Vet Check: Bloat – What You Know Can Save Your Dog's Life

Issue 2 | March/April 2017 | $9.95

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MWD Ayaks is put under general anesthesia before getting preventative surgery on his stomach. The procedure is designed to keep his stomach from twisting and causing a fatal condition in dogs his size and body type.

Vet Check BLOAT: WHAT YOU KNOW CAN SAVE YOUR DOG’S LIFE

By Dr. Alexis Newman

M

ost handlers have heard of bloat, but do you know what is occurring when a dog bloats or how it is treated or possibly prevented?

This article will explain what is occurring when a dog bloats, describe the symptoms, review the medical and surgical treatments of the condition, and explain the surgical procedures that can be performed to help prevent bloat from occurring in your K9.

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Gastric

Dilation-Volvulus (A.K.A. Bloat)

What Is Bloat?

People use bloat as a slang term for gastric dilatation-volvulus (GDV). Broken down, this means: gastric = stomach; dilatation = dilation or expansion, usually due to gas buildup; volvulus = twisting of the stomach that can be severe enough to obstruct the esophagus. To visualize the process, think of how a balloon animal is made: a balloon is inflated and then twisted.

The medical term bloat actually refers to the stomach becoming bloated or distended with gas or food without the twist. This can occur when a dog ingests a large amount of food or material as well as several other reasons. Distension without an underlying cause is rare. This condition can be compared to the balloon being inflated and distended, but not twisted. Gastric distention is treated differently than GDV. For this article, the term bloat will be used to refer to distention only. The abbreviation “GDV” will be used when discussing the syndrome of gastric dilatation-volvulus.

There are some differences between distention alone and GDV.

Bloat (Gastric Distention) • Stomach retains normal anatomical position • Not common • Often treated medically, but may require hospitalization • Often has an identifiable underlying cause (ingestion of too much fluid or material, outflow obstruction from stomach, intestinal disease causing decrease in motility) • Can progress to become a critical condition

GDV Twisting of the stomach

• Stomach is distended and rotated • Life-threatening emergency requiring surgery • Medical management is warranted if patient cannot get to surgery immediately, but surgery should not be delayed longer than necessary

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Images aquired from veterinarysecrets.com

Underlying Causes What causes GDV? That is the million-bone question! As with any syndrome, the underlying causes are multifactorial and not completely understood. We do know of several risk factors: Breed – Some breeds, such as Great Danes, Doberman pinschers, and German shepherds, are predisposed to GDV. This may be based on genetics as well as body configuration, especially having a deep chest.

Deep, narrow chest – Dogs with this body type have an abdominal cavity that allows room for the stomach to turn and twist.

Age – GDV can occur at any age, but the risk increases after age seven. The youngest I have seen a dog develop GDV is about three years of age, but they are typically older than that.

Once-a-day meals – This is one of the few risk factors that you can actually minimize. Dogs that eat only one large meal a day are at risk of stretching the ligaments that hold the stomach.

In turn, this may increase the dog’s risk of developing GDV over time. I recommend at least two feedings (of smaller meals) each day.

Body fat – Having an extremely lean dog/ underweight dog without significant fat in the abdominal cavity can allow for more room for the stomach to turn and twist.

A direct relative with GDV – A dog that has a close relative that had GDV has a greatly increased risk of developing the condition.

Stress – This is a common risk factor. Working dogs may develop GDV after a long training session or a stressful pursuit.

I bet many of you just thought to yourself: That describes my dog!

Symptoms As symptoms progress, your dog will experience increasing levels of pain and will develop cardiovascular shock. Time is important, but how tightly the stomach (the “balloon”) is twisted is equally important in terms of the progression of the symptoms and your dog’s status and prognosis. Stay alert if your dog displays any of the following symptoms: Abdominal distention – As the stomach becomes more dilated with gas, you may notice your dog’s abdomen becoming enlarged. Be careful, though: if your dog is very deep chested, the stomach may be tucked under the ribs, and you may not be able to appreciate the distention. Do not rely solely on this as a symptom.

Hypersalivation – Dogs with GDV often become nauseated, and they may not be able to pass fluid into the stomach, so it accumulates. You may see thick, ropey saliva or foamy fluid.

Vomiting, dry heaving – Depending on how tightly the stomach is twisted, your dog may still be able to expel food or water. However, dogs with GDV often cannot get anything out of their stomachs, so your dog may begin dry heaving.

