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{{short description|Medical condition in dogs}}
{{other uses}}
{{About|"bloat" in dogs|other uses|Bloat (disambiguation)}}
{{Refimprove|date=April 2009}}
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[[File:Bloat x-ray.JPG|thumb|X-ray of a dog with GDV. The "double bubble" pattern indicates that stomach torsion has occurred.]]
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[[File:gdv1.jpg|thumb|X-ray from the underside of a dog with GDV. The dark area is the buildup of gas.]]
'''Gastric dilatation volvulus''' ('''GDV'''), also known as '''gastric dilation''', '''twisted stomach''', or '''gastric torsion''', is a [[medical condition]] that affects dogs and rarely cats and [[guinea pig]]s,<ref name="gdv"/> in which the [[stomach]] becomes overstretched and rotated by excessive [[gas]] content. The condition also involves compression of the [[Thoracic diaphragm|diaphragm]] and caudal [[vena cava]]e. The word '''bloat''' is often used as a general term to mean [[Abdominal distension|gas distension]] without stomach torsion (a normal change after eating), or to refer to GDV.


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GDV is a life-threatening condition in dogs that requires prompt treatment. It is common in certain breeds; deep-chested breeds are especially at risk. [[Mortality rate]]s in dogs range from 10 to 60%, even with treatment.<ref name="Aronson_2000">{{cite journal|author=Aronson, Lillian R.|author2=Brockman, Daniel J. |author3=Brown, Dorothy Cimino |title=Gastrointestinal Emergencies|journal=The Veterinary Clinics of North America|year=2000|volume=30|issue=1 |pages=558–569|doi=10.1016/s0195-5616(00)50039-4|pmid=10853276 |pmc=1374121}}</ref> With surgery, the mortality rate is 15 to 33 percent.<ref name="Beck">{{cite journal |vauthors=Beck J, Staatz A, Pelsue D, Kudnig S, MacPhail C, Seim H, Monnet E |title=Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992-2003) |journal=J. Am. Vet. Med. Assoc. |volume=229 |issue=12 |pages=1934–9 |year=2006 |pmid=17173533 |doi=10.2460/javma.229.12.1934}}</ref>
'''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. The name comes from the [[Middle English]] ''blout'', meaning soft or puffed, which is from the [[Old Norse]] ''blautr'', meaning soft or soaked.<ref>{{cite web | title = bloat | work = American Heritage Dictionary of the English Language: Fourth Edition | publisher = Bartleby.com | year = 2000 | url = http://www.bartleby.com/61/80/B0328000.html | accessdate = 2007-05-13 }}</ref> '''Meteorism''', its name derived from the writings of [[Hippocrates]], is now rarely used in [[English language|English]]. The condition occurs most commonly in domesticated animals, especially [[ruminant]]s and certain [[dog]] breeds.


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==Symptoms==
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In dogs, gas accumulation in the stomach is usually associated with [[volvulus]] of the stomach, which prevents gas from escaping. Deep-chested breeds are especially at risk. [[Mortality rate]]s in dogs range from 10 to 60 percent, even with treatment.<ref name=Aronson_2000>{{cite journal|author=Aronson, Lillian R.|coauthors=Brockman, Daniel J., Brown, Dorothy Cimino|title=Gastrointestinal Emergencies|journal=The Veterinary Clinics of North America|year=2000|volume=30|pages=558–569}}</ref> With surgery, the mortality rate is 15 to 33 percent.<ref name=Beck>{{cite journal |author=Beck J, Staatz A, Pelsue D, Kudnig S, MacPhail C, Seim H, Monnet E |title=Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992-2003) |journal=J. Am. Vet. Med. Assoc. |volume=229 |issue=12 |pages=1934–9 |year=2006 |pmid=17173533 |doi=10.2460/javma.229.12.1934}}</ref>
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Symptoms are not necessarily distinguishable from other kinds of distress. A dog might stand uncomfortably and seem to be in extreme discomfort for no apparent reason. Other possible symptoms include firm distension of the [[abdomen]], weakness, depression, difficulty breathing, [[ptyalism|hypersalivation]], and retching without producing any vomitus (nonproductive vomiting). Many dogs with GDV have cardiac [[Heart arrhythmia|arrhythmia]]s (40% in one study).<ref>{{cite journal |vauthors=Brockman D, Washabau R, Drobatz K |title=Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992) |journal=J. Am. Vet. Med. Assoc. |volume=207 |issue=4 |pages=460–4 |year=1995 |pmid=7591946}}</ref> Chronic GDV in dogs, include symptoms such as loss of appetite, vomiting, and weight loss.<ref name=Fossum>{{cite web | last = Fossum | first = Theresa W. | title = Gastric Dilatation Volvulus: What's New? | work = Proceedings of the 31st World Congress | publisher= World Small Animal Veterinary Association | year = 2006 | url = http://www.ivis.org/proceedings/wsava/2006/lecture25/Fossum4.pdf?LA=1 | format = PDF | access-date = 2007-04-17 }}</ref> [[Hypovolaemia]] may occur and in severe cases [[hypovolaemic shock]] and [[hypoperfusion]].<ref name="gdv"/>
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[[Image:Bloat x-ray.JPG|thumb|X-ray of a dog with bloat. Note the classic "double bubble" pattern indicating that stomach torsion has occurred in this case]]


Blood [[dyscrasia]]s have been identified in patients with GDV. Haemological conditions that may be identified include: [[neutrophilic]] [[leukocytosis]], [[lymphopaenia]], [[leukopaenia]], [[thrombocytopaenia]], and [[haemoconcentration]]. Other conditions include: [[hepatocelluar damage]], [[cholestasis]], [[azotemia]] and [[hypokalaemia]].<ref name="gdv"/>
==Causes==
==Causes==
Bloat in dogs is likely caused by a multitude of factors, but in all cases the immediate prerequisite is a dysfunction of the [[sphincter]] between the [[esophagus]] and stomach and an obstruction of outflow through the [[pylorus]],or a clog.<ref name=Parton>{{cite journal |author=Parton A, Volk S, Weisse C |title=Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus |journal=J. Am. Vet. Med. Assoc. |volume=228 |issue=12 |pages=1895–900 |year=2006 |pmid=16784379 |doi=10.2460/javma.228.12.1895}}</ref> Some of the more widely acknowledged factors for developing bloat include increased age, breed, having a deep and narrow chest, stress, eating foods such as kibble that expand in the stomach, overfeeding, too much water consumption in a small period of time; before or after exercise and other causes of gastrointestinal disease and distress. Studies have indicated that the risk of bloat in dogs perceived as happy by their owners is decreased, and increased in dogs perceived as fearful. This may be due to the [[physiology|physiological]] effects of the dog's personality on the function and motility of the gastrointestinal system.<ref>{{cite journal |author=Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T |title=Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs |journal=J. Am. Vet. Med. Assoc. |volume=216 |issue=1 |pages=40–5 |year=2000 |pmid=10638316 |doi=10.2460/javma.2000.216.40}}</ref>; alternatively perhaps the dogs become unhappy/uncomfortable as a consequence of the conditions that lead up to exhibiting bloat. Dogs with [[inflammatory bowel disease]] may be at an increased risk for bloat.<ref>{{cite journal |author=Braun L, Lester S, Kuzma A, Hosie S |title=Gastric dilatation-volvulus in the dog with histological evidence of preexisting inflammatory bowel disease: a retrospective study of 23 cases |journal=Journal of the American Animal Hospital Association |volume=32 |issue=4 |pages=287–90 |year=1996 |pmid=8784718}}</ref> [[Image:gdv1.jpg|thumb|X-ray from the underside of a dog with intestinal GDV. The dark area is the build up of gas.]]
Gastric dilatation volvulus is multifactorial without any one cause being identified, but in all cases the immediate prerequisite is a dysfunction of the [[sphincter]] between the [[esophagus]] and stomach and an obstruction of outflow through the [[pylorus]].<ref name=Parton>{{cite journal |vauthors=Parton A, Volk S, Weisse C |title=Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus |journal=J. Am. Vet. Med. Assoc. |volume=228 |issue=12 |pages=1895–900 |year=2006 |pmid=16784379 |doi=10.2460/javma.228.12.1895}}</ref><ref name="gdv">{{cite book| last=Monnet | first=Eric | first2=Elisa M |last2=Mazzaferro| title=Small Animal Soft Tissue Surgery | publisher=John Wiley & Sons | publication-place=Hoboken, NJ | date=2023-05-31 | isbn=978-1-119-69368-0 | pages=53-74 |chapter=Gastric dilatation volvulus syndrome}}</ref>


