So, this new post does get a little nerdy so bare with me. I hope you enjoy some more learning! This case is one that turns a “normal” day into a whirlwind! This begins with a 9 year old neutered male Great Dane that came in for sudden onset of retching, panicking, and severe abdominal pain. Owner stated that his belly also appeared to be bloated. On exam, his heart rate was abnormally increased, weak and non-synchronous pulses in hind limbs (femoral artery), panting, retching with no production, and stretching. His abdomen was bloated and tight. A right lateral (laying on right side) x-ray was immediately completed due to the high suspicion of one diagnosis.
Image Below: This image shows normal abdominal structures and their location (gastric axis). The stomach normally appears as a thin air filled structure near the diaphragm (Green oval). In this case, a meal was ingested prior to taking (speckled appearance).
Image Below: This image shows what’s called Gastric Dilatation and Volvulus (GDV), which means, severe bloating and twisting of the stomach. This image is what we call a “smurf’s hat”. It shows and abnormal placement of the pylorus above the body of the stomach.
What is it and how does it happen? Well, there are many risk factors that have been linked
- Deep chested Large or Giant breeds
- Consuming a large meal
- Exercise within 30 minutes of meal
- Being fed 1 meal/day
- Elevated feedings
- Already have had a splenectomy (removal of spleen)
- Diets with high oil content (sunflower, animal fat, etc.)
- middle aged and older
Well, what are the consequences?
- Loss of blood supply to heart from abdominal venous system due to twisting
- Loss of blood supply to the lining of the stomach and spleen
- Rupture of the stomach
- Large amount of pressure on the diaphragm decreasing breathing ability (oxygenation/ventilation)
- If the stomach becomes gas filled enough, it can rotate/twist (volvulus). This is the main culprit for cutting off blood supply to the spleen and stomach
Unfortunately, every part of the body is affected by poor ventilation/oxygenation and can injure cells all over the body. Everything needs proper oxygenation and the lack of oxygen will put your pet into shock!
- Abdominal distention
- Stretching and standing
- Retching/gagging without any production (“dry heaving”)
- As it progresses: panting, severely bloated abdomen, weakness, collapse, recumbent/unable to rise, heart arrhythmias (abnormal rhythm)
- Stabilization! This includes high volumes of intravenous fluids to aid in circulation.
- Decompression (gas removal) of stomach
- Surgery, even without volvulus! This will be needed to decrease stomach volume, removed food and fluid contents. The stomach will be thoroughly investigated for trauma and injured/non repairable tissue. Once replaced back into normal location, a gastropexy will be completed. This permanently keeps the stomach in the appropriate location by suturing the pylorus to the adjacent abdominal wall. Surgery also allows you to investigate the other internal organs for trauma from lack of circulation. In some cases, a splenectomy (removal of spleen) will also need to be completed. For the case above, his spleen was indeed removed.
Then what? Well, they need to remain in clinic to be stabilized even after surgery. They are withheld food and water for 12 hours and then slowly both are introduced throughout the day.
Is there prevention? YES (for at least the twisting part)! Prophylactic gastropexy can be done at any age. Many parents like to have it done while getting spayed or neutered. Bloating is still possible with this treatment but prevents full rotation of the stomach. Also, feed several smaller meals throughout the day on the ground and try not to allow exercise for at least 30 minutes after food ingestion.
Whew! That was a long one!