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Bloat (GDV) in Your Dog - Treatment
Gastric dilatation and volvulus (GDV) is commonly known as bloat. This article is intended to help pet owners understand the treatment that your veterinarian will recommend if your dog ever suffers from this condition.
When a dog bloats, the stomach fills with air and twists around itself. This causes several problems for your pet. The blood flow to the stomach is restricted, which leads to tissue damage in the lining and the wall of the stomach. If the blood flow is not restored in time, sections of the stomach can die.
When the stomach twists, gas is no longer able to exit either to the esophagus or small intestines. This leads to severe distention of the stomach which presses on the major blood vessels that pass between the front and the rear of the body. This impedes circulation and leads to shock.
A companion article about the symptoms and diagnosis of GDV can be found at this link.
When You First Arrive
When you first arrive at the veterinary hospital, the staff may need to walk or carry your dog to their triage or treatment area. You will probably not be able to accompany your dog at this point, but keep in mind that the technicians and doctors are doing their best to provide your pet with the care he needs.
If your dog has symptoms that suggest bloat as a likely diagnosis, the staff may ask you for permission to take an x-ray or start an intravenous (IV) catheter. The doctor will typically examine your dog, determine the initial treatment plan, and will then leave the technicians to work while she comes to speak with you.
Stabilization - What Does That Mean?
One of the main goals for any emergency patient is stabilization. If something is stable, it means that it is not changing or fluctuating, and that everything in a system is in homeostasis. In a medical emergency, a patient's condition can deteriorate quickly, with a decreasing blood pressure, increasing heart rate, changing respiratory patterns, loss of consciousness, increase or decrease in temperature, or ongoing hemorrhage.
When the medical staff says that they are trying to stabilize your dog, the goal is to limit these abnormal changes in the body to return the pet's functions to a normal state. With a condition like bloat, it is unlikely that your dog will be completely stable until the twisted stomach is returned to a normal position. However, even some degree of stabilization can improve your pet's chances of survival.
To stabilize a dog with GDV, there are two important factors to address:
- IV catheter(s) and fluid support
- Decreasing stomach pressure
Most emergency hospitals will place two IV catheters in a dog with bloat. A catheter is a small tube that feeds into a vein and will typically be placed into a front leg. The veterinarian will start your dog on fluids to support the blood pressure and oxygen delivery to the cells of the body. Medications such as a narcotic for pain relief and an antibiotic may be given at this time.
Two Options to Decrease Stomach Pressure
When the stomach is severely distended with gas in a case of GDV, this puts pressure on the large blood vessels that travel from the back to the front of the pet's body. The distention can also contribute to damage of the wall and lining of the stomach.
There are two techniques that can be used to decrease the stomach pressure to help to stabilize your dog. The simplest is called trocharization. In this procedure, the veterinarian will shave a patch of fur on your dog's side. Since the stomach is severely enlarged, it will be pressed up against the body wall of your dog and will be directly beneath the skin. The vet will clean the skin and then puncture the skin and stomach with a needle. The vet will hold the needle in place while stomach gas flows out.
The other technique that can relieve stomach pressure is to pass a large tube into the mouth and down into the stomach. While this can sometimes be done while the pet is awake, many dogs do not tolerate this and require sedation. Additionally, with the stomach twisted, it can be difficult to get the tube to pass from the esophagus to the stomach until the stomach can be untwisted at surgery.
Many emergency veterinarians will trocharize the stomach first and will then sedate the dog for surgery, passing the stomach tube once the pet has been heavily sedated or anesthetized.
Diagnostic Tests and Bloat
What Does This Evaluate?
Confirms the diagosis of GDV
Complete Blood Count (CBC)
Red blood cells, white blood cells, platelets
Blood Chemistry Profile
Liver, kidneys, blood glucose, proteins
Sodium, potassium - helps to guide fluid treatment
Tissue perfusion, some relevance to prognosis
Coagulation Tests (PT, PTT, ACT)
Blood clotting ability, can relate to complications
Kidney function, diabetes, dehydration
Why Is My Vet Recommending Other Tests?
Each dog that presents to the hospital is a little different. However, there are a few diagnostic tests that most veterinarians will recommend in the course of treatment. The table above outlines the importance and purposes of some of these tests.
The complete blood count (CBC), chemistry panel, and electrolytes are recommended by veterinarians for any sick animal before anesthesia. Your regular vet may send blood samples to an outside laboratory for this type of testing, but an emergency facility will be able to evaluate these parameters on-site.
