Gastric Dilatation-Volvulus (Bloat) in Dogs
Veterinary care should include diagnostic tests and subsequent treatment recommendations.
Diagnosis In-depth of Canine GDV
Diagnostic tests are needed to recognize GDV, and exclude all other diseases, including:
Complete medical history and physical examination.
Clinical response to gastric decompression (passing a stomach tube or inserting a needle into the abdomen to relieve gas pressure).
Your veterinarian should assess your pet for shock. It is important to monitor vital signs, airway, breathing, heart rate and to identify bleeding disorders.
If the diagnosis is not clear, abdominal radiography (X-rays) is the first diagnostic test performed. An abdominal X-ray may reveal a large air-filled stomach with a soft tissue fold that appears to compartmentalize the stomach. This suggests that the stomach is twisted (volvulus). Air that is free floating in the abdomen suggests perforation of the stomach.
After initial stabilization of the patient a complete blood count (CBC) and blood biochemical test may be performed. Electrolyte abnormalities may be present.
An electrocardiogram (EKG) is often needed to monitor for cardiac arrhythmias.
Additional diagnostic tests may be recommended on an individual pet basis, including:
Arterial blood gas determinations may be needed to identify complications of shock.
Repeat biochemistries if initial tests are abnormal.
Blood lactate. This test may be prognostic as a higher level indicates a worse prognosis. It is believed that lactate levels greater than 6 mmol/L is associated with an increased mortality.
Coagulation studies should be done and fibrinogen levels should be tested to identify disseminated intravascular coagulopathy.
Treatment In-depth of Canine GDV
Treatments for GDV may include one or more of the following:
Initial therapy directed at treatment of shock and alleviation of gastric distension.
Rapid administration of intravenous fluids. Fluid choice may very to treat shock.
Antibiotic therapy is recommended to prevent complications of gastrointestinal injury.
Administration of flunixin meglumine (Banamine) to decrease prostaglandin synthesis for shock as previously recommend but is current use is controversial. Corticosteroids such as methylprednisolone sodium succinate and dexamethasone were previously used to treat endotoxemia and shock was but is not currently recommended.
Sedation or anesthesia to perform gastric decompression and lavage.
Gastric decompression and lavage is a procedure in which a large, flexible rubber or plastic tube is passed through the mouth into the stomach. This is done to relieve pressure and to remove the stomach’s contents. Decompression does relieve gastric dilatation, but does not correct a volvulus (twisting) if that is also present. Decompression also decreases pain and discomfort, improves venous blood return to the heart and helps reduce further injury to the stomach lining.
Once the tube is placed into the stomach, the stomach is flushed with warm water to remove fluid and food debris. This is called gastric lavage.
If the tube does not advance, a procedure called gastrocentesis may be needed. This procedure involves clipping hair over the side where the stomach is located and inserting a needle through the wall and into the stomach to remove air. This removal of air and pressure will often allow a tube to be inserted.
A temporary pharyngostomy tube, which is a tube that goes from behind the jaw to the stomach, can be placed if the dog is too unstable for surgery due to cardiac arrhythmias or other complications. However, in most cases of GDV, the next step is abdominal surgery.
Surgery is the definitive treatment for GDV. While gastric decompression via tubing can effectively treat this disease, surgery is the best treatment and follows shock therapy, gastric decompression and arrhythmia stabilization.
If volvulus is present, surgery is needed to return the stomach to its normal position. Surgery should not be delayed unnecessarily. Surgery is also essential to allow visual inspection of the stomach wall because this tissue may not be viable if it has been deprived of blood supply for very long. During surgery, the stomach is repositioned, the spleen examined (and untwisted), devitalized (dead) stomach wall can be removed, and the spleen can be removed if it does not become normal after untwisting.
If the patient is stable after these procedures, a gastropexy is usually performed, which is a procedure to attach the stomach to the abdominal wall and help to prevent recurrence of GDV. There are several surgical techniques for gastropexy such as tube gastropexy, circumcostal gastropexy, belt loop gastropexy and muscle flap (incisional) gastropexy. Each of these techniques has proponents. In a comparison between the different surgical types, all were found to have similar effectiveness. The tube gastrotomy was found to have the most complications. The best technique is the one that your veterinarian is familiar with and can perform.
Unfortunately, some dogs suffer extensive injury to their stomach such that the bulk of muscle is devitalized or dead, especially if the GDV has been prolonged and care was not sought quickly. In such cases, euthanasia may be the only course as removal of the stomach is not a practical option.
After surgery, post-operative care by your veterinarian may include:
Monitoring for 2 to 4 days that includes observation for arrhythmias using and electrocardiogram. Severe arrhythmias may be treated with drug therapy such as potassium supplementation, Lidocaineor Procainamide.
Monitoring of urine output
Post-operative pain treatment
Fluid therapy to ensure that an adequate blood potassium level is maintained
Post-operative wound care
Antibiotics are usually continued. Even with the sterile procedures employed during surgery, there is the risk that devitalized stomach tissue or intestine injured by shock (low blood flow) may allow bacteria to move into the circulation.
Reduction of stomach inflammation can be treated with cimetidine (Tagamet®), ranitidine (Zantac®) or famotidine (Pepcid®).
Enhancement of gastric motility can be treated with Metoclopramide HCl (Reglan®) or Cisapride. Gastric motility is often abnormal post-operatively due to gastric distension, lack of blood flow to the tissue, and the surgery itself.