Bloat

OVERVIEW: 

 

Gastric torsion, more commonly known as bloat, is one of the most serious health problems found in domestic dogs.  Gastric Torsion is infamous among owners of those dog breeds most likely to be stricken with the condition, not only because the condition is usually fatal without medical treatment, but it kills so quickly that a dog that is perfectly healthy in the morning may be dead or in a coma when its owner returns from work.  Gastric Torsion is also known by many other names including gastric dilation, gastric volvulus, gastric dilation-volvulus syndrome, GDV, torsion of the stomach, dilation of the stomach, and distension of the stomach.  All of these names are disputed by various subgroups of the veterinary community, largely due to disputes over the true causes and nature of the condition.

 

There is substantial disagreement in the veterinary community about many aspects of gastric torsion and its causes; although, all agree on a few key features of the condition.  Gastric torsion occurs when a dog’s stomach rotates inside of its body.  This shift can range in severity from a few degrees to several full rotations, and the rotational direction may be different in each case.

 

As one might expect, there are a number of very severe effects from the stomach twisting.  To begin with, food and gas are prevented from leaving or entering the stomach.  This leads to food and gas buildup inside of the stomach, which in turn makes the bloat more severe.  As more and more food and gas become trapped, the stomach swells and distends, causing discomfort and pain and making the blockage even worse.  At the same time, the dog is forced to either vomit up any food that cannot enter the stomach or choke on it if it becomes lodged in the esophagus.  It is not only the digestive tract that becomes blocked when the dog’s stomach twists, but also the circulatory system as well.  The blood vessels around the stomach and adjoined organs are squeezed when the stomach rotates, usually reducing the amount of blood that can flow through them but sometimes closing them entirely.  The flow of blood, and therefore the oxygen and nutrients it carries as well, to the digestive tract is immediately impacted, and those organs begin to shut down.  More seriously, the flow of blood back to the heart is greatly reduced as increasing amounts of the precious fluid become trapped in the digestive system.  As the heart pumps blood to the entire body, if there is less blood for the heart to pump there is less blood for the entire body.  Blood pressure drops and every system in the body starts to receive progressively less oxygen and vital nutrients.  One by one, every system in the dog’s body shuts down.  As the systems begin to die, they release toxins into the bloodstream, poisoning what little blood remains.  Unless proper medical treatment is provided rapidly (and even immediate treatment is not always enough), the dog is very likely to slip into a coma and die.  The exact cause of death varies greatly from case to case, but some of the most common are complete body failure, an individual system failing completely, cardiac failure, lack of oxygen to the brain, stomach ripping or breaking open, and blood poisoning.  The degeneration of a dog suffering from bloat can be unbelievably rapid.  Depending on the severity of the gastric torsion, a perfectly healthy dog can be in a coma or dead within as little two hours, and very, very few dogs survive longer than 36 hours.

 

There are two major theories regarding the development of gastric torsion, both of which are hotly disputed among veterinarians.  The mechanical theory holds that gastric torsion is purely the result of a physical twist of the stomach.  According to this theory, the stomach normally swings in a pendulum-like fashion within the dog’s body, especially when it is full of food.  When the dog makes a sudden movement such as running or jumping, the pendulum swings so hard that it rotates completely around its point of fixation, in this case the esophagus and small intestine.  According to this theory, the stomach becomes distended with food or gasses because they cannot escape from the stomach, making the stomach dilation an effect of the condition rather than its cause.  Proponents of the mechanical theory believe that gastric torsion is more likely to occur after feeding because the food in the stomach weighs it down and therefore increases the power and distance of each stomach swing.

 

The second major theory regarding the cause of gastric torsion is the dilation theory.  According to the dilation theory, the stomach fills with air and gasses prior to the stomach twisting and actually causes it.  Under this theory, the dog’s stomach fills with air as a result of very heavy breathing, digestive fermentation, or perhaps both.  Recent studies have concluded that most of the distension is caused by oxygen entering the stomach during feeding, but have definitely not ruled out other oxygen sources or gasses.  As the stomach fills with gasses it expands.  The expanding stomach is forced to rotate as it comes into contact with other body organs that are less mobile than the stomach.  Research has shown that dog’s stomachs begin to twist either clockwise or counterclockwise within the body as a result of being filled with air, and that the turn is either clockwise or counterclockwise depending upon the location of the spleen when the dilation started.  As the turn becomes more severe, the severity of the condition worsens as well.  Proponents of the dilation theory believe that gastric torsion is more likely to occur after feeding because the dog takes oxygen into its stomach as it eats.

