What is bloat?
When talking about a condition called ‘bloat’ we are normally referring to an emergency in dogs whereby the stomach becomes very distended and rotates. This creates the typical appearance of a swollen abdomen and a very uncomfortable dog.
The correct veterinary term is actually gastric dilatation and volvulus or GDV and it is a life-threatening condition. There is a similar condition known as gastric dilatation (GD) which is normally less serious – but nonetheless requires veterinary attention to differentiate between the two and provide adequate treatment.
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Why is it so serious?
The problem with a distended, twisted stomach is multifactorial. Here’s what can happen:
- The distension puts too much pressure on the stomach wall, reducing blood supply so it starts to die. In the worst case, this means the stomach bursts open.
- The spleen is closely attached to the stomach meaning that it will often twist as well, this reduces its blood supply and can cause ischemia (tissue dying off because of inadequate blood supply). Damage to the spleen can also alter the function of the heart causing shock.
- Pressure is put on the vena cava, which is the big vein that takes blood back to the heart. This reduces the amount of blood the heart can access and pump, another cause of shock.
- These changes can lead to a chain of events leading to dysfunction of the kidneys and other vital organs. Dogs with GDV are normally very poorly pets and time is of the essence.
What causes bloat in dogs?
So, bloat normally occurs in older, large deep-chested breeds such as the Great Dane, German Shepherd, Husky, Labrador and so forth; however, it can theoretically occur in any breed. The true cause is still not completely ascertained but we have identified various risk factors that seem to be associated with the condition. These include wolfing down meals, a nervous temperament, being fed one large meal a day and an older age.
What are the signs of bloat?
Sometimes you’ll be able to appreciate a distended tummy. However, the stomach is tucked up inside the ribcage and as these dogs often have large ribcages, the swelling can’t always be seen. Warning signs include restlessness, retching without producing anything or only bringing up some clear to white froth or saliva, discomfort and abdominal pain. These will often occur within an hour or so of eating. The signs of GD are very similar.
How is bloat diagnosed?
A lot of cases are pretty typical, just mentioning unproductive retching over the phone will get any emergency team already setting up for a GDV. Sometimes the obvious distension, pain, fast heart rate, poor pulses and shock will be enough for a working diagnosis but an x-ray is taken to differentiate GDV from GD.
So, how is it treated?
The pet will normally be hospitalised straight away. Untreated dogs with GDV will die.
One or more catheters are placed to start getting fluids in to help with the shock and bloods are taken to assess organ function and damage. At the same time, the dogs are given painkillers because both GD and GDV are incredibly painful.
A tube is passed through the mouth to see if gas can be removed from the stomach. If there is no twist and only GD is present then this is often successful and sufficient to stabilise the dog. If it isn’t, a needle is passed into the distended stomach to remove the air as fast as possible. The pain from the distended stomach is enormous so they show clear relief as the gas is emptied.
We take radiographs to check for GDV. If there is no torsion then the cases are treated for dilatation alone and often recover quickly, but it can take a bit of time to get the guts moving again. However, if the x-ray shows that the stomach has twisted then the pet is stabilised as much as possible with different types of fluids, painkillers, antibiotics and other medications. When able to better deal with anaesthesia, they can be taken to surgery – normally within an hour or so. In some cases, they cannot be adequately stabilised before surgery and it has to be done as soon as possible to relieve the obstruction and prevent further damage.
At surgery there are multiple steps. First is untwisting the stomach to relieve the obstruction, then to decompress it we use the tube down the oesophagus again – now it can pass into the stomach we can get rid of the gas and liquid. We check the stomach over to make sure the tissue isn’t too damaged and there aren’t any tears. The stomach is also checked where the needle is going to be put, just to ensure it is okay. We examine the spleen to make sure it’s not damaged, sometimes we have to remove it.
Finally, we do a “gastropexy” to help prevent this from happening again. This is where we make a cut into the stomach and the wall of the abdomen and tack them together with sutures so the stomach can’t get out of position in future. We recommend this for dogs with GD, and really any dog at risk of GDV for being a large, deep-chested breed.
After the operation, dogs are hospitalised at least 48 hours. In the initial stages they remain in intensive care where we keep a careful eye on their pain, blood pressure, heart rhythm, bloods and so on. As they improve, we can step back a little and get them eating and drinking again. Many cases are discharged within two days with pain medication and do well, as with GD it can take some time for the intestines to get moving properly again so they might have additional medication to help. Owners are normally advised to feel small frequent meals,
How serious is GDV?
GDV patients are very sick and surgery is high risk because they’re compromised by the obstruction. Some cases just aren’t candidates for surgery and we have to talk with their owners about putting them to sleep. This is always tough because often just hours earlier they were fine. Sadly, some pets will get to surgery but won’t make it through. Worse prognoses are associated with removing parts of the stomach or spleen. Similarly, they may be lost in the recovery stage, because their bodies are just too weak.
However, some patients are caught early on, they arrive with minimal changes, get through the surgery and recover in a couple of days quite uneventfully. It does depend on the individual case but the sooner caught and treated the better. So if your dog is displaying any symptoms, make sure your contact your vet immediately.
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