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Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs in which the
stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
becomes overstretched and rotated by excessive
gas Gas is one of the four fundamental states of matter (the others being solid, liquid, and plasma). A pure gas may be made up of individual atoms (e.g. a noble gas like neon), elemental molecules made from one type of atom (e.g. oxygen), or ...
content. 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 rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of de ...
s in dogs range from 10 to 60%, even with treatment. With surgery, the mortality rate is 15 to 33 percent.


Symptoms

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 The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...
, weakness, depression, difficulty breathing, hypersalivation, and retching without producing any vomitus (nonproductive vomiting). Many dogs with GDV have cardiac
arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
s (40% in one study). Chronic GDV in dogs, include symptoms such as loss of appetite, vomiting, and weight loss.


Causes

Gastric dilatation volvulus 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 The pylorus ( or ), or pyloric part, connects the stomach to the duodenum. The pylorus is considered as having two parts, the ''pyloric antrum'' (opening to the body of the stomach) and the ''pyloric canal'' (opening to the duodenum). The ''pylori ...
. Some of the more widely acknowledged factors for developing GDV include increased age, breed, having a deep and narrow chest, 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. The risk of bloat in dogs perceived as happy by their owners is decreased, and increased in dogs perceived as fearful. This may be owing to the
physiological Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
effects of the dog's personality on the function and motility of the gastrointestinal system. Alternatively, the dogs may become unhappy/uncomfortable as a consequence of the conditions that lead up to exhibiting bloat. Dogs with
inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as well ...
may be at an increased risk for bloat.


Dietary factors

One common recommendation in the past has been to raise the food bowl of dogs when they eat, but this may actually increase the risk of GDV. Eating only once daily and eating food consisting of particles less than in size also may increase the risk of GDV. 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.


Pathophysiology

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. 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. 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 Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emerge ...
. 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. 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 Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
, peritonitis, and death by
toxic shock Toxic shock syndrome (TSS) is a condition caused by bacterial toxins. Symptoms may include fever, rash, skin peeling, and low blood pressure. There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelit ...
.


Diagnosis

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 Tympany or tympanites (sometimes tympanism or tympania), also known as meteorism (especially in humans), is a medical condition in which excess gas accumulates in the gastrointestinal tract and causes abdominal distension. The term is from the Gr ...
. Shock is diagnosed by the presence of pale
mucous membrane A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It is ...
s with poor
capillary A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...
refill, increased heart rate, and poor pulse quality.
Radiographs Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...
(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 Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
and to the right of the body of the stomach, is
cranial Standard anatomical terms of location are used to unambiguously describe the anatomy of animals, including humans. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position prov ...
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).


Treatment

Gastric dilatation volvulus is an emergency medical condition; having the animal examined by a veterinarian is imperative. GDV can become fatal within a matter of minutes. Treatment usually involves resuscitation with intravenous fluid therapy, usually a combination of isotonic fluids and hypertonic saline or a
colloid A colloid is a mixture in which one substance consisting of microscopically dispersed insoluble particles is suspended throughout another substance. Some definitions specify that the particles must be dispersed in a liquid, while others extend ...
al solution such as
hetastarch Hydroxyethyl starch (HES/HAES), sold under the brand name Voluven among others, is a nonionic starch derivative, used as a volume expander in intravenous therapy. The use of HES on critically ill patients is associated with an increased risk of d ...
, and emergency surgery. The stomach is initially decompressed by passing a stomach tube, or if that is not possible, trocars 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 to reduce the chances of infection. During surgery, the stomach is placed back into its correct position, and the abdomen is examined for any devitalized tissue (especially the stomach and spleen). A partial gastrectomy may be necessary if any necrosis of the stomach wall occurs.


Prevention

Recurrence of GDV attacks can be a problem, occurring in up to 80% of dogs treated medically only (without surgery). To prevent recurrence, at the same time the bloat is treated surgically, a right-side
gastropexy Gastropexy is a surgical operation in which the stomach is sutured to the abdominal wall or the diaphragm. Gastropexys in which the stomach is sutured to the diaphragm are sometimes performed as a treatment of GERD to prevent the stomach from mo ...
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. 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. 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.


Prognosis

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 Sepsis, formerly known as septicemia (septicaemia in British English) or blood poisoning, is a life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs. This initial stage is follo ...
, hypotension, or disseminated intravascular coagulation are negative prognostic indicators. Historically, GDV has held a guarded prognosis. 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%". Mortality rates approach 10 to 40% even with treatment. With prompt treatment and good preoperative stabilization of the patient, mortality is significantly lessened to 10% overall (in a referral setting). Negative prognostic indicators following surgical intervention include postoperative
cardiac arrhythmia Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
,
splenectomy A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal o ...
, or splenectomy with partial
gastric resection The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach is ...
. 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.


Epidemiology

As a general rule, GDV is of greatest risk to deep-chested dogs. The five breeds at greatest risk are Great Danes,
Weimaraner The Weimaraner ( ) is a large dog that was originally bred as a hunting dog in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear and deer. As the popularity of large game hunting began t ...
s, St. Bernards,
Gordon Setter The Gordon Setter is a large breed of dog, a member of the setter family that also includes both the better-known Irish Setter and the English Setter. Setter breeds are classified as members of either the Sporting or Gundog Group depending on ...
s, and
Irish Setter The Irish Setter ( ga, sotar rua, literally "red setter") is a setter, a breed of gundog, and family dog. The term ''Irish Setter'' is commonly used to encompass the show-bred dog recognised by the American Kennel Club as well as the field-bred ...
s. In fact, the lifetime risk for a Great Dane to develop GDV has been estimated to be close to 37%. Standard Poodles are also at risk for this health problem, as are Irish Wolfhounds,
German Shorthaired Pointer The German Shorthaired Pointer (GSP) is a medium to large sized breed of pointing dog developed in the 19th century in Germany for hunting. A versatile hunting breed, being an all-purpose gun dog suitable for both land and water, they are stream ...
s, German Shepherds, and Rhodesian Ridgebacks.
Basset Hound The Basset Hound is a short-legged breed of dog in the hound family. The Basset is a scent hound that was originally bred for the purpose of hunting hare. Their sense of smell and ability to ''ground-scent'' is second only to the Bloodhound.Hart ...
s and
Dachshund The dachshund ( or ; German: "badger dog"), also known as the wiener dog, badger dog, and sausage dog, is a short-legged, long-bodied, hound-type dog breed. The dog may be smooth-haired, wire-haired, or long-haired, and comes in a variety of ...
s have the greatest risk for dogs less than .


Society and culture

*In the novel and film ''Marley & Me'', Marley develops and ultimately dies of "bloat". *In "
Dog of Death "Dog of Death" is the nineteenth episode of the third season of the American animated television series ''The Simpsons''. It originally aired on the Fox network in the United States on March 12, 1992. In the episode, Santa's Little Helper falls il ...
," an episode of the animated TV series ''
The Simpsons ''The Simpsons'' is an American animated sitcom created by Matt Groening for the Fox Broadcasting Company. The series is a satirical depiction of American life, epitomized by the Simpson family, which consists of Homer Simpson, Homer, Marge ...
'', the family dog
Santa's Little Helper Santa's Little Helper is a fictional dog in the American animated television series ''The Simpsons''. He is the pet greyhound of the Simpson family. He was previously voiced by Frank Welker, and is currently voiced by Dan Castellaneta. The dog ...
develops a "twisted stomach", necessitating surgery.


References

{{Reflist, 3 Dog diseases