[[Hypergastrinaemia]] has been hypothesised as a cause of GDV. [[Pyloric hypertrophy]] as a result of hypergastrinaemia was presumed to cause [[pyloric outflow obstruction]], retarding [[gastric emptying]]. Studies have not found evidence to support this theory.<ref name="gdv"/> One study found no association between pyloric hypertrophy and GDV.<ref>{{cite journal | last=GREENFIELD | first=CATHY L. | last2=WALSHAW | first2=RICHARD | last3=THOMAS | first3=MICHAEL W. | title=Significance of the Heineke‐Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation‐Volvulus A Prospective Clinical Study | journal=Veterinary Surgery | publisher=Wiley | volume=18 | issue=1 | year=1989 | issn=0161-3499 | doi=10.1111/j.1532-950x.1989.tb01038.x | pages=22–26}}</ref>
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===Dietary factors===
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One common recommendation in the past has been to raise the food bowl of the dog when it eats. However, studies have shown that this may actually increase the risk of bloat.<ref>{{cite journal |author=Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T |title=Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs |journal=J. Am. Vet. Med. Assoc. |volume=217 |issue=10 |pages=1492–9 |year=2000 |pmid=11128539 |doi=10.2460/javma.2000.217.1492}}</ref> Eating only once daily<ref>{{cite journal |author=Glickman L, Glickman N, Schellenberg D, Simpson K, Lantz G |title=Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: a practitioner/owner case-control study |journal=Journal of the American Animal Hospital Association |volume=33 |issue=3 |pages=197–204 |year=1997 |pmid=9138229}}</ref> and eating food consisting of particles less than 30&nbsp;mm in size also may increase the risk of bloat.<ref>{{cite journal |doi=10.1136/vr.143.2.48 |author=Theyse L, van de Brom W, van Sluijs F |title=Small size of food particles and age as risk factors for gastric dilatation volvulus in great danes |journal=Vet. Rec. |volume=143 |issue=2 |pages=48–50 |year=1998 |pmid=9699253}}</ref> One study looking at the ingredients of dry dog food found that while neither grains, soy, nor animal proteins increased risk of bloat, foods containing an increased amount of added oils or fats do increase the risk, possibly due to delayed emptying of the stomach.<ref>{{cite journal |author=Raghavan M, Glickman N, Glickman L |title=The effect of ingredients in dry dog foods on the risk of gastric dilatation-volvulus in dogs |journal=Journal of the American Animal Hospital Association |volume=42 |issue=1 |pages=28–36 |year=2006 |pmid=16397192}}</ref>


Impairment of gastric [[myoelectricity]] retarding gastric emptying has been hypothesised as a cause of GDV. Currently no study has identified an association between gastric myoelectricity and GDV.<ref name="gdv"/>
===Breed susceptibility===

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As a general rule, bloat is of greatest risk to deep-chested dogs. The five breeds at greatest risk are [[Great Dane]]s, [[Weimaraner]]s, [[St. Bernard (dog)|St. Bernard]]s, [[Gordon Setter]]s, and [[Irish Setter]]s.<ref>{{cite journal |author=Glickman L, Glickman N, Pérez C, Schellenberg D, Lantz G |title=Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs |journal=J. Am. Vet. Med. Assoc. |volume=204 |issue=9 |pages=1465–71 |year=1994 |pmid=8050972}}</ref> In fact, the lifetime risk for a Great Dane to develop bloat has been estimated to be close to 37 percent.<ref>{{cite journal |author=Ward M, Patronek G, Glickman L |title=Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation-volvulus |journal=Prev. Vet. Med. |volume=60 |issue=4 |pages=319–29 |year=2003 |pmid=12941556 |doi=10.1016/S0167-5877(03)00142-9}}</ref> [[Poodle|Standard Poodle]]s are also at risk for this health problem,<ref name=Merck>{{cite web | title = Gastric Dilatation-volvulus | work = The Merck Veterinary Manual | year = 2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23305.htm | accessdate = 2007-04-17 }}</ref> as are [[Irish Wolfhound]]s<ref>[Incidence of and breed-related risk factors
===Risk factors===
for gastric dilatation-volvulus in dogs | http://avmajournals.avma.org/doi/abs/10.2460/javma.2000.216.40?journalCode=javma ]</ref>, [[Doberman Pinscher]]s, [[Rottweiler]]s<ref>[http://dogtime.com/bloat.html Bloat | DogTime - Warning signs to watch for<!-- Bot generated title -->]</ref> and [[Rhodesian Ridgeback]]s. [[Basset Hound]]s have the greatest risk for dogs less than 23&nbsp;kg/50&nbsp;lbs.<ref name=Aronson_2000/>
Dog breeds that have a higher depth to width ratio of the thorax are significantly more likely to acquire GDV than other breeds. If there is a family history of the condition the risk is even more severe, highlighting a heritability to the predisposing factors. Body weight is a factor with obese dogs being less likely to develop GDV than healthy or underweight dogs.<ref name="gdv"/>

Stress is known to impair gastrointestinal function. Stress has been identified as a risk factor for GDV, the exact manner for this is not currently known.<ref name="gdv"/><ref>{{cite journal | last=Elwood | first=C. M. | title=Risk factors for gastric dilatation in Irish setter dogs | journal=Journal of Small Animal Practice | volume=39 | issue=4 | date=1998 | issn=0022-4510 | doi=10.1111/j.1748-5827.1998.tb03627.x | pages=185–190}}</ref>

