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Gastric dilatation-volvulus (GDV) is an acute, life threatening disorder that is a medical and surgical emergency. Early recognition and treatment are essential for a successful outcome. Gastric dilatation refers to distension of the stomach, usually with swallowed air. Gastric dilatation may or may not be complicated by volvulus. GDV occurs when the stomach rotates on its long axis, resulting in complete gastric outflow obstruction. Concurrent obstruction of the gastro-esophageal junction (beginning of the stomach where it attaches to the esophagus) prevents relief of fluid and gas accumulation by vomiting or belching.
Massive gastric distension impairs blood flow through the veins of the abdomen causing shock and toxicity. The intestines are affected, causing the body to become too acidic, and predisposing the body to a coagulation disorder in which the body is unable to clot blood properly (DIC). The spleen is often affected and can swell, causing more toxicity. The stomach wall may also die due to loss of blood supply, which is invariably fatal.
CAUSE:
The cause of GDV is unknown. An anatomic predisposition may play a role. Deep- chested dogs are more commonly affected.
Overeating, and exercise immediately after or before eating may predispose to GDV. This is why many clinicians advise twice daily feeding rather than once daily, to prevent gorging.
SIGNS:
Acute onset abdominal distension, which will feel like an air-filled drum.
Nonproductive retching and belching.
Salivating, restlessness, and respiratory distress are also observed.
DIAGNOSIS:
Usually evident by clinical examination.
Radiography (Xrays) aris often performed to confirm the disorder.
LABORATORY TESTS:
Metabolic acidosis is common
Low blood potassium will cause heart arrhythmias and muscle weakness
MEDICAL MANAGEMENT:
Sedation to pass a tube into the stomach if possible, to release the gas and lavage the stomach contents.
If passing of the tube is not possible, place several large bore needles through the skin into the distended stomach to relieve gas.
If the above techniques are not possible, surgery is needed immediately. However, the patient MUST be stabilised before surgery. This includes giving intravenous fluids, potassium chloride or other electrolytes depending on blood biochemistry results, antibiotics and steroids to help combat circulatory shock. Cardiac arrhythmias should also be monitored closely and treated if neccessary.
SURGICAL MANAGEMENT:
The goals of surgical intervention are the following:
Reposition the stomach and spleen
Removing damaged stomach and splenic tissue (often the entire spleen needs to be removed)
Permanently fixing the stomach to the abdominal wall to prevent future recurrences. It is beyond the scope of this article to describe the different surgical techniques practised.
Gastric Dilatation and Volvulus (GDV) is a life threatening condition. In many cases, the patient is brought to the veterinary clinic too late to save him/her. In these cases, the surgeon will usually attempt the surgery, but if there is severe necrosis of the whole of the stomach wall, the dog may be humanely euthanased under anesthetic.
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