If dog is diagnosed with bloat, take care immediately
By Bruno Massat, DVM, DACVS, DECVS, CCRP
Friday, May 8, 2009
Published in the "Your Pet" column of The Nashua Telegraph.
The column runs on the second and fourth Fridays of each month.
Owners of Great Danes are all too familiar with the syndrome of gastric dilatation and volvulus in simple terms a "twisted stomach."
Also known as bloat because of the abdominal distension usually present, it is one of the most serious emergencies in dogs, with a mortality rate of 30 percent. Bloat is more common in large or giant purebreds, but any dog can be affected. The six common breeds with the highest risk are Great Dane, Weimaraner, Saint Bernard, Gordon and Irish setters, and standard poodle. Increasing age and body type, such as having a deep and narrow chest, are other risk factors. Overeating, eating under stress (such as competition between dogs to get to the food), exercising after a meal or once-a-day feeding also increase the risk of GDV.
Bloating should be considered in any dog with sudden abdominal distension, listlessness and retching. It occurs when normal gas cannot escape the stomach. The triggering mechanism is unknown. As the stomach becomes distended, it can twist. The enlarged stomach applies pressure on the abdominal large veins, decreasing the amount of blood returning to the heart and impairing tissue blood perfusion. The pressure applied on the diaphragm and the lungs causes respiratory distress. When blood supply to the stomach is cut off, it can rupture, creating contamination of the abdominal cavity with ingested food and gastric secretions. The result of this cascade of events is "shock," failure of all major organs and death. If you have the slightest doubt that your dog is bloating, seek emergency care immediately!
The diagnosis of bloating is usually straightforward. Abdominal radiographs are taken for confirmation. The first goal of the emergency veterinarian is to provide gastric decompression. The preferred method is careful introduction of a tube through the mouth within the stomach cavity for evacuation of gas, fluid and partially digested food. If not feasible because the stomach opening is too tied secondary to the torsion, decompression with a large needle may be required.
The second simultaneous goal is to restore an adequate amount of circulating fluid within the vascular system to improve organ function. This is achieved by IV injection of large quantities of fluids, whose type and composition will also correct for anomalies in blood electrolyte content and acidity.
Finally, when the patient is more stable for general anesthesia, surgery is performed. The surgeon first repositions the stomach in a normal position. Viability of its wall is assessed and a partial resection may be required. Stapling surgical instruments are used to decrease surgical time.
Alternately, in case of extensive stomach necrosis, rupture and abdominal contamination, a humane intra-operative euthanasia may be preferable. The next step is to evaluate the blood supply to the spleen. Because of its proximity to the stomach, it can also be compromised by a GDV. Fortunately, the spleen is not a vital organ, which may be removed safely. The last part is to suture the stomach to the inside body wall to hopefully prevent recurrence of twisting in case of possible future bloating, a procedure called a gastropexy.
The patient is then allowed to recover in the ICU for continuous care, monitoring and administration of medications. One particular emphasis is the control of postoperative pain. Postoperative complications are possible – irregular heartbeat, coagulation problem and peritonitis, to name a few – and hospitalization is required for at least 48 hours.
So, if you are the owner of a dog predisposed to bloating, I recommend the following measures:
• Minimize the risk of occurrence by feeding smaller and more frequent meals in a stress-free environment. No exercise immediately after eating.
• Be aware of the clinical signs of bloating and, if suspected, seek medical help immediately.
• With the help of your veterinarian, make contingency plans for after-hour emergency care.
• Consider a prophylactic gastropexy, a procedure performed ahead of time to prevent twisting of the stomach in case of bloating; the anesthesia at the time of spaying or neutering is a perfect opportunity. The procedure can be done laparoscopically in a minimally invasive way.
• Treatment of bloating is expensive and a pet insurance helps.
The optimistic view of a disease with a mortality rate of 30 percent is the survival rate of 70 percent. But to be on the correct side of the math, immediate and aggressive treatment is imperative. When it comes to treating GDV, there's no time for hesitation.
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