 

The mechanical theory is still widely supported among many members of the veterinary community, although it has fallen into disfavor recently due to the rise of the dilation theory.  There is not much evidence to suggest that a dog’s stomach normally swings like a pendulum, while there is growing evidence that they do twist when filled with air.  It is also very possible that both theories are partially correct.  Some cases of gastric torsion may be primary mechanical in nature, others related to stomach dilation, and still others by a combination of the two factors.  Until more research is conducted the full truth will probably never be known, although the exact cause has little impact on the condition’s progression, symptoms, or treatments.

 

Anyone suspecting their dog is suffering from gastric torsion should call their veterinarian immediately or an emergency veterinarian if it is after their normal veterinarian’s business hours.  Without rapid veterinary attention gastric torsion is almost always fatal, and the sooner it comes the better.  Even a time difference of an hour or less can make a huge impact on a dog’s survival chances, although with gastric torsion there are never any guarantees. 


 

RISK FACTORS: 

 

The following factors have been shown or are thought to influence the likelihood of a dog developing gastric torsion:

 

Breed:  Certain dog breeds are considerably more likely to develop gastric torsion than others, especially the Great Dane which has an estimated 37 percent chance of developing the condition within its lifetime. Other breeds that tend to be a high risk for developing bloat include the Bloodhound, St. Bernard, Weimaraner, German Shorthaired Pointer, Irish Setter, Gordon Setter, Standard Poodle, Irish Wolfhound, Doberman Pinscher, German Shepherd Dog, Rottweiler, Rhodesian Ridgeback and Basset Hound; the Basset Hound being at the highest risk of all breeds under 50 lbs.

 

Size:  In general, the larger the dog, the more likely it is to develop gastric torsion.

 

Chest: Dogs with deep and wide chests are much more likely to develop gastric torsion than dogs with narrow chests.  It is believed that this is because the stomachs in dogs with wider chests have more room to move and therefore rotate than those of dogs with narrower chests.

 

Hereditary: Veterinarians are split on the issue of whether gastric torsion is hereditary.  It does not appear that the condition itself is necessarily hereditary, but the risk factors associated with it, such as deep wide chests, often are.  Most veterinarians do recommend not breeding dogs that have experienced gastric torsion, but not all do and in any case the condition most frequently occurs in dogs that have advanced beyond breeding age.

 

Age:  Studies conducted by Purdue University indicate that dogs over the age of 7 are more than twice as likely to develop gastric torsion as younger dogs.  It is thought that the ligaments which connect the stomach to other parts of the body deteriorate with age, making the condition more likely.  However, dogs of any age may be stricken with gastric torsion, even young puppies.

 

Gender:  Some believe that male dogs are more likely to develop gastric torsion, but others claim both sexes are equally likely.

 

Eating Habits: Dogs which eat a single large meal are much more likely to develop gastric torsion than dogs which each two or three smaller meals or continuously throughout the day.

 

Food Bowl Height:  Some claim that raised food dishes prevent gastric torsion, but recent studies indicate otherwise.  Studies conducted by Purdue University suggest that raised food bowls may increase a dog’s likelihood for developing bloat by as much as 200%.

 

Activity: Dogs which perform vigorous activity such as work or exercise immediately after eating are at a much greater risk of developing gastric torsion.

 

Temperament: Dogs that tend to be more aggressive, fearful, or anxious tend to suffer from higher rates of gastric torsion.

 

Weight: Some sources claim that underweight or lean dogs are more likely to develop bloat, but the scientific evidence for this claim is currently lacking.

 

Gas: Although unconfirmed with testing, there is a widespread belief that dogs with a greater tendency to be gassy are more likely to experience gastric torsion.  This belief is most widely held among those who believe that digestive gases are more important in the causes of the condition.

