Gastric Torsion In Dogs

Gastric torsion is one of the most serious non-traumatic emergencies in small animal practice. Also known as Gastric Dilatation Volvulus (GDV) or Bloat or Twisted Stomach, this is an acute, rapidly progressive, medical emergency of dogs characterized by malposition and uncharacteristic twisting of the stomach on its mesenteric axis due to increased intragastric pressure, with subsequent distention and gastric gas accumulation.

The two parts of this condition are Gastric dilatation (bloat) and volvulus (torsion). Gastric dilatation is an effect of fluid, gas, froth, or a mixture of all of this accumulation in the stomach either due to functional or mechanical disorders in the pyloric outflow.

Gastric Torsion is when the stomach distends and rotates around a clockwise direction in its long axis (just like a sausage which is warped and with both ends is closed) about the distal esophagus. Dislodgment and occlusion of the duodenum and pylorus occur. This hinders the outflow of the esophagus and duodenum. The effect of the distended stomach is that it compresses all of the other vital organs in close proximity.

The squeezing of large blood vessels within the abdomen cannot allow the blood flow to happen. This result in a decline in circulating blood volume and following a decrease in arterial blood pressure, tissue perfusion, and cardiac output culminating in hypovolemic shock. Splenic torsion, Devitalization of the gastric wall, endotoxic shock, and congestion of abdominal viscera further exacerbate the hypovolemic calamity.

• Looking down at the abdomen.
• Bloat (a swollen tummy).
• Distending abdomen
• Non-productive Retching (dry heaving- trying to vomit or feeling about to throw up).
• Difficulty breathing
• Abdominal distension, Abdomen swollen due to fluid accumulation.
• Excessive drooling
• Nausea
• Agitation / Shock
• Rapid heart rate
• Pale gums

Medications:

• IV fluids: Hypertonic saline, Ringer's, Plasmalyte, and Normosol-R.
• Gastric decompression: Orogastric intubation or percutaneous trocharization.
• Antibiotics: For dogs with suspected gastric necrosis - Amoxil (amoxicillin), Garamycin (gentamicin).
• Antiarrhythmics: Lidocaine, Sotalol, Mexiletine, and Amiodarone.
• Oxygen supplementation: Dogs with poor perfusion measures.
• Drugs that decrease reperfusion injury: Lidocaine and ketamine.
• Fresh frozen plasma: Deficiency of coagulation factors.

Surgery:

Gastropexy: The stomach wall is sutured to the diaphragm or abdominal wall.

Gastric decompression: Removal of stomach contents using a nasogastric tube.

Trocharization: Gastric decompression is done by inserting a needle on the left side of the abdomen i.e on the site of greatest tympany or greatest distention.

Pyloroplasty: This is a gastric drainage procedure done by breaching the pylorus to drain stomach outflow into the duodenum.

• Increase the frequency of mini-meals and avoid feeding large quantities of food at a single time.
• Dogs having a family history of bloat should be checked regularly.
• Underweight dogs should be fed carefully.
• Avoid moistened dry food, particularly if citric acid is used as a preservative.

• Dogs should have a comfortable, easy-going, or contented environment.
• Divide 2 meals into 4 mini-meals.
• Introduce a healthy late-night snacking right before sleep to decrease the night fasting period.
• Careful with your food measurements and don’t overindulge.
• Add canned dog food to the diet.
• Feed a dry food that includes a calcium-rich meat meal (such as fish meal, meat meal or bone meal, or chicken by-product meal).

Akita, Boxer, Basset Hound, German Shepherd, Great Dane, Gordon Setter, Irish Setter, Weimaraner, Saint Bernard, Newfoundland, Rottweiler, Doberman Pinscher, Old English Sheepdog, Standard Poodle, Cocker Spaniel, Shar Pei

1. Causes:

• Deep chest conformation i.e. slender chest that goes below the dog's (Bigger thoracic depth-to-width ratio).
• Large or Giant-breed dog.
• Hereditary, particularly having a first-degree relative with a history of GDV.
• The previous episode of gastric dilatation.
• History of the previous splenectomy.
• Increasing age
• A pre-existing gastric foreign body or gastrointestinal disease.
• Eating a meal quickly.
• The large volume of food is fed once daily.
• Living in an anxious, scared, or nervous environment.

2. Morbidity:

• The dog breeds that are considered to be most at risk for gastric torsion are Large and deep-chested dogs.
• Even small-and medium-breed dogs with a deep chest conformation, including Basset hounds, Cocker spaniels, and Shar-peis, can develop GDV. Mostly, the dogs are middle-aged to older as of the frequency of GDV increases with increasing age.
• Clinical studies demonstrate that the top three breeds that are at high risk of GDV were Great Dane, St. Bernard, and Weimaraner.
• Dogs over 45 - 50 kg have roughly a 25% risk of gastric torsion during their lifetime.
• Occasionally, Gastric dilatation occurs without torsion in older small dogs.

3. Mortality:

Gastric torsion is considered a medical emergency. Even with immediate care, the mortality rate is high. In general, the mortality rate due to torsion in dogs is 20% - 40%.

4. Diagnosis:

• Complete blood count (CBC).
• Biochemical profile
• Ultrasound and Abdominal x-rays.
• Abdominal fluid biopsy
• ECG
• Blood gas analysis

5. Prognosis:

The outcome depends on the severity of the torsion. If prompt medical attention is provided, then there is a good survival rate (>90%). Usually above 60% of dogs survive this disease.

Contact your vet right away, if you notice any of the following:

• Bloat (a swollen tummy).
• Distending abdomen
• Non-productive Retching (dry heaving- trying to vomit or feeling about to throw up).
• Difficulty breathing

1. Protein (moderate levels of bioavailable protein).
2. Leafy greens, fresh vegetables, and antioxidants.
3. 75% of a Dog’s food should be complete, wholesome food certified by the Association of American Feed Control Officials (AAFCO).
4. The remaining 25% of your dog’s diet can be canned food or other foods.
5. Omega fats: Omega-6 and omega-3 in a 4:1 ratio.
6. Regulated treats that are part of the daily calorie intake.
7. Bland diet: Boiled chicken, cooked rice, tofu, low-fat cottage cheese, boiled hamburger, canned tuna, etc.

As in many cases, the Gastric torsion etiology is often serious in nature and it should be dealt with immediately and efficiently. GDV is considered a medical emergency. Even with immediate care, the mortality rate is relatively high.