Camino Animal Clinic #A

There are many injuries and physical disorders which represent life-threatening emergencies. However, the condition called gastric dilatation and volvulus, “bloat” arises quickly and needs immediate medical attention. Gastric dilatation is an acute, life threatening disorder that is a medical and surgical emergency. Early recognition and treatment are essential for a successful outcome.

The normal stomach sits high in the abdomen and contains a small amount of gas, some mucus, and any food being digested. It undergoes a normal rhythm of contraction, receiving food from the esophagus above, grinding the food, and passing the ground food to the small intestine at its other end.

In the bloated stomach, gas and/or food stretches the stomach many times its normal size, causing tremendous abdominal pain. This grossly distended stomach has a tendency to rotate, thus twisting off not only its own blood supply but the only exit routes for the gas inside. Not only is this condition extremely painful, but it is also rapidly life-threatening. A dog with a bloated, twisted stomach (Gastric Dilatation and Volvulus) can die in a matter of hours unless he receives veterinary treatment.

This condition affects dog breeds which are said to be "deep chested," meaning the length of their chest from backbone to sternum is relatively long while the chest width from right to left is narrow. Thes are usually large and giant breed dogs. Examples of deep chested breeds are the Great Dane, St. Bernard, Weimaraner, German Shepherd, and Greyhounds. However, any dog can have bloat, even small breeds of dogs, like Chihuahuas and Dachshunds.

Dogs weighing more than 99 pounds have approximately a 20% risk of bloat

We also see bloat more in dogs that have eaten a large meal and exercised heavily shortly thereafter. No specific diet or dietary ingredient has been proven to be associated with bloat. Some factors found to increase and decrease the risk of bloat are listed below:

Factors Increasing the Risk of Bloating
Feeding only one meal a day

Having closely related family members with a history of bloat.

Eating rapidly.

Being thin or underweight.

Fearful or anxious temperament.

Male dogs are more likely to bloat than females.

Older dogs (7 - 12 years) were the highest risk group.

Factors Decreasing the Risk of Bloat

Inclusion of canned dog food in the diet.

Inclusion of table scraps in the diet.

Happy or easy-going temperament.

Eating 2 or more meals per day.

The dog may have an obviously distended stomach especially near the ribs but this is not always evident depending on the dog's body configuration. The most common finding is unproductive vomiting. The pet appears highly nauseated and is retching but little is coming up.

Clinical signs you might notice in your pet
Restlessness & discomfort

Frequently changing positions, often accompanied by whining

Excessive drooling

Panting or labored breathing

Retching and unsuccessful attempts at vomiting

Distention of the abdomen

In severe cases collapse and the inability to stand or walk may occur

If any of these symptoms are seen, bring your dog to the veterinarian IMMEDIATELY.

Diagnosis
-Careful physical examination to detect signs of shock and abdominal bloating.
-X-rays are frequently used to further examine the stomach

Treatment

IV (Intravenous) fluid administration
Intensive monitoring of blood values, heart rhythm, and blood pressure
Release of excessive air in the stomach via passage of a tube
Surgery to untwist and affix the stomach:

Replacing the stomach to its normal position

Remove portions of stomach or spleen that are dead (necrotic)

Permanently attach the stomach to the inside body wall so twisting does not occur (gastropexy)

FIRST: THE STOMACH MUST BE DECOMPRESSED

The huge stomach is by now pressing on the major blood vessels carrying blood back to the heart. This stops normal circulation and sends the dog into shock. Making matters worse, the stomach tissue is dying because it is stretched too tightly to allow blood circulation through it. There can be no recovery until the stomach is untwisted and the gas released. A stomach tube and stomach pump are generally used for this but sometimes surgery is needed to achieve stomach decompression.

ALSO FIRST: RAPID IV FLUIDS MUST BE GIVEN TO REVERSE THE SHOCK

Intravenous catheters are placed and IV fluids are pumped into the system to replace the blood that cannot get past the bloated stomach to return to the heart. The intense pain associated with this disease causes the heart rate to race at such a high rate that heart failure can result. Pain medication is needed if the patient’s heart rate is to slow down. Medications for shock, antibiotics and electrolytes are all vital in stabilizing the patient.

ALSO FIRST: THE HEART RHYTHM IS ASSESSED AND STABILIZED

There is an abnormal heart rhythm, called "premature ventricular contraction" associated with bloat. If it is present, intravenous medications are needed to stabilize the heart rhythm. Since this condition may not be evident until the next day, continual EKG monitoring may be necessary. Disturbed heart rhythm already present at the beginning of treatment is associated with a 38% mortality rate.

All bloated dogs, once stable, should have surgery. Without surgery, the damage done inside cannot be assessed or repaired. Surgery, called gastropexy, allows the stomach to be tacked into normal position so that it cannot twist again. Without gastropexy, the recurrence rate of bloat may be as high as 75%.

Assessment of the internal damage is also very important to recovery. If there is a section of dying tissue on the stomach wall, this must be discovered and removed or the dog will die despite treatment. Also, the spleen, which is located adjacent to the stomach may twist with the stomach. The spleen may need to be removed as well. If the tissue damage is so bad that part of the stomach must be removed, the mortality rate jumps to 28-38%. If the tissue damage is so bad that the spleen must be removed, the mortality rate is 32 - 38%.

In 1993, a statistical study involving 134 dogs with gastric dilatation and volvulus was conducted by the School of Veterinary Medicine in Hanover, Germany.

Out of 134 dogs that came into the hospital with this condition:

10% died or were euthanized prior to surgery (factors involved included expense of treatment, severity/advancement of disease etc.)

33 dogs were treated with decompression and no surgery. Of these dogs, 8 (24%) died or were euthanized within the next 48 hours due to poor response to treatment. (Six of these 8 had actually re-bloated).

Of the dogs that did not have surgical treatment but did survive to go home, 76% had another episode of gastric dilatation and volvulus eventually.

88 dogs were treated with both decompression and surgery. Of these dogs, 10% (9 dogs) died in surgery, 18% (16 dogs) died in the week after surgery, 71.5% (63 dogs) went home in good condition. Of the dogs that went home in good condition, 6% (4 dogs) had a second episode of bloat later in life.

In this study 66.4% of the bloated dogs were male and 33.6% were female. Most dogs were between ages 7 and 12 years old. The German Shepherd dog and the Boxer appeared to have a greater risk for bloating than did other breeds.

Feed your dog 2-3 small meals/day instead of one large meal.

Gradually introduce any dietary changes over a period of several days.

Moisten dry food with water so the food expands BEFORE it is eaten.

Avoid feeding table scraps or “people food.”

Do NOT vigorously exercise your dog for at least one hour before meals and two hours after eating.

Don’t allow your dog to eat large quantities of food rapidly.

Don’t allow your dog to drink large amounts of water before or after meals.

If possible, observe your dog for the first signs of distress for 1-2 hours after eating.

Be especially watchful when your dog is under stress, such as being kenneled, hospitalized, or in training.

Sources:

www.marvistavet.com
www.veterinarypartner.com
www.cah.com
www.vsasurgery.com

Gastric Dilatation and Volvulus (Bloat)

If any of these symptoms are seen, bring your dog to the veterinarian IMMEDIATELY.