Other risk factors include: [[Pneumonyssoides caninum|nasal mite]] infection;<ref>{{cite journal | last=Bredal | first=W.P. | title= Pneumonyssoides caninum infection--a risk factor for gastric dilatation-volvulus in dogs | journal=Veterinary Research Communications | publisher=Springer Science and Business Media LLC | volume=22 | issue=4 | year=1998 | issn=0165-7380 | doi=10.1023/a:1006083013513 | pages=225–231}}</ref> gastrointestinal disease;<ref name="Glickman 2000"/> and [[inflammatory bowel disease]], with 61% of dogs with GDV having inflammatory bowel disease identified via [[biopsy]] in one study.<ref>{{cite journal | last=Braun | first=L | last2=Lester | first2=S | last3=Kuzma | first3=AB | last4=Hosie | first4=SC | title=Gastric dilatation-volvulus in the dog with histological evidence of preexisting inflammatory bowel disease: a retrospective study of 23 cases | journal=Journal of the American Animal Hospital Association | publisher=American Animal Hospital Association | volume=32 | issue=4 | date=1996-07-01 | issn=0587-2871 | doi=10.5326/15473317-32-4-287 | pages=287–290}}</ref>

The breeds most likely to develop GDV are the [[Great Dane]] (10 times more likely), [[Weimaraner]] (4.6) [[St Bernard dog|St Bernard]] (4.2) and the [[Irish Setter]] (3.5).<ref name="glick94"/> Other breeds with a predisposition include the [[Irish Wolfhound]], [[Borzoi]], [[English Mastiff]], [[Akita Inu|Akita]], [[Bull Mastiff]], [[pointing dog]]s, [[Bloodhound]], [[Grand Bleu de Gascogne]] and the standard [[Poodle]].<ref name="gdv"/> The Great Dane has been found to have a lifetime risk of 42.4% in one study,<ref name="Glickman 2000">{{cite journal |vauthors=Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T |title=Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs |journal=J. Am. Vet. Med. Assoc. |volume=216 |issue=1 |pages=40–5 |year=2000 |pmid=10638316 |doi=10.2460/javma.2000.216.40|doi-access=free }}</ref> which has led to the Great Dane being the focus of investigations into causes and risk factors for GDV.<ref name="gdv"/> One study has found certain [[allele]]s of the [[DLA88]], [[DRB1]] and [[TLR5]] genes, which are part of the canine immune system, to predispose a dog to GDV.<ref>{{cite journal | last=Harkey | first=Michael A. | last2=Villagran | first2=Alexandra M. | last3=Venkataraman | first3=Gopalakrishnan M. | last4=Leisenring | first4=Wendy M. | last5=Hullar | first5=Meredith A. J. | last6=Torok-Storb | first6=Beverly J. | title=Associations between gastric dilatation-volvulus in Great Danes and specific alleles of the canine immune-system genes DLA88, DRB1, and TLR5 | journal=American Journal of Veterinary Research | publisher=American Veterinary Medical Association (AVMA) | volume=78 | issue=8 | year=2017 | issn=0002-9645 | doi=10.2460/ajvr.78.8.934 | pages=934–945}}</ref> Further studies have associated these alleles with greater diversity in the [[gut microbiome]] and an increased risk of GDV.<ref>{{cite journal | last=Hullar | first=Meredith A. J. | last2=Lampe | first2=Johanna W. | last3=Torok-Storb | first3=Beverly J. | last4=Harkey | first4=Michael A. | title=The canine gut microbiome is associated with higher risk of gastric dilatation-volvulus and high risk genetic variants of the immune system | journal=PLOS ONE | publisher=Public Library of Science (PLoS) | volume=13 | issue=6 | date=2018-06-11 | issn=1932-6203 | doi=10.1371/journal.pone.0197686 | doi-access=free | page=e0197686}}</ref>

GDV has been reported across the age range in dogs. It is more likely to occur in older dogs but is not a geriatric disease and the risk plateaus after the first 2–4 years for large dogs.<ref name="gdv"/>
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===Dietary factors===
⚫
One common recommendation in the past has been to raise the food bowl of dogs when they eat, but this was shown to increase the risk in one study.<ref>{{cite journal |vauthors=Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T |s2cid=22006972 |title=Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs |journal=J. Am. Vet. Med. Assoc. |volume=217 |issue=10 |pages=1492–9 |year=2000 |pmid=11128539 |doi=10.2460/javma.2000.217.1492}}</ref> Eating only once daily<ref>{{cite journal |vauthors=Glickman L, Glickman N, Schellenberg D, Simpson K, Lantz G |title=Multiple risk factors for the gastric dilatation-volvulus syndrome in dogs: a practitioner/owner case-control study |journal=[[Journal of the American Animal Hospital Association]] |volume=33 |issue=3 |pages=197–204 |year=1997 |pmid=9138229 |doi= 10.5326/15473317-33-3-197}}</ref> and eating food consisting of particles less than {{cvt|30|mm|abbr=on}} in size also has been shown increase the risk of GDV.<ref>{{cite journal |doi=10.1136/vr.143.2.48 |vauthors=Theyse L, van de Brom W, van Sluijs F |title=Small size of food particles and age as risk factors for gastric dilatation volvulus in great danes |journal=Vet. Rec. |volume=143 |issue=2 |pages=48–50 |year=1998 |pmid=9699253}}</ref> One study looking at the ingredients of dry dog food found that while neither grains, soy, nor animal proteins increased risk of bloat, foods containing an increased amount of added oils or fats do increase the risk, possibly owing to delayed emptying of the stomach.<ref>{{cite journal |vauthors=Raghavan M, Glickman N, Glickman L |title=The effect of ingredients in dry dog foods on the risk of gastric dilatation-volvulus in dogs |journal=[[Journal of the American Animal Hospital Association]] |volume=42 |issue=1 |pages=28–36 |year=2006 |pmid=16397192 |doi=10.5326/0420028}}</ref>


==Pathophysiology==
==Pathophysiology==
The exact pathophysiology is not understood. It is still unknown what order the condition occurs: whether dilatation or volvulus occurs first.<ref name="gdv"/>
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The stomach twists around the longitudinal axis of the digestive tract, also known as ''volvulus''. Gas distension may occur prior to or after the stomach twists.<ref name=Parton/> The most common direction for rotation is clockwise, viewing the animal from behind. The stomach can rotate up to 360° in this direction and 90° counterclockwise. If the volvulus is greater than 180°, the [[esophagus]] is closed off, thereby preventing the animal from relieving the condition by belching or vomiting.<ref name=Merck/> The results of this distortion of normal anatomy and gas distension include [[hypotension]] (low blood pressure), decreased return of blood to the [[heart]], [[ischemia]] (loss of blood supply) of the stomach, and [[shock (medical)|shock]]. Pressure on the [[portal vein]] decreases blood flow to [[liver]] and decreases the ability of that organ to remove toxins and absorbed [[bacteria]] from the blood.<ref>{{cite web | last = Bright | first = Ronald M. | title = Gastric Dilatation-Volvulus: Risk Factors and Some New Minimally Invasive Gastropexy Techniques | work = Proceedings of the 29th World Congress of the World Small Animal Veterinary Association | year = 2004 | url = http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2004&PID=8763&O=Generic | accessdate = 2007-04-17 }}</ref> At the other end of the stomach, the [[spleen]] may be damaged if the twisting interrupts its blood supply. If not quickly treated, bloat can lead to [[blood poisoning]], [[peritonitis]] and death by [[toxic shock]].