A new type of blood test known as a lactate level has garnered a lot of interest in dogs with bloat. Initial studies showed that the lactate level could help predict your dog's prognosis. A higher lactate level was correlated to a more seriously diseased stomach and a higher mortality rate. This information has been refined in more recent studies, and research is ongoing. Currently, it is thought to be helpful to measure the lactate level before and then after stabilization. If the lactate level is low to start with, or if it decreases with stabilization, then there is generally a lower risk of stomach damage and a better prognosis for recovery.
Coagulation tests are often performed on dogs with GDV. This helps to evaluate your pet for a dangerous state known as disseminated intravascular coagulation (DIC). A discussion of DIC is beyond the scope of this article, but more information can be found at this link.
Additional diagnostics, such as a series of chest x-rays or a urinalysis, may give your veterinarian more information about the general health of your dog, but are not always performed due to the urgency of the situation.
Definitive Treatment - Yes, It's Surgery
Even with stabilization, your dog still has a serious medical condition. In most cases of GDV, the stomach will remain twisted through these initial treatment efforts. Ultimately, your dog will need anesthesia and surgery to address this.
Your veterinarian will place your dog under anesthesia and will prepare him for surgery. Modern anesthetic protocols are very safe and often combine a gas anesthetic with injectable drugs. You should speak with the veterinarian caring for your dog if you have questions about the specific protocol. With any anesthesia, there are always risks, and these risks may be increased in a dog suffering from shock or other complications from bloat.
What Is The Goal of Surgery?
There are three main goals of bloat surgery.
- The stomach needs to be untwisted and emptied.
- The stomach viability needs to be assessed.
- The stomach needs to be tacked in place to prevent recurrence.
While a few dogs' stomachs will spontaneously untwist, this can be difficult to determine until the stomach can be seen at surgery. If your dog is lucky enough to have the stomach return to the correct position, there is a high risk that the stomach will twist again. What if you're not home to get your dog help the next time it happens?
In surgery, the veterinarian will grasp one side of the stomach and will gently pull in the appropriate direction until the stomach flips back into place. If a stomach tube could not be introduced earlier, it will be done at this point. A technician will usually use a stomach pump to remove food, gas, liquid, or sometimes foreign material from your dog. If there is a large piece of foreign material that cannot fit through the tube, the veterinarian may need to make an incision into the stomach to remove it.
After the stomach has been returned to the correct position, it is assessed for viability. This means that the surgeon will try to determine if the wall of the stomach has been too damaged to survive.
If the veterinarian believes that a section of the stomach is not going to survive, then that portion will have to be removed. Dogs with a greater amount of stomach damage have a worse prognosis than those in which less or no stomach resection is required. However, if unhealthy tissue is left in place, it can lead to stomach rupture several days later, which is almost always fatal.
In severe cases of bloat, the spleen can also twist beside the stomach. If this has happened, your dog will need its spleen removed. Even if the spleen has not been twisted for a long time, it increases the risk of complications if it is untwisted and left inside.
The final step in bloat surgery is to tack the stomach into place so that it cannot rotate again. This procedure is called a gastropexy.
There are several gastropexy techniques that can be performed. They all involve some variation of creating an incision on the exterior surface of the stomach and the interior surface of the rib muscles and then suturing (stitching) those two incisions together. Once the body heals this internal incision, the scar tissue remains and holds the stomach fixed to the body wall.
Some of the names of the different techniques are incisional gastropexy, belt-loop gastropexy, or circumcostal gastropexy.
For dogs of high-risk breeds, this procedure can even be performed in a non-emergent setting to prevent them from developing GDV. The video below shows this surgery being done via laparoscopy, in which tiny incisions are used with small cameras and specially designed instruments. Not all veterinary facilities will have this option available, but it is becoming more popular.
Prophylactic Laparoscopic Gastropexy
After surgery, a dog with bloat will be monitored for complications for at least 48 hours. These can include irregular heart rhythms and regurgitation. DIC is still a concern, especially for dogs in which a portion of the stomach was removed.
Minor complications can be similar to those for any abdominal surgery, such as infections, swelling or bruising of the incision, or licking at the incision.
Your pet will need to be on pain medications as well, and the veterinary hospital can deliver stronger doses in the hospital than you will be able to give at home.
A dog with GDV can typically come home from the hospital in 2 - 3 days if there are no complications. Your veterinarian should send your pet home with written instructions that outline your pet's individual home care.
In general, you will have to monitor the incision and your pet's overall demeanor and appetite. Rest is required to allow the abdominal muscles and skin to heal. Common medications prescribed may include antibiotics, pain relievers, or anti-nausea drugs.
Once the gastropexy procedure has been performed, it is extremely unlikely for this condition to recur. Many dogs can be successfully treated for bloat and can go on to live happy, healthy lives for years to come.