Gastric Dilatation-Volvulus (GDV)
More commonly known as Bloat – and what BRT owners need to know
by Richard Hawkes, DVM
Bloat, also known as gastric dilatation-volvulus (GDV) or gastric torsion, is something any owner of a large or giant dog breed should know about – especially owners of deep-chested dogs like the Black Russian Terrier. GDV is a twisting or flipping of the stomach on its axis. When this occurs, the pylorus (small opening at the base of the stomach through which partially digested food moves), as well as the gastroesophageal sphincter (muscle connecting the esophagus and stomach), become twisted closed. When this occurs, there is no way for gas to escape the stomach, causing it to expand or bloat.
Who is at risk for GDV? How does one prevent bloat in their dog? Can I prevent it myself? What are the signs? How is it treated? How much does it cost? These are all important questions. Let’s take a closer look at what you need to know to help prevent GDV in your Black Russian Terrier.
Gastric dilation-volvulus is always a surgical emergency
Bloat can occur in any dog, or cat for that matter, but is most frequently seen in large or giant breed, deep-chested dogs. While the Great Dane is the most commonly affected breed, I have treated bloat in several German Shepherds, Labrador Retrievers and mixed breeds, as these seem to make up a good percentage of the patients I see – but again, any dog can experience it.
While you cannot change the genetic make-up of your dog, there are some risk factors you can eliminate or reduce, thus reducing the chance of your dog bloating:
• A large meal followed by exercise may be the greatest risk factor for this condition.
• Smaller, more frequent meals help reduce the chance of the stomach twisting.
• Don’t let your dog exercise or roughhouse after eating a meal.
• Try to not let your dog eat too rapidly.
• It used to be thought that feeding from an elevated position (i.e., raised food bowls) would decrease the incidence of bloat; however, recent studies show elevated feeding to increase the incidence of bloat, so this should be avoided.
• Excessive water consumption (and let’s face it, BRTs love water) can increase risk.
While there is no DNA test to see if your dog is at risk for bloat (the primary risk factor being anatomic), an increased incidence of bloat has been shown in dogs having had a primary relative suffer from this condition. If you know that a parent or sibling of your dog has had GDV, consider your pet at increased risk and take appropriate precautions.
Treating GDV is very expensive, with the total care likely to exceed $2,000-$4,000 – depending on where you live.
How do I know if my dog is bloated? What can I do?
• The primary sign of a bloated dog is just that…a swollen, bloated abdomen.
• The abdomen will be very tense, hard and take on a swollen, rounded appearance.
• The dog will act very uncomfortable and may drool excessively.
• Often unproductive retching will be observed.
• Blood pressure may drop and the dog may collapse.
• Mucous membranes (gums) will often be pale with a slow capillary refill time.
• Pulse will be weak.
If you observe any of these signs, it is absolutely critical to have your dog seen immediately by your veterinarian or emergency clinic. Having the dog diagnosed and treated quickly is its best chance of surviving this ordeal.
Unfortunately, there is little you can do yourself once a dog begins to bloat. Passing of a stomach tube can release gases trapped in the stomach; however, it is extremely difficult to pass a tube when the stomach has been twisted closed. Needle decompression can release built-up gases through the body wall, but landmarks must be known to ensure it is done properly. These techniques should be left to a veterinarian.
How is bloat treated?
The diagnosis is made by physical exam and confirmed by x-rays. It is possible to have a bloated stomach that is not twisted, as well as a distended abdomen from other reasons that would not necessitate surgical intervention, thus it is important to confirm the diagnosis with imaging. Once the diagnosis is established, emergency treatment can begin.
• The veterinarian will first try to decompress the stomach with a stomach tube or a needle if the tube cannot be passed. This will release pressure on the stomach and help restore blood supply to the stomach and spleen. When the stomach twists, it will often cut off its own blood supply and possibly splenic blood supply as well. This can cause irreversible necrosis to the stomach and spleen.
• The next step is getting the dog stable for emergency surgery. Poor blood pressure and the possibility of septicemia (blood poisoning from toxins being released from a necrosing stomach or spleen) can make anesthesia very difficult. Often, one or two large bore catheters are placed for IV fluid support. Medications, such as antibiotics and steroids, are given to reduce septicemia and shock, and then anesthesia is induced. I generally prefer propofol and isoflurane. Surgery should not be delayed if possible.
