There are many injuries and physical disorders that represent
life-threatening emergencies. There is only one condition so drastic that it
overshadows them all in terms of rapidity of consequences and effort in
emergency treatment. This is the gastric dilatation and volvulus, known as
bloat.
What Is it and Why Is it so Serious?
The normal stomach sits high in the abdomen and contains a small amount
of gas, some mucus, and any food being digested. It undergoes a normal
rhythm of contraction, receiving food from the esophagus above, grinding the
food, and meting the ground food out to the small intestine at its other
end. Normally this proceeds uneventfully except for the occasional burp.
In the bloated stomach, gas and/or food stretches the stomach many times
its normal size, causing tremendous abdominal pain. For reasons we do not
fully understand, this grossly distended stomach has a tendency to rotate,
thus twisting off not only its own blood supply but the only exit routes for
the gas inside. This condition is extremely painful and also rapidly life
threatening. A dog with a bloated, twisted stomach (more scientifically
called Gastric Dilatation and Volvulus) will die in pain in a matter of
hours unless drastic steps are taken.
What Are the Risk Factors for Developing Bloat?
Classically, this condition affects dog breeds that are said to be deep
chested, meaning the length of their chest from backbone to sternum is
relatively long while the chest width from right to left is narrow. Examples
of deep chested breeds would be the Great Dane, Greyhound, and the setter
breeds. Still, any dog can bloat, even dachshunds and Chihuahuas.
In a study of bloat conducted at the veterinary school at Purdue
University, purebred dogs were 3 times more likely to bloat as were mixed
breed dogs!
Classically also, the dog had eaten a large meal and exercised heavily
shortly thereafter. Still, we usually do not know why a given dog bloats on
an individual basis. No specific diet or dietary ingredient has been proven
to be associated with bloat. Obesity does not predispose a dog to bloat.
How to Tell if Your Dog Has Bloated
The dog may have an obviously distended stomach especially near the ribs
but this is not always evident depending on the dog's body configuration.
The biggest clue is the vomiting: the pet appears highly nauseated and is
retching but little is coming up.
If this is seen, rush your dog to the veterinarian immediately.
What Has to Be Done
There are several steps to saving a bloated dog's life. Part of the
problem is that all steps should be done at the same time and as quickly as
possible.
First: The Stomach Must Be Decompressed
By now, the huge stomach is pressing on the major blood vessels carrying
blood back to the heart. This stops normal circulation and sends the dog
into shock. Making matters worse, the stomach tissue is dying because it is
stretched too tightly to allow blood circulation through it. There can be no
recovery until the stomach is untwisted and the gas released. A stomach tube
and stomach pump are generally used for this but sometime surgery is needed
to achieve stomach decompression.
Also First: Rapid Iv Fluids Must Be Given to Reverse the Shock
Intravenous catheters are placed and life-giving fluid solutions are rushed
in to replace the blood that cannot get past the bloated stomach to return
to the heart.
Also First: The Heart Rhythm Is Assessed and Stabilized
There is a dangerous rhythm problem called a premature ventricular
contraction, or "pvc," associated with bloat and it must be ruled out. If it
is present, intravenous medications are needed to stabilize the rhythm.
Since this rhythm problem may not be evident until even the next day,
continual EKG monitoring may be necessary.
Getting the bloated dog's stomach decompressed and reversing the shock is
an adventure in itself but the work is not yet half finished.
Surgery
All bloated dogs, once stable, should have surgery. Without surgery, the
damage done inside cannot be assessed or repaired plus bloat may recur at
any point, even within the next few hours and the above adventure must be
repeated. Surgery allows the stomach to be tacked into normal position so
that it may never again twist.
Assessment of the internal damage is also very important to recovery. If
there is a section of dying tissue on the stomach wall, this must be
discovered and removed or the dog will die despite the heroics described
above. Also, the spleen, which is located adjacent to the stomach may twist
with the stomach. The spleen may require removal, too.
After the expense and effort of the stomach decompression, it is tempting
to forgo the further expense of surgery. However, consider that the next
time your dog bloats, you may not be there to catch it in time and,
according the study described below, without surgery there is a 24%
mortality rate and a 76% chance of re-bloating at some point. The best
choice is to finish the treatment that has been started and have the abdomen
explored. If the stomach can be surgically tacked into place, recurrence
rate drops to 6%.
Results Of a Statistical Study
In 1993, a statistical study involving 134 dogs with gastric dilatation
and volvulus was conducted by the School of Veterinary Medicine in Hanover,
Germany.
Out of 134 dogs that came into the hospital with this condition:
10% died or were euthanized prior to surgery (factors involved included
expense of treatment, severity/advancement of disease etc.)
33 dogs were treated with decompression and no surgery. Of these dogs, 8
(24%) died or were euthanized within the next 48 hours due to poor response
to treatment. (Six of these 8 had actually re-bloated).
Of the dogs that did not have surgical treatment but did survive to go
home, 76% had another episode of gastric dilatation and volvulus eventually.
88 dogs were treated with both decompression and surgery. Of these dogs,
10% (9 dogs) died in surgery, 18% (16 dogs) died in the week after surgery,
71.5% (63 dogs) went home in good condition. Of the dogs that went home in
good condition, 6% (4 dogs) had a second episode of bloat later in life.
In this study 66.4% of the bloated dogs were male and 33.6% were female.
Most dogs were between ages 7 and 12 years old. The German Shepherd dog and
the Boxer appeared to have a greater risk for bloating than did other
breeds.
Meyer-Lindenberg A., Harder A., Fehr M., Luerssen D., Brunnberg L.
Treatment of gastric dilatation-volvulus and a rapid method for prevention
of relapse in dogs: 134 cases (1988-1991) Journal of the AVMA, Vol 23, No 9,
Nov 1 1993, 1301-1307.
It is crucially important that the owners of big dogs be aware of this
condition and prepared for it. Know where to take your dog during overnight
or Sunday hours for emergency care. Avoid exercising your dog after a large
meal. Know what to watch for. Enjoy the special friendship a large dog
provides but at the same time be aware of the large dog's special needs and
concerns.
May/June, 2003
