Monday, October 24, 2011

The mother of all emergencies !

The title can only mean one thing - Gastric dilitation and volvulus, or GDV.

GDV used to frighten me - but after my several jobs in the ER, it's now one of my favorite things to treat.  It's adrenaline inducing, requires significant technical skill, lots of medical and surgical knowledge, and has the potential to be cured.  It's a condition where I can definitely say that I saved the pets' life - without me, they would have faced certain death. I don't have a specific patient to share with you, but at the request of a reader, I wanted to provide some information about the condition and hopefully improve awareness and understanding of this condition.  Hopefully your pet never experiences GDV, but if they do, you'll be prepared.

What is GDV?
GDV is an extremely life-threatening emergency.  GDV is most common in large breed, deep chested dogs.  Great Danes, Pitbulls, Boxers, Chows, Greyhounds, and Labradors are among the most commonly affected breeds.

Typically, a GDV patient will start with initial symptoms of restlessness, a bloated or distended appearance to the abdomen, followed by unproductive retching, panting and pain.  This quickly progresses into a patient who becomes moribund; unable to walk, move, with a very high heart rate, pale gums, signs of shock, and rapidly progresses to a lethal state.

Why does it occur? 
Like so many medical conditions, the specific cause of GDV is unknown.  What is known is that the stomach fills with gas, rotates, and then leaves both the inlet (the esophagus) and the outlet (the pylorus) unable to let anything escape the stomach, including gas.  As the stomach fills like a balloon, it becomes massively stretched, compromizing blood flow to other organs, damaging the lining of the stomach and reducing much-needed blood flow to the stomach wall, and compressing large veins within the abdomen.

What can I do at home?
GET TO A VETERINARIAN IMMEDIATELY.  There is absolutely nothing you can do for your pet at home except for remain calm, place them in your vehicle, and travel to your nearest veterinary facility (this may be your general practicioner, or may be an emergency hospital).  Do not waste time at home.  Once the symptoms of bloat are noted, immediate action is imperative to recovery of your pet.

Upon arrival to the veterinary facility, your pet will be triaged.  Technicians and the veterinarian will evaluate vitals, including mucous membrane color, heart rate, pulse quality, evaluate the distention of the abdomen.  If symptoms are consistent with bloat, the veterinarian will recommend immeidate action, including an IV catheter, IV fluids for blood pressure support, pain relief, and decompression the stomach.  After your pet is receving these treatments, radiographs will be recommended for the definitive diagnosis of GDV.  A patient with GDV would have a radiograph (x-ray) that looks something like this:

Image from public domain, wikipedia commons
This image represents the stomach, filled with gas (dilitation) and twisted (volvulus).

Can my pet be saved?
 In a word, yes.  Advances in veterinary medicine over the last 20-30 years have significantly improved statistical outcomes for GDV.  Treatment however, can never guarantee a successful outcome. These are just some of the things that your veterinarian must consider when treating your pet with GDV:
  • Rapid, accurate diagnosis
  • Stabilization of obstructive shock caused by the massively dilated stomach
  • Restoration of blood flow to vital organs
  • Stabilization of blood pressure
  • Evaluation of electrolytes, lactate (an indicator of shock), and kidney values
  • Evaluation of concurrent illnesses (some pets who GDV are geriatric, with other conditions to consider) 
  • Balanced, multimodal anesthesia in a patient who is significantly compromised (very much unlike a young healthy patient for a spay or neuter)
  • Maintaining sterile surgical field
  • Abdominal exploration to untwist the stomach and asesss vital organs
  • Assessment of the stomach wall, which can become necrotic (die off) as a result of the GDV
  • Management of hemorrhage
  • Management of cardiac arrythmias which commonly occur in conjunction with GDV
  • Careful, gentle tissue handling, conscientious surgical technique
  • Attachment of the stomach to the body wall to prevent any further twisting in the future (a pexy)
  • Adequate post-operative monitoring and supportive care
This is not indented to be an all-inclusive list, but is intended to give you some idea of the degree of education needed to recover your pet when they experience GDV.  Some statistics estimate that 70-80% of GDV patients survive to discharge.

How much will it cost?
As a result of the involved care, GDV is an expensive condition to cure.  Depending on part of the country, cost of living, and your pet's specific conditions, development of complications, ets, an average GDV treatment may cost in the realm of $2500-$6000+

What will my pet's life be like afterwards?
Most pets who recover from the surgery of GDV go on to live normal, active, happy lives.  Most patients who have a pexy performed can never twist their stomach again; however, there are reports of second-time offenders.  This is fairly uncommon -- in one study, only 6% of patients treated experienced a second torsion at some time in their lives.

Is there any prevention for GDV?
Actually - YES!  At risk breeds can have a prophylactic gastropexy, which is the same as the pexy discussed above.  It prevents twisting of the stomach, and can be performed easily at the same time as a spay (for a female dog), relatively inexpensively and without the need for a second surgery.

Questions? Bring them on in the comments!

~ER Doc


  1. Thank you! Maybe that will save another dog..

  2. Of course! Please let me know if there's any other topics you'd like to read about!

  3. Hi... On october 4th, my great dane torsed a second time in 2years despite her tack. When she was tacked, the surgeon, our specialist and regular vet all said what you did: that it is highly unlikely that another torsion will ever happen (even though the sentence is worded to say that it could happen again, the delivery and tone was one of security).

    The problem with that is the sense of false security, so that when I took her into the emergency clinic and she kept falling to the ground and I said to the vet "the only time I have ever seen her do that is when she torsed the first time" I didnt even think that she had torsed.

    That sense of security proved to be lethal because not even the specialist - who is a very good and very thorough doctor - had suspected it. My dane also suffered from addison's disease which complicated the sense of security even further.

    She died a horrific death. We were together on the floor of an exam room waiting and she died right there. Nothing to relief her suffering.

    An autopsy was performed. I asked the pathologist why she had not had a distended abdomen like she did the first time. He said the tack had remained and her stomach turned on it, leaving no room for the stomach to bloat out.

    It is October 30th and my devastation is as rife today as it was 26 days ago.

    There is no blame in this instance. My girl had a specialist who cared about her deeply and was devastated to have lost her. But I do feel really cheated by the sense of security that was provided. If caught, she would have had a good chance of survival because the ER team here in Toronto are dedicated and top-rate.

    So here is a story, a real life story of a second torsion, and although they are rare, I implore you to be aware the reality of it and when you tell future clients that a second torsion is highly unlikely, deliver it with insecurity not security. But security killed in our case.

  4. So sorry about your loss. I'm sure you know that your doctors did everything they could to save her. Nobody is perfect, even though we wish doctors were 100%, they can't be.

    My heart goes out to you.