relative with GDV, large breeds that eat fast, and stressed/nervous pets. Contrary to popular belief raised food bowls will increase the risk of GDV (not decrease the risk.)

What is happening to a dog with GVD and why is it so severe?
When a dog has a distended or rotated stomach, it will press on the major blood vessels in the body that carry blood back to the heart to ultimately impair or halt circulation, leading to a drop in blood pressure and sending the dog into shock. What makes this situation even worse is the fact that the stomach is stretched so tight that the circulation of blood through the tissue is poor and therefore it begins dying (necrosis). The only relief that initiates recovery is untwisting of the stomach and release of the gas, or worst case scenario is that the tissue will tear and spill the stomach contents into the abdomen leading to sepsis. Secondary to GDV life threatening complications include: sepsis, peritonitis, and cardiac arrhythmias to name a few.

What is the treatment for GDV?
The first thing that will be immediately addressed when you bring your dog to the veterinarian is the patient’s state of shock. This is done by placement of an intravenous catheter (sometimes two catheters are used) and administration of large volumes of fluid. Diagnostic testing can be done simultaneously, as a quick radiograph (x-ray) can confirm the suspicion of bloat and to determine if the stomach is twisted or simply bloated. Lab work will also be completed, which may give some insight to the extent of damage already done to internal tissues and organs. Next the stomach will be decompressed by placement of a stomach tube prior to immediate surgery which is necessary to correct a gastric volvulus. In cases of a simple dilatation, a stomach tube may be sufficient to remove gas and fluid to de-compress the stomach. After surgery, GDV patients are often critical and remain hospitalized for a few days for supportive care and monitoring for secondary complications such as bleeding, heart arrhythmias and infection and failure of devitalized organ tissues from being in shock.

How can you prevent a dog from getting GDV?
A procedure called “Gastropexy” is a surgical procedure that can be performed in breeds at risk for developing GDV. This is a procedure where the stomach is sutured to the body wall which will prevent it from rotating along its axis. This is a procedure that can be done during a spay or neuter procedure as a puppy or adult, or this can be done as a minimally invasive procedure by laparoscopy. Many theories are out there with respect to prevention of GDV, however some studies suggest that feeding dogs from raised food bowls can contribute to the development of GDV. In addition, assuring that dogs eat slowly also reduces the chance of Bloat/GDV. Special bowls with built in crevices can be purchased and used to help slow a dog that eats quickly. Lastly, since GDV has some genetic predisposition, it is recommended that breeders remove a dog from the breeding pool if a first degree relative has GDV.