 

 

SIGNS & SYMPTOMS: 

 

While each individual case of gastric torsion is slightly different, there are a number of common symptoms present in most cases.  Some of the earliest are breathlessness, difficulty breathing, restlessness, excessive drooling, abdominal discomfort and/or pain, retching, and vomiting which may or may not produce food.  More rarely, foam or mucus may be present around the dog’s lips.  In virtually all cases of bloat, the dog’s abdominal region swells to a size much larger than normal, and also often becomes very hard.  Other symptoms may include pale mucous membranes, most noticeable on the dog’s gums, and prolonged capillary refill time, which can be observed by pressing a finger against the gums and seeing how long it takes them to return to a pinkish color.  The behavior of the dog also frequently changes, with most affected animals becoming increasingly immobile and frantic as the condition worsens.

 

DIAGNOSIS & TESTS: 

 

Gastric torsion is very easy to diagnose properly, which is very lucky because rapid diagnosis and treatment are absolutely imperative to give the dog any chance of survival.  The breed, size, physical characteristics, and history of each individual dog play a major role.  For example, a Great Dane suffering from a hard and distended stomach will almost always be assumed to have bloat.  The next stage is a physical and visual exam.  Special attention will be paid to the size and hardness of the chest to see if they are enlarged or hardened.  Several other parts of the body will be examined as well.  One of the most common tests involves the gums.  The veterinarian will examine the gums to check their color and press a finger against them to see how quickly they return to a normal color.  Heart rate and blood pressure will be checked to see if they are abnormal, especially if they are lower than they should be.  If it is thought that the dog has bloat, emergency x-rays will be taken.  The veterinarian will check these x-rays for several things.  First, the size and location of the stomach will be observed.  Secondly, the location of the pylorus will be examined.  Normally the pylorus is located ventral and to the right of the stomach, but in dogs affected by gastric torsion it is often cranial and to the left.  Other features such as air bubbles may also be evident from an x-ray.

 

CONVENTIONAL TREATMENT & MANAGEMENT: 

 

Gastric Torsion is a true emergency and immediate veterinary treatment is necessary.  Although there are a few first aid techniques that can be used to increase the dog’s chances of survival, dogs experiencing gastric torsion must be given emergency surgery as quickly as possible.

 

If one suspects that they’re dog is experiencing gastric torsion, they should immediately call the veterinarian.  If veterinary care cannot be provided immediately, owners should provide some basic first aid with their veterinarian’s prior approval.  While these treatments will not save the dog’s life, they can greatly increase its chances of survival.  1 – 2 doses of Famotidine (known commercially as Pepcid) may be used, although some veterinarians prefer Simethicone.  If veterinary care is hours away, more severe steps may have to be taken.  A tube may be passed down the dog’s throat to allow it to release the gaseous buildup inside of its stomach.  This procedure must be done very carefully to prevent esophagus or stomach rupture.  This procedure can be very challenging and is often very uncomfortable for the dog.

 

Different veterinarians prefer to treat gastric torsion differently.  Some prefer to immediately anesthetize the animals and perform surgery as quickly as possible.  During these surgeries, large amounts of intravenous fluids and medicines are given.  Immediate surgery is more often used in very severe or advanced cases.  Other veterinarians prefer not to begin surgery immediately.  These veterinarians begin treatment with a minor surgical procedure designed to reduce the distension of the stomach.  Other treatments, such as medication and intravenous fluids are provided shortly afterwards until the dog is no longer in shock.  Once the dog has stabilized, a more invasive surgery is performed.  Those vets who use the second method do so because more stable dogs are more likely to survive surgical procedures.  Any treatment will require a balancing act of the likelihood of surviving surgery immediately with the likelihood of survival if such surgery is delayed.

