Taco Belle Times: "Tails" of a Baby Boomer Veterinarian: BLOAT (GASTRIC DILATION) IN DOGS

There has always been an assortment of great food choices when traveling throughout our state. I recently traveled up to Butner, NC to visit Architectural Trees to obtain some specimens for a conifer garden at the house. On the way home, Bill’s Bar-Q enticed me into getting some southern comfort food, topped off by coconut pie. Yes it was quite good!

Unfortunately, many times pets, either by choice or by accident, present with over distended stomachs. Sometimes it is by getting into extra food or the trash cans. In other cases there is no obvious cause of the swelling. In the case below, a young puppy overate, then vomited, and aspirated food into his lungs.

WHAT IS CLASSICAL BLOAT/DILATION? HOW IS THIS DIFFERENT FROM VOLVULUS?

Bloat, a veterinary emergency in dogs, is a condition in which the stomach is distended with air, more scientifically called Gastric dilation. When the dilated stomach rotates 90 to 360 degrees it called gastric dilation and volvulus (GDV).

It is more common in large breeds of dogs over seven years of age. The most commonly affected breeds are the Great Dane, Weimaraner, Saint Bernard, Gordon setter, Irish setter, Doberman Pinscher, Old English sheepdog, and Standard Poodle. The Bassett hound is at greatest risk among smaller breeds. The underlying causes for GDV are poorly understood, although there are several recognized risk factors which are described below.

WHAT ARE THE SIGNS NOTED BY OWNERS?

They are often that of acute distress: distended abdomen, pain, drooling, retching, increased heart rate, and difficulty breathing.

EXPLAIN THE SEQUENCE OF EVENTS LEADING TO THE RAPID CRISIS?

Due to a compromise of the circulatory system from a compression of vessels by the dilated stomach, acute collapse, shock, and even death may come quickly. The severe shock comes quickly and is accompanied by death of the stomach lining, enlarged spleen, and even stomach rupturing which releases toxins into the abdomen and general circulation. Death may happen in as little as 4 to 6 hours, and it the second leading cause of death in large breeds of dogs, second only to cancer.

ARE THERE COMMON FINDINGS ON RADIOGRAPHS (X-RAYS)?

Radiographs demonstrate a severely enlarged, gas-filled stomach that if twisted has several compartments called a “double bubble” that may ping when thumped.

EMERGENCY CARE STEPS?

In many cases, the patient is so compromised that emergency treatment to tap off the gas from the stomach is required by placing catheters in two to three veins to administer lifesaving IV fluids for shock. Emergency surgery supersedes the ability to take time for diagnostics. Definitive treatment involves surgery to correct the position of the stomach, remove devitalized, non-viable tissue (spleen and portions of stomach if necessary), and to perform a gastropexy (stomach tack) to lower the risk of reoccurrence. Intensive 24-hour post-surgical care is critical to decreasing mortality. Treatment for infection, electrolyte abnormalities, shock, pain, and heart arrhythmias can be emotionally and financially draining.

RISK/PROGNOSIS?

The prognosis is up to a 15% mortality rate for patients with GDV treated surgically with a viable stomach lining. However, if circulation to the stomach wall has been compromised with delays of five or more hours, there is an increased risk of death. Other factors associated with a guarded prognosis include low body temperature and low blood pressure at presentation.

NAME THE ACTIONS THAT MAY LOWER THE RISK?

Prevention is an evolving target with no solid definitive answers. It is strongly recommended to perform a Prophylactic gastropexy (stomach tacking) in breeds at high risk for GDV to lower the risk of stomach twisting. Some surgeons perform the procedure via laparoscopy. Several recommendations have been made to prevent gastric bloat after discharge or to prevent GDV in dogs that have not had a gastropexy such as dividing feedings into several small meals a day, do not feed dry foods that contain an oil or fat ingredient listed as one of the first four ingredients, or feed a small kibble size (<30mm). Avoid stress during feeding. Do not elevate feeding bowl during eating and discourage rapid consumption. Restrict exercise before and after meals.

Betsy Sigmon DVM

Hospital director/owner Creature Comforts Animal Hospital

Special thanks to Dr. Kyle Mathews, Professor, Small Animal Surgery at NCSU for his assistance in review of this article

The Chi is Caroline Sheremeta