⚫
The stomach twists around the longitudinal axis of the digestive tract, also known as '''volvulus'''.<ref name=Parton/> The most common direction for rotation is clockwise, viewing the animal from behind. The stomach can rotate up to 360° in this direction and 90° counterclockwise. If the volvulus is greater than 180°, the [[esophagus]] is closed off, thereby preventing the animal from relieving the condition by belching or vomiting.<ref name=Merck/> The results of this distortion of normal anatomy and gas distension include [[hypotension]] (low blood pressure), decreased return of blood to the heart, [[ischemia]] (loss of blood supply) of the stomach, and [[Shock (circulatory)|shock]]. Pressure on the [[portal vein]] decreases blood flow to liver and decreases the ability of that organ to remove toxins and absorbed bacteria from the blood.<ref>{{cite web | last = Bright | first = Ronald M. | title = Gastric dilatation-volvulus: risk factors and some new minimally invasive gastropexy techniques | work = Proceedings of the 29th World Congress of the World Small Animal Veterinary Association | year = 2004 | url = http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2004&PID=8763&O=Generic | access-date = 2007-04-17 }}</ref> Rotations of up to 360° have been reported but typically rotations stop around 270°.<ref name="gdv"/>
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==Symptoms==
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Symptoms are not necessarily distinguishable from other kinds of distress. A dog might stand uncomfortably and seem to be in extreme discomfort for no apparent reason. Other possible symptoms include firm distension of the [[abdomen]], weakness, depression, difficulty breathing, hypersalivation, and retching without vomiting. A high rate of dogs with bloat have cardiac [[arrhythmia]]s (40 percent in one study).<ref>{{cite journal |author=Brockman D, Washabau R, Drobatz K |title=Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992) |journal=J. Am. Vet. Med. Assoc. |volume=207 |issue=4 |pages=460–4 |year=1995 |pmid=7591946}}</ref> Chronic bloat may occur in dogs, symptoms of which include loss of appetite, vomiting and weight loss.<ref name=Fossum>{{cite web | last = Fossum | first = Theresa W. | title = Gastric Dilatation Volvulus: What's New? | work = Proceedings of the 31st World Congress of the World Small Animal Veterinary Association | year = 2006 | url = http://www.ivis.org/proceedings/wsava/2006/lecture25/Fossum4.pdf?LA=1 | format = PDF | accessdate = 2007-04-17 }}</ref>


==Diagnosis==
==Diagnosis==
[[Image:GDV x-ray.JPG|thumb|Bloat in a dog, with "double bubble" sign]]
[[File:GDV x-ray.JPG|thumb|Bloat in a dog, with "double-bubble" sign]]
A diagnosis of bloat is made by several factors. The breed and history will often give a significant suspicion of bloat, and the physical exam will often reveal the telltale sign of a distended abdomen with abdominal [[Tympanites|tympany]]. Shock is diagnosed by the presence of pale [[mucous membrane]]s with poor [[capillary]] refill, increased heart rate, and poor [[pulse]] quality. [[X-rays]] (usually taken after decompression of the stomach if the dog is unstable) will show a stomach distended with gas. The pylorus, which normally is [[Anatomical terms of location|ventral]] and to the right of the body of the stomach, will be [[Anatomical terms of location|cranial]] to the body of the stomach and left of the midline, often separated on the x-ray by soft tissue and giving the appearance of a separate gas filled pocket (double bubble sign).<ref name=Fossum/>
A diagnosis of GDV is made by several factors. The breed and history often gives a significant suspicion of the condition, and a physical examination often reveals the telltale sign of a distended abdomen with abdominal [[tympany]]. Shock is diagnosed by the presence of pale [[mucous membrane]]s with poor [[capillary]] refill, increased heart rate, and poor [[pulse]] quality. [[Radiography|Radiographs]] (X-rays), usually taken after decompression of the stomach if the dog is unstable, shows a stomach distended with gas. The pylorus, which normally is [[Anatomical terms of location|ventral]] and to the right of the body of the stomach, is [[Anatomical terms of location|cranial]] to the body of the stomach and left of the midline, often separated on the X-ray by soft tissue and giving the appearance of a separate gas-filled pocket (double-bubble sign).<ref name=Fossum/>


==Treatment==
==Treatment==
Patients with GDV need to be stabilised as soon as possible. Perfusion and blood pressure need to be normalised before any further treatment can be performed. [[Analgesia]] should also be provided.<ref name="gdv"/>
Bloat is an emergency medical condition: having the animal examined by a [[veterinarian]] is imperative. Bloat can become fatal within a matter of minutes.


Patients require [[intravenous fluid therapy]] with [[Saline (medicine)|saline]]. [[Colloid fluids]] may be required if the patient does not respond well to the [[crystalloid solution]]. [[Antiarrhythmic]] drugs should be administered after starting fluid therapy to stabilise blood pressure. Other drugs such as [[dobutamine]] should be provided if blood pressure fails to normalise, only as a last resort. Other [[vasopressor]]s can be used such as [[ephedrine]], [[phenylephrine]], and [[epinephrine]].<ref name="gdv"/>
===First Aid===
At the first signs of bloat (restlessness and inability to sit or lie down comfortably) a dog owner can administer 1-2 tablets of [[Famotidine]] also known commercially as [[Pepcid]] down the dog's throat. Some vets recommend giving [[Simethicone]] during the early signs of a bloat emergency.{{cn|date=November 2011}}


[[Decompression (surgery)|Percutaneous decompression]] is the easiest method of treating GDV. A large catheter is inserted into the gastric [[Lumen (anatomy)|lumen]]. If done incorrectly the [[spleen]] may be [[lacerate]]d or punctured. Potentially the content of the stomach may leak if the procedure is performed incorrectly.<ref name="gdv"/>
A more invasive measure could include passing a tube down the dog's throat, as an emergency [[first aid]] technique. This is not an easy task and cannot readily be improvised; some web sites document so-called bloat first aid kits and contain descriptions of the first aid a dog owner can provide at the time an attack of bloat is discovered. [http://www.kifka.com/Elektrik/BloatFirstAid.htm] [http://www.dachshund.org/bloat_instructions.html] [http://www.moderndogmagazine.com/pdf/FIRST_AID_CARE_FOR_PETS.pdf] This is not a substitute for immediate veterinary treatment. There is risk of esophagus or stomach rupture if the tube is inserted too forcefully, or if the stomach is [[necrotic]].


