Gastric Dilation Volvulus – Gastropexy

One of the diseases that can prove fatal to your dog is called “Gastric Dilatation-Volvulus (GDV)”.  GDV is linked to the dog eating big plates of food which cause expansion of the stomach.  This enlargement can be so extreme that gases trapped with any food may not be able to escape.   The expanding stomach contains pressurized substances changing the stomach size.  The danger lies in the fact that the overly enlarged organ can stop enough blood flow from the heart, thereby starving the stomach of oxygen.  The blood flow loss can also affect the stomach lining.  Due to the excessively large stomach size, the walls can burst.  Another problem is that breathing can be compromised because of the enlarged organ applying pressure to the diaphragm.  This means that the whole body of the dog ends up receiving less oxygen, causing damage in many of the tissues of the body.

If the stomach is enlarged enough, it can twist within the abdominal cavity.  This twisting is termed “volvulus”.  Due to the new position of the stomach, supply of blood to both stomach and spleen is compromised.  The animal is usually shocked because of changes within their system.  To treat this condition, your pet needs to be stabilized.  The stomach needs to be manually decompressed, and then surgically repositioned.  This procedure is called a gastropexy.  Thereafter, one needs to check the other organs within the abdomen to assess whether any damage has resulted so that it may be treated concurrently.

An exact understanding of the above condition has eluded researchers who have set out to determine factors that place dogs at risk. However, certain similarities have been noted pertaining to the type of dogs affected.  Firstly, the height of the thorax of the dog is greater than the width.  Feeding of a single meal that is large once per day also seems to be common in dogs that experience this condition.  It seems apparent that larger breeds and older dogs are more prone to suffering from GDV.  Other reasons include lifting the plate and in cases of previous spleen removal.

A study that was conducted in 2006 showed that dog food that is dry and containing additives of various oils or fats (vegetable or animal) raise the risk of GDV development.

This condition has occurred in nearly all dog breeds but seems to occur more frequently in Irish setters, Great Danes, St. Bernard, Gordon Setters and Weimaraners.

The first indicator that your dog will show is pain within the abdomen.  This pain is recognizable by a look of anxiousness or the dog physically looking at their stomach.  Dogs with abdominal pain will stand and stretch often, their abdomen will be enlarged, and drooling or unproductive vomiting will take place.

At more advanced stages of the disease, the dog may start panting, have a belly which is bloated, become subdued or show weakness.  When being examined physically, their heart rate and breathing will be faster, while their pulse might be difficult to feel, and on applying pressure to a point, the time to return to normal color will be lengthy times. The abdomen will be distended.

Stabilizing and operating seems to have a higher success rate when done in the early stages of the disease and the prognosis drops when the disease is more severe.  Should any symptoms be prevalent in your dog, have an evaluation done as soon as possible.  Surgery will be recommended if the existence of gastric dilatation where rotation is present or absent. Treatment is specialized and is usually undertaken by someone who is certified by the ACVS.

When the severity of the condition progresses, it has negative effects that last longer and begin to affect other parts of the body as well.  The breathing difficulties that the dog experiences, cause limited oxygen to be delivered to various tissues.  This is known as hypoxia and causes cells in other essential organs like the liver or kidneys, to die.  Hypoxia can cause the heart to beat abnormally also known as “cardiac arrhythmia”.  Within the digestive system, gastrointestinal tract lining can experience death of cells and peel off.

Progression of the disease causes an increase in toxins.  If the stomach is surgically deflated, these toxins can be circulated throughout the animal’s body. This will cause more arrhythmia within the cardiac system and can cause acute liver or kidney failure. Bacteria that may enter the blood stream causes bacteremia and results in sepsis forming.

With this condition, blood tests including a full blood count (CBC), analysis of serum, electrolyte levels, and an analysis of the urine, will be performed. Any disturbances to metabolism are identified. Elimination or problems is also possible, especially when the symptoms experienced are also indicative of other diseases.

Measurement of blood gas is necessary to ascertain the seriousness of the compromised breathing that the animal experiences. Cardiac arrhythmias are usually diagnosed through an electrocardiogram (ECG) and radiography as seen in image.  Further testing that may be required will be discussed with you by your veterinarian caregiver.

The dog will be stabilized by using a drip to provide fluids and additional oxygen will be given through a mask.  When the dog is stable, decompression of the stomach is done by inserting a tube into the stomach via the esophagus.  This allows excess air and fluids to escape.  Often the stomach is flushed with water through this tube. Sometimes it is necessary to place a needle through the abdomen form outside and into the belly to get rid of air, which helps to create space for the tube to be inserted. The operation, under anesthetic, will only take place once your veterinarian has established that the pet is stable.

During the surgery, the abdomen is explored, and the stomach rotation is reversed.  In addition to this the health of the wall of the stomach, and other organs is assessed. Should these organs show disease, spleen removal, also called a splenectomy; or a partial gastrectomy (where some of the wall of the stomach is excised) are done. When the stomach is back to its usual position, permanent fixation to the walls of the abdomen is carried out.  This is known as a gastropexy, and it stops the stomach revolving again should gastric dilatation reoccur.

Your pet will stay in hospital to maintain fluids intravenously.  Observation for any complications or cardiac arrhythmias is performed. The dog will need to be prevented from exercising or excessive movement for a few weeks so that healing can take place.

The dog may only eat small meals twice to thrice per day instead of eating one big meal.  You will need to keep an eye out for symptoms which will indicate reoccurrence.

The success rate of treating gastric dilatation and volvulus is about 85%. This decreases if the disease is serious or has been left undiagnosed for a lengthy period (six hours or more), The anesthetic is the greatest risk factor to dogs with gastric dilatation.  Also, dogs who had prior cardiac arrhythmia are at greater risk of dying.  Another risk factor which decreases the success rate is when it is necessary to remove other damaged organs.  Finally, the amount of blood that the dog has lost through the stomach will affect success rate.

The operation is risky, and death can occur prior to operating, while the operation is in progress or post-procedurally. Cardiac arrhythmia is frequently observed post-surgery and needs to be treated.  Toxins that are given off by the stomach during the surgery can cause death of tissue and other organs may be compromised by this.  In addition, many dogs display some form of gastric dilatation and this surgery prevents rotation of the stomach which can put the dog in danger of death.   There is always a certain amount of risk associated with surgery, including infection occurring where the stitches have been placed.  This is called dehiscence and will require that surgery be performed again to rectify it.

Many veterinarians are recommending what is known as prophylactic gastropexy which means having the surgery to prevent a future crisis.  This is usually advised for dogs which are predisposed to developing this condition.  If this is the case, the prophylactic gastropexy is performed concurrently to spaying or neutering. Laparoscopic and endoscopic surgery is less invasive and the surgery to proactively fix this problem is more easily achieved the when the problem has not yet occurred (Image 2).