 

Every gastric torsion surgery has four major goals: release the gaseous buildup within the stomach, restore proper circulation, untwist the stomach, and return the stomach to its normal position.   The exact surgical order and procedure will be determined by the exact nature and severity of the dog’s condition.  As a general rule, the quicker the dog makes it to surgery, the less severe and more successful the surgery is likely to be.  For example, dogs with mild bloat may only require a tube down the throat coupled with a minor surgical procedure and medication while very severe bloat may require large incisions on the dog’s sides which extend to the stomach followed by massive internal surgery.   In order to survive gastric torsion, surgery is essentially always necessary.  However, even nearly immediate surgery does not always guarantee survival.  Even the most highly skilled and experienced veterinary surgeon will not be able to save every victim of gastric torsion, especially those suffering from more advanced cases.

 

Provided that the dog survives surgery, extra care will still be necessary for some time.  In all cases, food and water intake must be closely monitored for many days to many weeks.  Some dogs may require intravenous fluids for several hours or even days.  Depending upon the extent of the internal damage, additional surgical procedures may also be necessary to repair other systems or organs.

 

POTENTIAL COMPLICATIONS: 

 

There are almost innumerable complications from gastric torsion and its treatments.  Because this condition impacts blood flow to the entire body, it can severely damage or entirely stop the function of essentially every organ and body system.  Examples of some of the more common complications arising from gastric torsion include blood poisoning, reduced blood pressure, cardiac failure, brain death, kidney failure, liver failure, intestinal wall damage, esophageal damage, burst stomach walls, septicemia, and bruising of the internal organs, but there are nearly endless other possibilities.  Although there are exceptions, most of the complications of gastric torsion are immediate rather than long term (though many are life-threatening).

 

Unfortunately, the treatments necessary to cure gastric torsion often have as many complications as the condition itself.  Oftentimes, treatment requires a tube to be maneuvered down a dog’s throat.  If not done properly, severe damage to the esophagus can result such as tearing or puncturing.  There are also many potential complications from the surgeries necessary to treat gastric torsion.  Some dogs are allergic to anesthetic which can cause swelling, anabolic shock, respiratory failure, death, and many other problems.  Surgical cuts may cause a dog to bleed to death, especially if it has an undiagnosed blood disorder such as Von Willebrand’s disease.  There is always the possibility that surgery may unintentionally damage another part of the body, damage which may be fatal without additional surgical procedures.

 

HOLISTIC REMEDIES: 

 

There are no widely (or even commonly) accepted treatments for gastric torsion.  This condition is essentially always fatal without rapid surgery.  Because gastric torsion can kill within a matter of hours, treatments must resolve the problem immediately unlike most holistic remedies which take time.  Additionally, gastric torsion prevents digestion meaning that it prevents any cures which require a dog to consume anything from working.  Because the condition requires the manipulation of organs that are surrounded by other organs, it cannot be cured with surface contact alone.  A few sources indicate that consuming grass has aided gastric torsion, but they are almost certainly mistaking a stomach ache or other digestive issues with this deadly condition.

 

PREVENTION & HELPFUL TIPS: 

 

Unfortunately, gastric torsion is not entirely preventable, and even those owners who take the utmost precautions may still find that their dog develops the condition.  There are, however, a number of steps that owners can take to dramatically reduce the chances that their dog suffers from gastric torsion.  Because large meals are thought to greatly increase a dog’s chances of developing gastric torsion, veterinarians recommend owners feed their dogs two or three small meals every day instead of a single large one.  The same precautions involve drinking, smaller amounts at one time are better.  It has also been demonstrated that dog’s that are allowed to eat small amounts of food whenever they want to throughout the day via constant access to food are much less likely to develop gastric torsion, although this can also lead to other problems such as obesity.

 

Rapid activity shortly after consuming a meal has also been shown to substantially increase a dog’s likelihood of gastric torsion, so owners should prevent their dogs from performing any rigorous physical activity immediately after eating.  At the very minimum, at least 1 hour should pass between a meal and exercise/strenuous play/work, although 2 would be more ideal.  Some veterinarians recommend avoiding any foods that are thought to result in flatulence, such as soy, beans, and beet pulp, but this is not universally accepted.  Many also believe that feeding a dog raw fruits and vegetables is helpful because it provides roughage, but this is also not universally accepted.  Some veterinarians have found that anti-inflatulent products such as Simethecone or other drugs such as Reglan and Metoclopramide Hydrochloride can help prevent gastric torsion as well, but these methods have not found widespread acceptance.

 

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