Orogastric [[intubation]] is another method for treatment. An [[orogastric tube]] is entered into the stomach via the [[oesophageal sphincter]], [[tepid]] water is sent as a [[Bolus (medicine)|bolus]] through the tube into the stomach to [[lavage]] it. Fluid should be regurgitated up the tube. If it is not then a [[stomach perforation]] has likely occurred.<ref name="gdv"/>
It would always be advisable to seek veterinary advice before attempting any procedures at home as these may further worsen the animal's condition.<ref>{{cite web | title = Gastric Dilatation/Volvulus General Review | work = Small Animal Gastroenterology | publisher = University of Pennsylvania School of Veterinary Medicine | year = 2002 | url = http://cal.vet.upenn.edu/projects/sagastro/genrev/revgdv.htm#Possible Complications | accessdate = 2006-12-05 }}</ref>
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[[File:gdv2.jpg|thumb|X-ray from the side of a dog with intestinal GDV.]]


To restore the stomach to the normal position an [[exploratory laparotomy]] (explap) is needed. Sometimes a [[gastrectomy]] may be required. During the explap the stomach is rotated up to 360° to put it back into the right position, although typically such extreme rotation is not needed. Pulling on the [[pylorus]] allows for the stomach to be repositioned. Sometimes the dilatation is serious enough that the stomach requires further decompression before repositioning. Other organs of the digestive system are assessed during the procedure. [[Splenectomy]] may be required. [[Gastropexy]] involves suturing the [[pyloric antrum]] to the abdominal wall to prevent recurrence of GDV. Patients that do not receive a gastropexy have a high likelihood of GDV recurrence with one study finding 80% of dogs that suffered a GDV but did not undergo a gastropexy having GDV reoccur.<ref name="gdv"/>
===Veterinary treatment===
Treatment usually involves resuscitation with [[intravenous therapy|intravenous fluid therapy]], usually a combination of [[isotonic solutions|isotonic]] fluids and [[hypertonic saline]] or a [[colloid]]al solution such as [[hetastarch]], and emergency [[surgery]]. The stomach is initially decompressed by passing a stomach tube, or if that is not possible, multiple [[trocar]]s can be passed through the skin into the stomach to remove the gas, alternatively the trocars may be inserted directly into the stomach following anaesthesia in order to reduce the chances of infection. During surgery, the stomach is placed back into its correct position, the abdomen is examined for any devitalized tissue (especially the stomach and [[spleen]]). A partial [[gastrectomy]] may be necessary if there is any [[necrosis]] of the stomach wall.


===Prevention and reduction of recurrence===
==Prevention==
Recurrence of bloat attacks can be a problem, occurring in up to 80 percent of dogs treated medically only (without surgery).<ref name=Rawlings>{{cite journal |author=Rawlings C, Mahaffey M, Bement S, Canalis C |title=Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation |journal=J. Am. Vet. Med. Assoc. |volume=221 |issue=11 |pages=1576–81 |year=2002 |pmid=12479327 |doi=10.2460/javma.2002.221.1576}}</ref> To prevent recurrence, at the same time the bloat is treated surgically, a right-side [[gastropexy]] is often performed, which by a variety of methods firmly attaches the stomach wall to the body wall, to prevent it from twisting inside the abdominal cavity in the future. While dogs that have had gastropexies still may develop gas distension of the stomach, there is a significant reduction in recurrence of gastric volvulus. One study showed that out of 136 dogs that had surgery for bloat, 4.3 percent of those that did have gastropexies had a recurrence, while 54.5 percent of those without the additional surgery recurred.<ref>{{cite journal |author=Glickman L, Lantz G, Schellenberg D, Glickman N |title=A prospective study of survival and recurrence following the acute gastric dilatation-volvulus syndrome in 136 dogs |journal=Journal of the American Animal Hospital Association |volume=34 |issue=3 |pages=253–9 |year=1998 |pmid=9590454}}</ref> Gastropexies are also performed [[prophylaxis|prophylactically]] in dogs considered to be at high risk of bloat, including dogs with previous episodes of bloat or with gastrointestinal disease predisposing to bloat, and dogs with a first-order relative (parent or sibling) with a history of bloat.<ref name=Rawlings/>
Recurrence of GDV attacks can be a problem, occurring in up to 80% of dogs treated medically only (without surgery).<ref name=Rawlings>{{cite journal |vauthors=Rawlings C, Mahaffey M, Bement S, Canalis C |title=Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation |journal=J. Am. Vet. Med. Assoc. |volume=221 |issue=11 |pages=1576–81 |year=2002 |pmid=12479327 |doi=10.2460/javma.2002.221.1576}}</ref> To prevent recurrence, at the same time the bloat is treated surgically, a right-side [[Canine gastropexy|gastropexy]] is often performed, which by a variety of methods firmly attaches the stomach wall to the body wall, to prevent it from twisting inside the abdominal cavity in the future. While dogs that have had gastropexies still may develop gas distension of the stomach, a significant reduction in recurrence of gastric volvulus is seen. Of 136 dogs that had surgery for gastric dilatation-volvulus, six that did have gastropexies had a recurrence, while 74 (54.5%) of those without the additional surgery recurred.<ref>{{cite journal |vauthors=Glickman L, Lantz G, Schellenberg D, Glickman N |title=A prospective study of survival and recurrence following the acute gastric dilatation-volvulus syndrome in 136 dogs |journal=[[Journal of the American Animal Hospital Association]] |volume=34 |issue=3 |pages=253–9 |year=1998 |pmid=9590454 |doi=10.5326/15473317-34-3-253}}</ref> Gastropexies are also performed [[prophylaxis|prophylactically]] in dogs considered to be at high risk of GDV, including dogs with previous episodes or with gastrointestinal disease predisposing to GDV, and dogs with a first-order relative (parent or sibling) with a history of it.<ref name=Rawlings/>


Precautions that are likely to help prevent bloat include feeding small meals throughout the day instead of one big meal and not exercising immediately before or after a meal.<ref name=Wingfield>{{cite book | last = Wingfield | first = Wayne E. | title = Veterinary Emergency Medicine Secrets | publisher = Hanley & Belfus, Inc | year = 1997 | isbn = 1-56053-215-7 }}</ref>
Precautions that are likely to help prevent gastric dilatation-volvulus include feeding small meals throughout the day instead of one big meal, and not exercising immediately before or after a meal.<ref name=Wingfield>{{cite book | last = Wingfield | first = Wayne E. | title = Veterinary Emergency Medicine Secrets | publisher = Hanley & Belfus, Inc | year = 1997 | isbn = 978-1-56053-215-6 }}</ref>


==Prognosis==
==Prognosis==
[[File:Splenic necrosis.JPG|thumb|A necrotic spleen removed following splenectomy in a dog with GDV. The black/darker end is where the necrosis has occurred]]
Immediate treatment is the most important factor in a favorable prognosis. A delay in treatment greater than six hours or the presence of [[peritonitis]], [[sepsis]], [[hypotension]], or [[disseminated intravascular coagulation]] are negative prognostic factors.<ref name=Beck/>
Immediate treatment is the most important factor in a favorable prognosis. A delay in treatment greater than 6 hours or the presence of [[peritonitis]], [[sepsis]], [[hypotension]], or [[disseminated intravascular coagulation]] are negative prognostic indicators.<ref name=Beck/> Patients that lack the ability to walk are 4.4 times more likely to die. [[Comatose]] patients are 36 times more likely to die. Dogs that show depression when presented are three times more likely to die.<ref name="gdv"/>