Groaning – GDV is an extremely painful condition, and many dogs will begin to vocalize or groan as the condition progresses.

Weakness, shock – As his stomach becomes more distended, the patient will go into cardiovascular shock. This occurs for several reasons, including decreased blood flow to the heart, increased pain and devitalization of the stomach tissue. The result is decreased blood pressure and increased heart rate, as the heart and other tissues are not able to obtain enough oxygen.

Excessive panting – This occurs due to the pain, pressure on the diaphragm and in the abdomen, and increased heart rate. Panting is one of the ways that the body attempts to get more oxygen.

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“

A Picture is Worth a Thousand Words

”

Several years ago, I came across this video and now use it as part of my presentation to handlers.

Although a little bit difficult to watch, these are the exact symptoms you can expect to see; the video is also very well narrated: https://www.youtube.com/watch?v=U1WrT2719yo

Or, just go to YouTube and type in “Akita Bloat.”

Field Triage It should be stressed that nothing should delay veterinary care. GDV is a life-threatening condition. However, at times, it may be appropriate to provide some care to your K9 partner in the field prior to receiving veterinary care.

It is important to minimize additional stress or unnecessary movement, so keep the patient quiet. When you do, avoid abdominal pressure.

Remember that as the stomach becomes distended, it resembles an overinflated and twisted balloon.

Increased pressure on the stomach will lead to more pain and could increase the risk of the stomach rupturing if it is severely compromised.

Handlers who have had the appropriate training can provide additional procedures. Ask your dog’s veterinarian for specific training, if interested.

Gastric trocar is recommended only for those who have had proper training. In this procedure, a needle is passed through the skin into the stomach.

The goal is to relieve pressure on the stomach by releasing some of the air. Another option is to administer oxygen via face mask or oxygen line,

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if available. These dogs go into cardiovascular shock, so if supplemental oxygen can be provided, it may help increase the dog’s odds of survival.

As with oxygen, intravenous fluids are vital in treating cardiovascular shock. They are the most important initial treatment for these patients.

These dogs’ blood pressure can decrease rapidly and their heart rates can increase significantly.

You can be trained to administer IV fluids that help support their cardiovascular system. For an 80-pound dog, two to three liters of IV fluids is an appropriate starting point (unless your K9 has underlying heart disease).

Stomach tube placement is recommended only if transport to a veterinary clinic facility cannot occur immediately. You can be trained to do this procedure, but it is difficult to perform on an awake and stressed K9. Often, pain meds or sedation are given prior. A tube is passed from the mouth into the stomach, with the goal of deflating the stomach. (However, it typically remains twisted.) Unfortunately, if the twist is too tight, you may not be able to pass a tube into the stomach.

Regardless of what you can do in the field, provide rapid transport. GDV is a lifethreatening emergency that can progress rapidly.

Presentation to a veterinarian trained to treat this condition is imperative.

Treatment Let’s walk through the process from admission to recovery in our hospital. Patients can present in varying degrees of stability; they may be in critical condition or in serious but stable condition.

Again, keep in mind that without treatment, GDV is life threatening.

We place at least one IV catheter and start intravenous at shock doses.

The blood pressure and heart rate need to be controlled.

As previously discussed, GDV is an extremely painful condition that contributes to the cardiovascular shock. We treat patients aggressively with pain medication at the time of presentation.

We give oxygen because the dog’s tissues are compromised. We may be able to trocarize the stomach with a needle to quickly “deflate” it. The ability to do this varies.

If a stomach tube can be passed from the mouth into the stomach, it is extremely valuable to decompress the stomach and relieve discomfort.

Most patients will not tolerate placement of a stomach tube without sedation or anesthesia or unless the dog is minimally responsive.

Depending on how tightly twisted the stomach is, we may or may not be able to pass the tube into the stomach.

We take radiographs (X-rays) to confirm GDV. This is the standard for diagnosing the condition. X-rays will differentiate bloat from GDV. If your dog is older, we may also take radiographs of his chest to look for any other underlying disease prior to pursuing surgery.

We perform bloodwork. An otherwise healthy dog with GDV may have normal bloodwork, but it is important to evaluate bloodwork

for any signs of any underlying disease, especially in older dogs.

