Gastric Dilatation/Volvus Syndrome In Dogs

Overview

Gastric dilatation is a condition that can develop in many different breeds of dogs. The condition is commonly associated with large meals and causes the stomach to dilate because of food and gas and may get to a point where neither may be expelled. As the stomach begins to dilate and expand, the pressure in the stomach begins to increase. The increased pressure and size of the stomach may have several severe consequences, including preventing adequate blood return to the heart from the abdomen, loss of blood flow to the lining of the stomach, and rupture of the stomach wall. As the stomach expands, it may also put pressure on the diaphragm preventing the lungs from adequately expanding, which leads to decreased ability to maintain normal breathing (ventilation).

 

A lateral radiograph of a dog with a gastric volvulus. Note the stomach is markedly distended with gas (which shows up as black on the radiograph) and the stomach is occupying nearly the entire abdomen.

 

The entire body suffers from the poor ventilation leading to death of cells in many tissues. Additionally, the stomach can become dilated enough to rotate in the abdomen, a condition called volvulus. The rotation can occasionally lead to blockage to the blood supply to the spleen and the stomach wall requiring surgical removal of the dead tissues. Most of these patients are in shock due to the effects on the entire body. The treatment of this condition involves stabilization of the patient, decompression of the stomach and surgery to return the stomach to the normal position permanently (gastropexy) and evaluate abdominal organs for damage and treat them appropriately as determined at the time of surgery.

 

Another image of a dog with GDV/Bloat

 

 

 

 

Causes

Several studies have been published that have evaluated risk factors and causes for gastric dilatation and volvulus in dogs. This syndrome is not completely understood; however, we know that there is an association in dogs that have a deep chest (increased thoracic height to width ratio), dogs that are fed a single large meal once daily, older dogs and dogs that are related to other dogs that have had the condition. Additionally, it has been suggested that elevated feeding, dogs that have previously had a spleen removed, large or giant breed dogs, and stress may result in an increased incidence of this condition. A 2006 study also determined that dogs fed dry dog foods that list oils (e.g. sunflower oil, animal fat) among the first four label ingredients predispose a high risk dog to GDV.

 

 

Incidence and Prevalence

Several studies have been published that have evaluated risk factors and causes for gastric dilatation and volvulus in dogs. This syndrome is not completely understood; however, we know that there is an association in dogs that have a deep chest (increased thoracic height to width ratio), dogs that are fed a single large meal once daily, older dogs and dogs that are related to other dogs that have had the condition. Additionally, it has been suggested that elevated feeding, dogs that have previously had a spleen removed, large or giant breed dogs, and stress may result in an increased incidence of this condition. A 2006 study also determined that dogs fed dry dog foods that list oils (e.g. sunflower oil, animal fat) among the first four label ingredients predispose a high risk dog to GDV.

 

Signs and Symptoms

Initial signs are often associated with abdominal pain. These can include but are not limited to:

  • an anxious look or looking at the abdomen
  • standing and stretching
  • drooling
  • distending abdomen
  • retching without producing anything

As the disease progresses, the animal may begin to pant, have abdominal distension, or be weak and collapse and be recumbent. On physical examination, patients often have elevated heart and respiratory rates, have poor pulse quality, and have poor capillary refill times. Abdominal distension is commonly noted.

 

 

Treatment Options

Stabilization of the patient is paramount and often begins with intravenous fluids and oxygen therapy. Gastric decompression often follows, which includes the passing of a tube down the esophagus into to stomach to release the air and fluid accumulation and can be frequently followed with lavage (flushing of water) into and out of the stomach to remove remaining food particles. In certain cases this is not possible and a needle or catheter may be placed into the stomach from outside the body to release air and aid in the passing of the tube. The time for general anesthesia and surgical stabilization will be determined by the stability of your pet and at the discretion of the surgeon. Surgery involves full exploration of the abdomen and de-rotation of the stomach. Additionally, the viability of the stomach wall, the spleen, and all other organs will be determined. Removal of part of the stomach wall (partial gastrectomy) or the spleen (splenectomy) is occasionally performed. Once the stomach is returned to the normal position in the abdomen, it should be fixed to the body wall (gastropexy).

 

A gastropexy. Note that the stomach has been sutured to the abdominal wall in order to prevent it from expanding and twisting again.

 

Courtesy:  ACVS