Historically, GDV has held a guarded prognosis.<ref>{{cite web| url= http://marylandpetemergency.com/canine-bloat-gdv.html| website= marylandpetemergency.com| title= Canine Bloat: Gastric Dilatation and Volvulus (GDV): 'The Mother of All Emergencies'| publisher= Animal Emergency Hospital | access-date= October 15, 2017}}</ref> Although "early studies showed mortality rates between 33 and 68% for dogs with GDV," studies from 2007 to 2012 "reported mortality rates between 10 and 26.8%".<ref>{{cite journal| journal= Can Vet J | date= October 2014| volume= 55| number= 10| pages= 981–984| pmc= 4187373| title= Occurrence and recurrence of gastric dilatation with or without volvulus after incisional gastropexy| first1= John F.| last1= Przywara| first2= Steven B.| last2= Abel| first3= John T.| last3= Peacock| first4= Susan| last4= Shott| pmid=25320388}}</ref> Mortality rates approach 10 to 40% even with treatment.<ref name= "ASPCA bloat">{{cite web| url= http://www.aspca.org/pet-care/dog-care/bloat | title= Bloat| website= aspca.org| publisher= [[The American Society for the Prevention of Cruelty to Animals]]| archive-url= https://web.archive.org/web/20140701044216/http://www.aspca.org/pet-care/dog-care/bloat| url-status= dead| archive-date= July 1, 2014| access-date= 15 October 2017}}</ref> With prompt treatment and good preoperative stabilization of the patient, mortality is significantly lessened to 10% overall (in a referral setting).<ref name= "retro 306">{{cite journal | title = A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs | vauthors= Mackenzie G, Barnhart M, Kennedy S, DeHoff W, Schertel E| journal = [[Journal of the American Animal Hospital Association]] | volume = 46| number= 2 | date= March–April 2010 | pages = 97–102 | pmid= 20194364| doi= 10.5326/0460097}}</ref> Negative prognostic indicators following surgical intervention include postoperative [[cardiac arrhythmia]], [[splenectomy]], or splenectomy with partial [[gastric resection]]. A longer time from presentation to surgery was associated with a lower mortality, presumably because these dogs had received more complete preoperative fluid resuscitation, thus were better cardiovascularly stabilized prior to the procedure.<ref name= "retro 306" />
==Bloat in cattle==
In cattle, bloating is most often caused by the animal eating young and lush pasture, usually if the pasture has a high proportion of [[legumes]] ([[medick |medicks]], [[clover]] or lucerne ([[alfalfa]])).<ref>http://www.dpi.nsw.gov.au/__data/assets/pdf_file/0009/111411/bloat.pdf</ref>
Legumes contain foaming agents which trap air bubbles in the ruminant's [[rumen]] and prevent them from belching to relieve the pressure. This causes a build up of pressure in the rumen which manifests as an obvious swelling on the left side.
Signs of bloat in cattle are distended left abdomen, stopping of grazing, lethargy, appearing distressed, difficulty in urinating or defecating, rapid breathing and staggering.
In mild and moderate cases an antibloating agent will be administered orally or through a stomach tube and the ruminant should be exercised. In severe cases a wide bore [[trochar]] and [[cannula]] can be inserted into the rumen on the left flank to release the gas and liquid.<ref>[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/21705.htm Diseases of the Ruminant Forestomach : Bloat], Merck Veterinary Manual</ref>
In emergency cases of frothy bloat, this may not be enough and a 10–20&nbsp;cm incision may need to be made in the animal’s side and the froth manually removed. Veterinary care is then needed to clean and stitch the wound and administer an [[antibiotic]] to the animal.


Prognosis is guarded if the [[cardia]] is necrotic.<ref name="gdv"/> Many dogs are euthanised due to risks of performing surgery or inability to afford costly surgery and treatment.<ref name="gdv"/>
⚫
==References==
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{{Reflist|2}}


==External links==
==Epidemiology==
⚫
As a general rule, GDV is of greatest risk to deep-chested dogs. The five breeds at greatest risk are [[Great Dane]]s, [[Weimaraner]]s, [[St. Bernard (dog)|St. Bernards]], [[Gordon Setter]]s, and [[Irish Setter]]s.<ref name="glick94">{{cite journal |vauthors=Glickman L, Glickman N, Pérez C, Schellenberg D, Lantz G |title=Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs |journal=J. Am. Vet. Med. Assoc. |volume=204 |issue=9 |pages=1465–71 |year=1994 |pmid=8050972}}</ref> In fact, the lifetime risk for a Great Dane to develop GDV has been estimated to be close to 37%.<ref>{{cite journal |vauthors=Ward M, Patronek G, Glickman L |title=Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation-volvulus |journal=Prev. Vet. Med. |volume=60 |issue=4 |pages=319–29 |year=2003 |pmid=12941556 |doi=10.1016/S0167-5877(03)00142-9}}</ref> [[Poodle|Standard Poodle]]s are also at risk for this health problem,<ref name=Merck>{{cite web | title = Gastric Dilatation-volvulus | work = The Merck Veterinary Manual | year = 2006 | url = http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/23305.htm | access-date = 2007-04-17 }}</ref> as are [[Irish Wolfhound]]s, [[German Shorthaired Pointer]]s, [[German Shepherd]]s, and [[Rhodesian Ridgeback]]s. [[Basset Hound]]s and [[Dachshund]]s have the greatest risk for dogs less than {{convert|50|lb|abbr=on}}.<ref name=Aronson_2000/>
*[http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=672 ''Bloat The Mother of All Emergencies'' from The Pet Health Library]
*[http://www.canismajor.com/dog/bloat.html Dog Owner's Guide: Bloat]


==Society and culture==
⚫
[[Category:Dog diseases]]
*In the [[Marley and Me|novel]] and [[Marley & Me (film)|film]] ''Marley & Me'', Marley develops and ultimately dies of "bloat".<ref>{{cite web| last1= Lucas |first1= D|title='Bloat' refers to 2 different stomach ailments in pets|url=https://www.usatoday.com/story/life/pets/delawarepets/2014/06/16/bloat-refers-different-stomach-ailments-pets/10623801/|website=USA TODAY|access-date=2017-07-28|language=en|date=15 September 2014}}</ref>
[[Category:Bovine diseases]]
*In "[[Dog of Death]]," an episode of the animated TV series ''[[The Simpsons]]'', the family dog [[Santa's Little Helper]] develops a "twisted stomach", necessitating surgery.<ref>{{cite web|title=The Simpsons - 'Dog of Death'|url=http://cwsanfrancisco.cbslocal.com/2014/03/15/the-simpsons-dog-of-death/|website= cwsanfrancisco.cbslocal.com| publisher= KBCW/CBS Local|access-date=29 July 2017|date=15 March 2014}}</ref>


⚫
==References==
[[bs:Torzija želuca (veterina)]]
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{{Reflist|3}}
[[cs:Torze žaludku]]

[[de:Magendrehung]]
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[[Category:Dog diseases]]
[[fr:Retournement de l'estomac]]
[[it:Torsione dello stomaco]]
[[nl:Maagtorsie]]
[[pl:Skręt żołądka]]
[[pt:Síndrome da dilatação vólvulo-gástrica]]
[[tr:Gastrik dilatasyon volvulus]]

Latest revision as of 04:23, 9 August 2024

This article is about "bloat" in dogs. For other uses, see Bloat (disambiguation).
X-ray of a dog with GDV. The "double bubble" pattern indicates that stomach torsion has occurred.
X-ray from the underside of a dog with GDV. The dark area is the buildup of gas.

Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs and rarely cats and guinea pigs,[1] in which the stomach becomes overstretched and rotated by excessive gas content. The condition also involves compression of the diaphragm and caudal vena cavae. The word bloat is often used as a general term to mean gas distension without stomach torsion (a normal change after eating), or to refer to GDV.

GDV is a life-threatening condition in dogs that requires prompt treatment. It is common in certain breeds; deep-chested breeds are especially at risk. Mortality rates in dogs range from 10 to 60%, even with treatment.[2] With surgery, the mortality rate is 15 to 33 percent.[3]

Symptoms

[edit]

Symptoms are not necessarily distinguishable from other kinds of distress. A dog might stand uncomfortably and seem to be in extreme discomfort for no apparent reason. Other possible symptoms include firm distension of the abdomen, weakness, depression, difficulty breathing, hypersalivation, and retching without producing any vomitus (nonproductive vomiting). Many dogs with GDV have cardiac arrhythmias (40% in one study).[4] Chronic GDV in dogs, include symptoms such as loss of appetite, vomiting, and weight loss.[5] Hypovolaemia may occur and in severe cases hypovolaemic shock and hypoperfusion.[1]

Blood dyscrasias have been identified in patients with GDV. Haemological conditions that may be identified include: neutrophilic leukocytosis, lymphopaenia, leukopaenia, thrombocytopaenia, and haemoconcentration. Other conditions include: hepatocelluar damage, cholestasis, azotemia and hypokalaemia.[1]

Causes

[edit]

Gastric dilatation volvulus is multifactorial without any one cause being identified, but in all cases the immediate prerequisite is a dysfunction of the sphincter between the esophagus and stomach and an obstruction of outflow through the pylorus.[6][1]

Hypergastrinaemia has been hypothesised as a cause of GDV. Pyloric hypertrophy as a result of hypergastrinaemia was presumed to cause pyloric outflow obstruction, retarding gastric emptying. Studies have not found evidence to support this theory.[1] One study found no association between pyloric hypertrophy and GDV.[7]

Impairment of gastric myoelectricity retarding gastric emptying has been hypothesised as a cause of GDV. Currently no study has identified an association between gastric myoelectricity and GDV.[1]

Risk factors

[edit]

Dog breeds that have a higher depth to width ratio of the thorax are significantly more likely to acquire GDV than other breeds. If there is a family history of the condition the risk is even more severe, highlighting a heritability to the predisposing factors. Body weight is a factor with obese dogs being less likely to develop GDV than healthy or underweight dogs.[1]

Stress is known to impair gastrointestinal function. Stress has been identified as a risk factor for GDV, the exact manner for this is not currently known.[1][8]

Other risk factors include: nasal mite infection;[9] gastrointestinal disease;[10] and inflammatory bowel disease, with 61% of dogs with GDV having inflammatory bowel disease identified via biopsy in one study.[11]

The breeds most likely to develop GDV are the Great Dane (10 times more likely), Weimaraner (4.6) St Bernard (4.2) and the Irish Setter (3.5).[12] Other breeds with a predisposition include the Irish Wolfhound, Borzoi, English Mastiff, Akita, Bull Mastiff, pointing dogs, Bloodhound, Grand Bleu de Gascogne and the standard Poodle.[1] The Great Dane has been found to have a lifetime risk of 42.4% in one study,[10] which has led to the Great Dane being the focus of investigations into causes and risk factors for GDV.[1] One study has found certain alleles of the DLA88, DRB1 and TLR5 genes, which are part of the canine immune system, to predispose a dog to GDV.[13] Further studies have associated these alleles with greater diversity in the gut microbiome and an increased risk of GDV.[14]

GDV has been reported across the age range in dogs. It is more likely to occur in older dogs but is not a geriatric disease and the risk plateaus after the first 2–4 years for large dogs.[1]

Dietary factors

[edit]

One common recommendation in the past has been to raise the food bowl of dogs when they eat, but this was shown to increase the risk in one study.[15] Eating only once daily[16] and eating food consisting of particles less than 30 mm (1.2 in) in size also has been shown increase the risk of GDV.[17] One study looking at the ingredients of dry dog food found that while neither grains, soy, nor animal proteins increased risk of bloat, foods containing an increased amount of added oils or fats do increase the risk, possibly owing to delayed emptying of the stomach.[18]

Pathophysiology

[edit]

The exact pathophysiology is not understood. It is still unknown what order the condition occurs: whether dilatation or volvulus occurs first.[1]

The stomach twists around the longitudinal axis of the digestive tract, also known as volvulus.[6] The most common direction for rotation is clockwise, viewing the animal from behind. The stomach can rotate up to 360° in this direction and 90° counterclockwise. If the volvulus is greater than 180°, the esophagus is closed off, thereby preventing the animal from relieving the condition by belching or vomiting.[19] The results of this distortion of normal anatomy and gas distension include hypotension (low blood pressure), decreased return of blood to the heart, ischemia (loss of blood supply) of the stomach, and shock. Pressure on the portal vein decreases blood flow to liver and decreases the ability of that organ to remove toxins and absorbed bacteria from the blood.[20] Rotations of up to 360° have been reported but typically rotations stop around 270°.[1]

Diagnosis

[edit]
Bloat in a dog, with "double-bubble" sign

A diagnosis of GDV is made by several factors. The breed and history often gives a significant suspicion of the condition, and a physical examination often reveals the telltale sign of a distended abdomen with abdominal tympany. Shock is diagnosed by the presence of pale mucous membranes with poor capillary refill, increased heart rate, and poor pulse quality. Radiographs (X-rays), usually taken after decompression of the stomach if the dog is unstable, shows a stomach distended with gas. The pylorus, which normally is ventral and to the right of the body of the stomach, is cranial to the body of the stomach and left of the midline, often separated on the X-ray by soft tissue and giving the appearance of a separate gas-filled pocket (double-bubble sign).[5]

Treatment

[edit]

Patients with GDV need to be stabilised as soon as possible. Perfusion and blood pressure need to be normalised before any further treatment can be performed. Analgesia should also be provided.[1]

Patients require intravenous fluid therapy with saline. Colloid fluids may be required if the patient does not respond well to the crystalloid solution. Antiarrhythmic drugs should be administered after starting fluid therapy to stabilise blood pressure. Other drugs such as dobutamine should be provided if blood pressure fails to normalise, only as a last resort. Other vasopressors can be used such as ephedrine, phenylephrine, and epinephrine.[1]

