Medicine: Canine Bloat: A very serious emergency condition

Canine bloat is a condition called Gastric Dilatation and Volvulus (GDV) which is when the stomach fills with gas and twists on its axis, trapping the air. This condition can lead to shock, heart arrhythmias and death within a very short period of time. This condition is an EMERGENCY. This is not something, which can wait until the morning, not even 1-hour.

What causes GDV? Unfortunately, the cause is not understood. We see it more commonly in deep chested dogs: Rottweilers, mastiffs, Great Danes, Doberman Pinschers, Irish Setters, Afghan Hounds, and German Shepherds; but also see it in other breeds as well. It was once thought to be associated with eating a lot of dry food and then a lot of water. Other theories included strenuous exercise such as running, jumping, and playing after eating. These theories have no evidence to support them. Most likely, the cause is a motility disorder in the stomach, which causes the gas build up and the secondary twisting (although this isn't proven either.)

What are the symptoms? The symptoms include unproductive vomiting (trying to vomit with nothing coming out), repeated vomiting, an enlarged tense abdomen, swelling under and behind the ribcage (especially on the left), abdominal pain, depression, and collapse. Sometimes the dog assumes the "prayer position" with the front legs forward and standing on the rear. This is a symptom of severe abdominal pain.

Although history and physical examination findings are suspicious, radiographs (x-rays) are the best diagnostic tools. If GDV is suspected, two things are immediately done.

• Treatment for shock. Intravenous fluids are given in large amounts to fight against low blood pressure
  
• Attempt to decompress the stomach. A tube is passed orally into the stomach. Sometimes we are lucky and the tube passes, easing the pressure. Usually, it does not. At this point emergency surgery is required to open up the stomach. While preparing for surgery, sometimes the air is drawn out with special needles and drains.

All dogs that bloat require surgery. If they can be decompressed, then it can wait until they are stable. If decompression is not possible, then it is performed immediately. The surgery consists of rotating the stomach back into position and permanently securing it to the body wall preventing future twisting. Sometimes the spleen is severely damaged during the bloat, as it is attached to the stomach and requires removal as well. Without surgery, there is a very high risk of recurrence. In an emergency, this surgery is risky but necessary.

After decompression, the dog needs to be monitored in case heart arrhythmia's start. These can start up to 48 hours after the bloat. These occur secondary to decompression and release of toxins produced in damaged tissues. These arrhythmias can be fatal and require treatment.

With aggressive emergency measures, surgery, and follow-up care, the survival rate is 60-70%. Once a gastropexy is performed, the stomach cannot twist again, although, depending on the method, it may dilate (which is not as life threatening).

What can prevent this from happening? Unfortunately, no food or exercise programs are proven to reduce bloating, although we don't recommend heavy exercise after eating. The best prevention is to perform a gastropexy even if a bloat has never occurred. This is generally done only in high-risk dogs (deep chested). When a female dog is spayed, it is very easy to make a longer incision and perform the gastropexy. With male dogs, it requires a second incision. If your dog is a high-risk dog for this, please do consider a prophylactic gastropexy. Remember, even with aggressive immediate therapy, survival is only 60-70 %.