Gastric dilation-volvulus (GDV) is a life-threatening condition of deep-chested large and giant breed dogs where the stomach dilates and rotates on itself, leading progressively to hypotension, shock, and death.
Although numerous mechanisms have been proposed, the etiology of the disorder remains obscure, although feeding from raised bowls and exercise after consuming a large meal is commonly reported. Splenic torsion has also been implicated as a cause since malposition of the spleen is commonly observed with GDV as well as gastric foreign bodies, drugs which inhibit gastric motility, abdominal trauma, spinal injuries or prolonged recumbency. Diets containing high levels of fish and egg dietary supplements, or containing soy, wheat corn or rice may also be factors. Splenectomy does not appear to increase the risk of GDV in dogs.
Large (Akita, Bloodhound, Collie, Irish Setter, Rottweiler, Standard Poodle, Weimaraner, Huntaway, Grand Bleu de Gascogne, German longhaired pointer, Neapolitan Mastiff) and giant breed (Great Dane, Irish Wolfhound, Newfoundland, Saint Bernard) dogs have a 6% incidence of GDV, with GDV accounting for 16% of all the deaths in these breeds. In small breed dogs, the Dachshund appears to be over-represented.
Distension due to volvulus leads to compression of the caudal vena cava, resulting in consequential decrease in venous return and reduced cardiac output, resulting in many cases to noncardiogenic shock. As a consequence of gastric mucosal damage, absorption of bacteria and endotoxins leads to aggravation of circulatory compromise and septic shock. Avulsion of the short gastric and right gastroepiploic vessels and splenic vein torsion may occur, causing thromboembolism, hemorrhage and/or disseminated intravascular coagulation.
Clinically affected dogs present in acute collapse, with a visibly distended abdomen. The ability to pass an orogastric tube does not rule out GDV. Some cases can be due to chronic gastric instability and presumed incomplete volvulus, which may present as weight loss, chronic vomiting, lethargy and abdominal pain.
Abdominal radiographs are usually diagnostic and ECGs usually show ventricular arrhythmias and sinus tachycardia. The presence of preoperative cardiac arrhythmias is associated with a higher mortality rate.
Treatment requires aggressive intravenous fluid therapy (usually with lactated Ringer's solution or and colloid fluids) and gastric decompression. Gastrocentesis should be performed in patients at risk from cardiac arrest or are too sick to approach surgically. Early treatment with intravenous lidocaine bolus (2mg/kg), followed by constant rate infusion of lidocaine for 24 hours post presentation decreases the occurrence of cardiac arrhythmias.
Once the dog is stabilized, surgical intervention is usually required. The basic goals of surgical treatment following decompression and derotation of the stomach is permanent fixation of the stomach in a manner that does not interfere with gastric function. Currently, the most widely used gastropexy techniques are incisional gastropexy, belt-loop gastropexy, and circumcostal gastropexy. Each of these techniques requires hand-suturing to produce a permanent adhesion of the stomach to the abdominal wall and do not require entrance into the gastric lumen.
A permanent incisional gastroplexy is the preferred treatment. Without gastropexy, a recurrence rate as high as 55% - 85% has been reported, compared with only 3% to 5% for dogs that did have a gastropexy.
Areas of stomach that are necrotic should be removed via gastrectomy. If there is a concern about pancreatitis, a jejunostomy tube should be placed for nutritional support.
With prompt treatment, survival approaches 85%.
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