Percutaneous decompression is the easiest method of treating GDV. A large catheter is inserted into the gastric lumen. If done incorrectly the spleen may be lacerated or punctured. Potentially the content of the stomach may leak if the procedure is performed incorrectly.[1]

Orogastric intubation is another method for treatment. An orogastric tube is entered into the stomach via the oesophageal sphincter, tepid water is sent as a bolus through the tube into the stomach to lavage it. Fluid should be regurgitated up the tube. If it is not then a stomach perforation has likely occurred.[1]

To restore the stomach to the normal position an exploratory laparotomy (explap) is needed. Sometimes a gastrectomy may be required. During the explap the stomach is rotated up to 360° to put it back into the right position, although typically such extreme rotation is not needed. Pulling on the pylorus allows for the stomach to be repositioned. Sometimes the dilatation is serious enough that the stomach requires further decompression before repositioning. Other organs of the digestive system are assessed during the procedure. Splenectomy may be required. Gastropexy involves suturing the pyloric antrum to the abdominal wall to prevent recurrence of GDV. Patients that do not receive a gastropexy have a high likelihood of GDV recurrence with one study finding 80% of dogs that suffered a GDV but did not undergo a gastropexy having GDV reoccur.[1]

Prevention

[edit]

Recurrence of GDV attacks can be a problem, occurring in up to 80% of dogs treated medically only (without surgery).[21] To prevent recurrence, at the same time the bloat is treated surgically, a right-side gastropexy is often performed, which by a variety of methods firmly attaches the stomach wall to the body wall, to prevent it from twisting inside the abdominal cavity in the future. While dogs that have had gastropexies still may develop gas distension of the stomach, a significant reduction in recurrence of gastric volvulus is seen. Of 136 dogs that had surgery for gastric dilatation-volvulus, six that did have gastropexies had a recurrence, while 74 (54.5%) of those without the additional surgery recurred.[22] Gastropexies are also performed prophylactically in dogs considered to be at high risk of GDV, including dogs with previous episodes or with gastrointestinal disease predisposing to GDV, and dogs with a first-order relative (parent or sibling) with a history of it.[21]

Precautions that are likely to help prevent gastric dilatation-volvulus include feeding small meals throughout the day instead of one big meal, and not exercising immediately before or after a meal.[23]

Prognosis

[edit]
A necrotic spleen removed following splenectomy in a dog with GDV. The black/darker end is where the necrosis has occurred

Immediate treatment is the most important factor in a favorable prognosis. A delay in treatment greater than 6 hours or the presence of peritonitis, sepsis, hypotension, or disseminated intravascular coagulation are negative prognostic indicators.[3] Patients that lack the ability to walk are 4.4 times more likely to die. Comatose patients are 36 times more likely to die. Dogs that show depression when presented are three times more likely to die.[1]

Historically, GDV has held a guarded prognosis.[24] Although "early studies showed mortality rates between 33 and 68% for dogs with GDV," studies from 2007 to 2012 "reported mortality rates between 10 and 26.8%".[25] Mortality rates approach 10 to 40% even with treatment.[26] With prompt treatment and good preoperative stabilization of the patient, mortality is significantly lessened to 10% overall (in a referral setting).[27] Negative prognostic indicators following surgical intervention include postoperative cardiac arrhythmia, splenectomy, or splenectomy with partial gastric resection. A longer time from presentation to surgery was associated with a lower mortality, presumably because these dogs had received more complete preoperative fluid resuscitation, thus were better cardiovascularly stabilized prior to the procedure.[27]

Prognosis is guarded if the cardia is necrotic.[1] Many dogs are euthanised due to risks of performing surgery or inability to afford costly surgery and treatment.[1]

Epidemiology

[edit]

As a general rule, GDV is of greatest risk to deep-chested dogs. The five breeds at greatest risk are Great Danes, Weimaraners, St. Bernards, Gordon Setters, and Irish Setters.[12] In fact, the lifetime risk for a Great Dane to develop GDV has been estimated to be close to 37%.[28] Standard Poodles are also at risk for this health problem,[19] as are Irish Wolfhounds, German Shorthaired Pointers, German Shepherds, and Rhodesian Ridgebacks. Basset Hounds and Dachshunds have the greatest risk for dogs less than 50 lb (23 kg).[2]

Society and culture

[edit]

References

[edit]
  1. ^ a b c d e f g h i j k l m n o p q r s t u Monnet, Eric; Mazzaferro, Elisa M (2023-05-31). "Gastric dilatation volvulus syndrome". Small Animal Soft Tissue Surgery. Hoboken, NJ: John Wiley & Sons. pp. 53–74. ISBN 978-1-119-69368-0.
  2. ^ a b Aronson, Lillian R.; Brockman, Daniel J.; Brown, Dorothy Cimino (2000). "Gastrointestinal Emergencies". The Veterinary Clinics of North America. 30 (1): 558–569. doi:10.1016/s0195-5616(00)50039-4. PMC 1374121. PMID 10853276.
  3. ^ a b Beck J, Staatz A, Pelsue D, Kudnig S, MacPhail C, Seim H, Monnet E (2006). "Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992-2003)". J. Am. Vet. Med. Assoc. 229 (12): 1934–9. doi:10.2460/javma.229.12.1934. PMID 17173533.
  4. ^ Brockman D, Washabau R, Drobatz K (1995). "Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992)". J. Am. Vet. Med. Assoc. 207 (4): 460–4. PMID 7591946.
  5. ^ a b Fossum, Theresa W. (2006). "Gastric Dilatation Volvulus: What's New?" (PDF). Proceedings of the 31st World Congress. World Small Animal Veterinary Association. Retrieved 2007-04-17.
  6. ^ a b Parton A, Volk S, Weisse C (2006). "Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus". J. Am. Vet. Med. Assoc. 228 (12): 1895–900. doi:10.2460/javma.228.12.1895. PMID 16784379.
  7. ^ GREENFIELD, CATHY L.; WALSHAW, RICHARD; THOMAS, MICHAEL W. (1989). "Significance of the Heineke‐Mikulicz Pyloroplasty in the Treatment of Gastric Dilatation‐Volvulus A Prospective Clinical Study". Veterinary Surgery. 18 (1). Wiley: 22–26. doi:10.1111/j.1532-950x.1989.tb01038.x. ISSN 0161-3499.
  8. ^ Elwood, C. M. (1998). "Risk factors for gastric dilatation in Irish setter dogs". Journal of Small Animal Practice. 39 (4): 185–190. doi:10.1111/j.1748-5827.1998.tb03627.x. ISSN 0022-4510.
  9. ^ Bredal, W.P. (1998). "Pneumonyssoides caninum infection--a risk factor for gastric dilatation-volvulus in dogs". Veterinary Research Communications. 22 (4). Springer Science and Business Media LLC: 225–231. doi:10.1023/a:1006083013513. ISSN 0165-7380.
  10. ^ a b Glickman L, Glickman N, Schellenberg D, Raghavan M, Lee T (2000). "Incidence of and breed-related risk factors for gastric dilatation-volvulus in dogs". J. Am. Vet. Med. Assoc. 216 (1): 40–5. doi:10.2460/javma.2000.216.40. PMID 10638316.
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