This is the first monthly blog post about interesting cases we have treated at Companion Animal Hospital. Our veterinarians will take turns each month writing about a special patient who has touched our lives. We hope the stories will be engaging and informative, as well as giving you an insight into the wide range of medical and surgical services that our highly trained staff are able to provide. If there are topics you would like us to cover, please let us know by sending us an email to petvets@ptd.net.

 

The Day Sam Bloated: A Case of Gastric Dilitation Volvulus (GDV)

Sam's owner called Companion Animal Hospital (CAH) late one morning to report that her 7 year old neutered male German Shepard was trying to vomit, but nothing was coming up. It seemed like his belly was getting bigger. Jennifer, one of our client relations team members, recognized right away that this had the potential to be a life threatening problem. She told the owner to bring Sam into CAH right away.  Once Sam arrived and was placed in a room, Tasha, an outpatient technician quickly went in to assess his status.  Knowing that he appeared to be in distress, she paged the Inpatient Veterinarian for that day, Dr. Stowell-Hardcastle.  She saw that Sam was laboring to breath, trying to vomit and had a very large, hard, bloated belly which all pointed towards the most serious life threatening non-traumatic emergency  veterinarians encounter:  Bloat with GDV. What she couldn't know in the room was whether the bloated, gas filled stomach had also twisted upon itself.  Every minute counted in saving Sam's life.

Sam was rushed to radiology where digital x-rays were taken to confirm the diagnosis before two certified veterinary technicians, Mandi and Sandy, began emergency nursing care.  After an IV catheter was placed to administer fluids and medications, Dr. Stowell-Hardcastle and her team began the process of decompressing the stomach by passing a stomach tube to relieve the gas pressure and evacuate the stomach of any fluids.  Sam visibly relaxed as his stomach deflated, but he wasn't out of the woods yet.  Although the stomach had gotten smaller, Sam still had signs of shock, pain and heart irregularities. Dr. Stowell-Hardcastle knew that Sam needed emergency surgery to untwist his stomach if he was going to have a change to survive.

Mandi and Sandy with many years of experience, were able to quickly prepare Sam for his move into the operating room. Once Sam was under anesthesia, he was connected to an ECG, blood pressure, heart rate, temperature, and CO2 monitoring equipment.  When his blood pressure was dropping, the techs quickly increased his IV fluid pump settings to stabilize his pressures.  All the while, Dr. Stowell-Hardcastle made an incision into his abdomen, identified his twisted stomach and spleen, and rotated them back into normal position.  Circulation to his stomach and spleen was quickly restored. Sam was one of the fortunate ones. There was no permanent damage to his stomach or spleen.  The stomach was filled and evacuated with warmed fluids multiple times until the doctor was sure no food or damaging fluids remained.

 Now, came the part of the surgery that would prevent Sam from every having his stomach twist again.  Dr. Stowell-Hardcastle performed a gastropexy where she sutured part of his stomach wall to his internal abdominal wall before closing his incision. Sam recovered in ICU for two days where he continued to get IV fluids, medications, pain management and nutritional support, before being discharged. 

Here are some more facts about bloat to help you recognize this life -threatening emergency:

Statistically we know that large, deep-chested breeds are more prone to Gastric Dilatation Volvulus. These include Great Danes, Saint Bernards, Weimaraners, Irish Setters, Gordon Setters, Standard Poodles, Basset Hounds, Doberman Pinschers, and Old English Sheepdogs. It must be noted that any dog can bloat, even Dachshunds and Chihuahuas. The condition usually occurs two to three hours after eating a large meal.

Additional facts about GDV:

 

            Dogs weighing over 100 pounds have approximately a 20% risk of bloat.

 

            Gastric dilatation (bloat), usually without volvulus (twist), occasionally occurs in elderly small dogs.

 

            The distended stomach pushes the posterior rib cage so that the dog appears swollen or "bloated". This is most obvious on the left side and gentle tapping of the swelling just behind the last rib often produces hollow, drum-like sounds.

 

            The enlarged stomach presses on the diaphragm and breathing becomes labored.

 

            The swollen stomach presses on the larger blood vessels in the abdomen and circulation is seriously compromised, resulting in systemic shock.

 

            Ultimately, the dog collapses and the distended abdomen becomes readily apparent as the dog lies on its side.

Factors Increasing the Risk of Bloat

            Feeding only one meal a day

            Having a family history of bloat (i.e. a parent or sibling that has suffered from this condition)

            Eating rapidly

            Being thin or underweight

            Having a fearful, anxious or nervous temperament

            Having a history of aggression toward people or other animals

            Male dogs are more likely to bloat than females

            Older dogs (7 - 12 years of age) were the highest risk group in a recent study