Gastric torsion (Bloat)
Bloat is a medical condition in which the stomach becomes overstretched by excessive gas content. It is also commonly referred to as torsion, gastric torsion, and gastric dilatation-volvulus (GDV) when the stomach is also twisted. The word bloat is often used as a general term to cover gas distension of the stomach with or without twisting. This condition can be fatal and requires IMMEDIATE medical attention. Symptoms of bloat can be:
- continuous pacing and an inability to get comfortable
- abdominal swelling after meals
- gagging or dry vomiting
- salivating, panting or whining
- distended stomach
- being quieter than usual
To avoid bloat, it is generally agreed that you should feed little meals often, rather than one large meal a day. Do not exercise your dog immediately before or after a meal and avoid allowing them to drink excessively after their meal. Slower eating is also understood to help prevent bloat.
This information was taken from TV vet, Marc Abraham's blog
The gastric torsion or gastric dilation volvulus (GDV) syndrome to give it its official name simply means the twisting of the stomach, usually due to it first being gas-filled. It can occur in any breed of dog but is most common in the deep-chested breeds such as the Boxer, Weimaraner, Irish Setter, GSD, Dalmatian and of course the Great Dane. There is still so much mystery around why this condition occurs so I’ll give you my take on it, having fixed over a hundred of them during my ten years of emergency work.
GDV occurs because it can. If there is enough room in the abdomen for movement of gas-filled organs then occasionally it will – just like some types of colic in horses. But why are the organs gas-filled in the first place? Well in my experience it’s usually down to two reasons.
Firstly, anxious animals (including ourselves) will usually swallow more times than relaxed ones. This constant intake of air or aerophagia (literally ‘eating air’) results in the stomach ballooning in size and changing the normal organ layout in the abdomen. I often saw this happen when stressed dogs were kenneled. Secondly, the dog’s got sudden access to, and eaten, a highly fermentable foodstuff that produces gas at an abnormal rate that the dog’s stomach can’t deal with efficiently, either by burping or exiting the stomach into the intestines.
Either way the dog is now bloated which is an emergency in itself but may not necessarily require surgery to fix. However if the stomach in this state does twist then, as most of you will know, the results are catastrophic.
The secret to saving a GDV is early detection. A conscientious owner will always know when something’s up but clinical signs can vary from the obvious and extremely painful and uncomfortable tympanic abdominal enlargement, pacing around and “trying to throw-up but can’t” to absolute shock and extreme lethargy.
Almost always they’ll have a small river of saliva flowing from their mouth, denied its normal one-way flow down the oesophagus into the obstructed stomach.
Both an expanding severe bloat and/or GDV will push-up on the diaphragm which in itself will restrict breathing and cause increasing discomfort and anxiety (sometimes even panic), but dealing with this shocked state can be a cause of great controversy amongst us vets.
The decision for stabilization before surgery is always a tough one as in theory the body will always react better to anaesthetic when it’s properly prepared but as time is of the essence I always go for aggressive fluid therapy and heavy intravenous sedation first (patients will usually respond well to safer halved drug-doses too).
The sedated patient is now out of pain and lying still, allowing us to take the invaluable X-Ray that is usually diagnostic proof that a GDV is occurring – the traditional ‘Popeye’s Arm ‘(pictured) – and when this pops out of your X-Ray developer you know you’ve got to get in there and sort it out!
A well-lubricated stomach-tube passed into the patient’s mouth and down the oesophagus in order to decompress the bloated stomach will usually get stuck at the twist (but then tied in position to the roof of the dog’s mouth becomes extremely useful mid-op), so in order to restore normal breathing patterns and correct decent blood-flow back to the heart from the back-half of the body, I’ll usually clip and disinfect a small patch of skin on the left flank and puncture the dog’s abdominal wall with a fairly wide-bore catheter.
This releases a putrid hissing stream of excess gas, immediately decompressing the bloated stomach and taking pressure off the diaphragm resulting in easier breathing, improved cardio-vascular system and is the first real step to effective stabilization before surgery.
Time is so important in the GDV because the twist can close-off the blood supply to the stomach wall resulting in tissue death (or necrosis) which in turn can lead to gut perforation and fatal peritonitis. Once the stomach is partially decompressed, intravenous fluids are going in ok and the breathing and other vital signs appear more normalized it’s time to go inside…
A mid-line incision almost always reveals a sheet of omentum (a lace-like sheet that protects the abdominal organs) covering the twisted stomach with a grossly enlarged spleen in the wrong place.
Sometimes the position of the stomach can be corrected by very careful maneuvering but it may require a further decompression before the stomach tube (that you’d prepared earlier) can find its way through the twist and even suck out any stomach contents followed by flushing the stomach wall – like a hospital stomach pump would.
After the stomach is repositioned it can then be fastened to the inner abdominal wall to help prevent the GDV happening again. There are a few ways of achieving this from simple sutures to an attachment resembling a belt of tissue passing through a loophole in the ribcage.
Patients are usually then kept in the hospital on fluids and under strict observation for at least 48 hours as post-operative effects such as toxins released by traumatized tissues may cause major complications including heart attacks, peritonitis and sudden death.
So the golden rule is with any emergency with your dog, and it’s the same with the approach to unfamiliar packages left on train station platform, “If you suspect it – report it”; as time is often the decider.
American Society for Prevention of Cruelty to Animals information on bloat