Prior to surgery, we give general anesthesia. If we could not previously pass a stomach tube, we’ll attempt it again after placing the endotracheal tube to protect the airway. The next step is clipping and sterilely prepping the patient’s abdomen.

The patient goes to surgery as soon as possible to relieve the distension and volvulus.

Our first step is to decompress the stomach further if needed.

We then rotate the stomach back into its normal anatomical position and evaluate the stomach tissues to determine if any of the stomach has been damaged enough to warrant removal. If a portion of the stomach is not viable, we will surgically remove it through a partial gastrectomy. If the entire stomach is devitalized, or if the portion of the stomach that attaches to the esophagus is devitalized, and it is determined that your dog will not be able to regain a good quality of life, we may recommend euthanasia.

We evaluate the spleen to determine if it should be removed. When the stomach twists, it is not uncommon for

the blood vessel of the spleen to be compromised. A splenectomy (removal of the spleen) may be necessary, but patients can still have a good recovery.

Finally, we perform a gastropexy—the surgical attachment of the stomach to the abdominal wall by one of several ways. The procedure I perform is an incisional gastropexy, in which I suture the stomach to the abdominal wall, just behind the last rib on the right side.

If performed appropriately, a patient will not be able to have a GDV occur in the future, although this does not prevent a simple bloat, or distension, of the stomach.

After Surgery Your dog’s recovery depends on how stable he was prior to surgery and which procedures were performed during surgery.

In a fairly stable patient, postop hospitalization typically lasts 24-48 hours and consists of IV fluid support and medical care to control discomfort and nausea.

These patients should be eating and drinking and be comfortable in order to be discharged.

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Prognosis

Preventing Recurrence

The prognosis largely depends on 1) how long the GDV was developing before medical and surgical intervention, 2) how tightly the stomach was twisted prior to care, since this can determine whether the stomach tissues are able to survive, and 3) the degree of damage to internal organs and the amount of blood loss. The majority of dogs who survive through surgery do quite well long term and can live a normal quality of life.

It is difficult to avoid some of the risk factors that were previously discussed. However, there are some procedures that can be performed to eliminate the risk of GDV, including a prophylactic gastropexy. There are three techniques that may be used for this procedure.

Risk of Recurrence

2. Laparoscopy-assisted gastropexy – This is performed instead of traditional (open) abdominal surgery. Under anesthesia, a camera and instruments are inserted through surgically placed ports into the patient’s abdomen. There are pros and cons to this procedure versus open abdominal surgery.

As discussed above, if the veterinarian performs the gastropexy appropriately, this should permanently attach the stomach to the body wall and virtually eliminate the potential for the torsion to occur again. The stomach could still bloat, but that would be highly unusual without an underlying cause, such as ingesting too much food or water, or primary intestinal disease.

1. Abdominal surgery – A dog can be taken to surgery to have the gastropexy performed, even if they have not had GDV occur. An incision is made along the midline of the dog’s abdomen, near the ribcage. The procedure should be considered whenever an at-risk dog is taken to surgery for other causes, such as a spay, urinary surgery or removal of a foreign body. However, this should be done only if your dog is stable in surgery and the veterinarian is comfortable performing the procedure.

3. Endoscopy-assisted gastropexy – This is a more recently developed procedure. Under anesthesia, a gastroscope is passed through the dog’s mouth into the stomach. The light from the endoscope is used to guide a skin incision over the stomach. The incision is then continued, and the stomach is sutured to the abdominal wall. This can be compared to performing a gastropexy from outside the dog instead of from the inside, but it accomplishes the same results.

I strongly encourage you to inquire whether your dog is a candidate for a prophylactic gastropexy if he ever needs surgery for another reason. For other dogs, the pros of gastropexy must be weighed against the cons. This is both a financial and a time-based decision. Also, it is important to remember that no surgical procedures, even those that are minimally invasive, are without risk.

Dr. Alexis Newman received her Doctor of Veterinary Medicine degree from Iowa State University in 1998. Following veterinary school, she completed a Surgical and Emergency Internship at California Animal Hospital in West Los Angeles. She has worked with police and working K9s for many years and understands the needs of the K9, the handler, and police departments. Her passion of working with police dogs and their handlers led to starting Partners and Paws Veterinary Services in June, 2013. Dr. Newman also enjoys working with sporting groups, rescue groups, and civilian dogs and cats.

Website: partnersandpaws.com

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