• Surgery involves manually de-rotating the stomach. After the stomach is put back in its correct orientation, it needs to be assessed for viability, as does the spleen. If there are areas that have not survived the twisting due to loss of blood supply, those areas need to be surgically resected. Splenectomy (removal of the spleen) is often needed in GDV surgery. If the spleen needs to be removed, or areas of the stomach need resection, overall survival rate decreases. After addressing any issues with stomach or spleen viability, the next step is to prevent the stomach from twisting again. This can be accomplished in a number of ways but will generally involve permanently fixating part of the stomach to the body wall. This will prevent the stomach from being able to twist, thus eliminating the chance of re-bloating.
My preferred method is called incisional gastropexy. An incision is made in the musculature over one of the caudal ribs at an area that approximates a normal position of the pylorus of the stomach. An incision is then made in the muscle layer of the pylorus. The two incisions are then sutured together, permanently healing the stomach to the body wall. Other techniques may involve harvesting a muscle flap from the stomach and wrapping it around a rib (circumcostal gastropexy), or placing a stomach tube through the stomach wall and exiting the abdomen through the body wall (tube gastropexy). When the tube is eventually removed, the stomach will be adhered to the body wall. There are other procedures as well. The procedure a surgeon is comfortable with and can be performed efficiently is best.
What is the prognosis?
Without surgery the prognosis for GDV is grave. All dogs will die a very painful death. The prognosis for survival with surgery is quite variable and will depend on several factors. These include what kind of shape the stomach and spleen are in, how well the dog handles the anesthesia and to some extent, the skill and speed of the surgeon. This is not a surgery for beginners. I have checked several references with respect to survival outcomes and one can expect an approximate 15 percent mortality rate if no surgical complications are encountered (such as stomach necrosis). If the surgeon must remove the necrotic areas of stomach, the mortality rate can be expected to increase above 30 percent. Recurrence is not common after tacking the stomach (less than 10 percent) but can occur due to the failure of the stomach to adhere to the body wall in the case of a tube-gastropexy, or not a large enough portion of the stomach being tacked, such that it can still twist on itself.
What is prophylactic gastropexy?
Prophylactic gastropexy is having a dog’s stomach tacked to the body wall before it has bloated, thus hoping to eliminate the possibility of the dog ever boating in the first place. This is sometimes done when an animal is spayed (not uncommonly seen in Great Danes). The obvious advantage is not having to worry about a dog bloating. There are several things an owner should consider regarding prophylactic stomach tack. The first is that GDV is not all that common, and good feeding and exercise strategies can greatly reduce the incidence. Second, the procedure itself is a rather invasive surgery. The stomach is moved and permanently adhered to the body wall. This requires a fairly large abdominal incision and some time to mend. If a dog is being spayed, even though it is already having abdominal surgery, the incision needs to be extended cranially to allow the surgeon to operate on the stomach. This leaves an extremely large incision to heal, as well as adding anesthetic time to the procedure. Cost may also be an issue, as this type of surgery does not come cheaply.
Can this be done endoscopically?
There has been a lot of advancement in canine surgical techniques, including the addition of endoscopically performed surgeries. There are some places that can perform a prophylactic stomach tack via an endoscope. Unfortunately, these are few and far between. The University of Pennsylvania School of Veterinary Medicine is one resource that offers these capabilities. It does tend to be expensive. Someday, it may be much more readily available and affordable. I would recommend contacting UPenn if you have an interest in this procedure.
First, I do not normally recommend prophylactic surgical tacking of stomachs for the Black Russian Terrier. I might consider it if I owned a Great Dane due to higher incidence in Danes.
The best things to do:
• Keep your BRT physically fit
• Divide food into at least two meals a day (instead of one large meal)
• Do not elevate food bowls
• Do not allow rambunctious play or exercise after eating
Following these simple guidelines should help reduce the chances that your BRT will suffer a GDV episode.
Be sure to check out all of our Black Russian Terrier health-related articles.