Gastric Dilatation-Volvulus (GDV) often referred to as "bloat", is a serious condition caused by abnormal dilatation and twisting of the stomach. The condition is initiated by abnormal accumulation of air, fluid or foam in the stomach (gastric dilatation). Bloating of the stomach is often related to swallowed air, although food and fluid also can be present. Bloat can occur with or without volvulus, or twisting. As the stomach enlarges, it may rotate 90 degrees to 360 degrees, twisting between its fixed attachments at the esophagus (food tube) and at the duodenum in the upper intestine.

Volvulus can completely obstruct emptying of the stomach. The twist also prevents burping, so the dog cannot obtain relief of air or stomach contents by belching or vomiting. In fact, a hallmark symptom of torsion is nonproductive attempts at vomiting. The bloated stomach obstructs the return of blood from the veins in the abdomen leading to low blood pressure, obstructive shock and associated complications. The dog also may seem short of breath due to pain and the physical compression of the chest and diaphragm caused by the expanding stomach.

The combination of bloating and torsion seriously reduces the blood supply to the stomach (gastric ischemia) and this can lead to necrosis (death) of the stomach wall. Shock and lack of blood supply to abdominal organs break down the integrity of the gastrointestinal tract lining and permit toxins and bacteria to enter the blood stream. Abnormal blood clotting - disseminated intravascular coagulation (DIC) - may develop. The spleen can be damaged or begin to bleed because it is attached to the stomach by a membrane, and it becomes twisted and rotated abnormally as the stomach turns. Heart function is compromised due to lack of venous blood return. Irregular heart rhythms often develop such as ventricular tachycardia. Shock and death follow if the condition is left untreated or if treatment is initiated too late in this devastating sequence.

GDV is most common in deep chested or large to giant breed dogs between two and ten years of age. GDV can also occur in other breeds, but this is comparably rare. GDV can sometimes be associated with eating or drinking before or after exercise.

What to Watch For

• Drooling
• Nausea
• Restlessness
• Abdominal distension
• Vomiting leading to nonproductive retching

GDV is life-threatening. See your veterinarian immediately if you suspect bloat or GDV.

Diagnosis

The diagnosis can usually be made based on the history and physical examination.

• Physical examination should include abdominal palpation and auscultation of heart and lungs.
• After your dog has been stabilized and initial treatment begun, radiographs may be taken. A lateral abdominal view in right lateral recumbency with dog lying on the right side, is the view of choice for differentiation of simple dilatation from dilatation-volvulus.
• After initial stabilization and treatment, a complete blood count and blood biochemical tests may be performed. Blood tests help to define concurrent abnormalities that may influence the choice of anesthesia.

Treatment

• Initial treatment of GDV will include emergency treatment for shock with intravenous fluids, drug therapy, and decompression of the stomach.
• Surgery is the recommended treatment to untwist and stabilize the stomach. To prevent recurrence, the stomach must be attached to the abdominal wall, known as gastropexy. If the spleen is badly damaged, it may need to be removed (splenectomy).

Home Care and Prevention

If you observe signs of GDV at home, see your veterinarian immediately. There is no recommended home therapy for GDV. Remember that giant-breed and deep-chested dogs are at increased risk.

Feed small frequent meals and limit water intake for one hour after eating, and avoid large volumes of water intake. Limit exercise after eating.

Gastric dilatation-volvulus (GDV) is a condition that is centered initially in the stomach, but eventually can affect the entire body. Some problems that can result are:

• Shock and cardiovascular complications
• Bleeding disorders
• Injured spleen
• Secondary infection
• Heart arrhythmias (irregular heartbeats. The arrhythmias are caused by poor oxygenation to the heart (myocardial ischemia), release of toxins, electrolyte abnormalities, acid-base abnormalities, and gastric receptor stimulation.

These problems can persist even as the GDV is successfully resolved. Other medical problems can lead to symptoms similar to those encountered in GDV, and it is important to exclude these conditions before establishing a definite diagnosis. They are:

• Gastric dilation without volvulus
• Aerophagia, which is swallowing air due to difficulty breathing (dyspnea)
• Ascites, or fluid accumulation in the abdomen

Veterinary care should include diagnostic tests and subsequent treatment recommendations.

Diagnosis In-depth

Diagnostic tests are needed to recognize GDV, and exclude all other diseases, including:

• Complete medical history and physical examination.
• Clinical response to gastric decompression (passing a stomach tube or inserting a needle into the abdomen to relieve gas pressure).
• Your veterinarian should assess your pet for shock. It is important to monitor vital signs, airway, breathing, heart rate and to identify bleeding disorders.
• If the diagnosis is not clear, abdominal radiography (X-rays) is the first diagnostic test performed. An abdominal X-ray may reveal a large air-filled stomach with a soft tissue fold that appears to compartmentalize the stomach. This suggests that the stomach is twisted (volvulus).

Optimal treatment for your pet requires a combination of home and professional veterinary care. Administer prescribed medication as directed and be certain to contact your veterinarian if you are experiencing problems treating your pet. Observe your pet's general activity level, appetite, and interest. Keep your pet in a supervised area of the home.

Antibiotic therapy is usually continued for seven to ten days. Drug therapy for ventricular arrhythmias (such as procainamide), is sometimes needed if arrhythmias are very severe.

Feed small frequent meals, often using a bland diet. Your veterinarian will discuss diet with you. Limit water intake for one hour after eating and always prevent your pet from ingesting large volumes of water. Avoid any exercise after eating.

Re-evaluation by your veterinarian is often recommended in seven to ten days with suture or staple removal and examination of the heart rate and rhythm.