Bloat, (Gastric Dilatation & Volvulus - GDV)

The Condition and Its Causes
Simply put, bloat describes a stomach which has become abnormally enlarged or distended. The stomach is filled with gas, food, liquid, or a combination thereof. Torsion is the abnormal positioning of the stomach which is caused by the stomach's rotation about its axis, i.e. twisting of the stomach. Bloat usually leads to torsion, although torsion can occur without bloat. Chronic gastric volvulus (ongoing mild torsion) may not cause typical signs of GDV, but should be suspected in dogs with intermittent vomiting, weight loss, mild bloating, rumbling sounds in the bowel and/or belching. Depending on how quickly the problem is dealt with, GDV may result in a stomach that is rotated by anywhere from 90° to 360°. Severe torsion usually means the displacement of both the stomach and the spleen (they exchange positions). The speed at which the stomach empties itself, as well as the stomach's digestive contraction pace, are thought to play a role in the development of GDV. Certain food types (such as peas, onions, beans etc.) are also implicated. Research analyses of gastric gas from dogs with GDV suggest that it predominantly results from swallowing air rather than from gastric fermentation (digestive disorder). Some people suggest a genetic predisposition to bloat, while others refute the suggestion. None of these theories has been scientifically proven, and all appear to be only partially true. Based on his extensive clinical experience with GDV cases, Dr. John Lammerding (a Board Certified Veterinary Surgeon) tends to think that GDV in young dogs may suggest a genetic predisposition. However, he believes that GDV in old dogs are typically caused by excessive hyperventilation (sucking in too much air) due to the fact that some old dogs, like old people, develop breathing difficulties due to the aging process. In the latter case, GDV could theoretically be prevented by keeping your dog calm and preventing him/her from hyperventilating. Regardless of the cause of GDV, the end result is a distended and twisted stomach. GDV results in physiological changes that create a medical and surgical emergency. GDV most commonly occurs in large, deep-chested breeds, but has also been reported in other smaller breeds Reported fatality rates range from 15% to 60%. There is also a high recurrence rate when surgery (Gastropexy) is not performed to permanently attach the stomach to an anatomically acceptable part of the body, such as a rib. Bloat surgery is a very painful and major operation, and is potentially life threatening especially in cases involving older dogs You should discuss the treatment of bloat and torsion with your veterinarian the next time you see him/her. Not all veterinarians are familiar with the proper emergency treatment of GDV and fewer yet are familiar with proper surgical technique and post-surgery care and monitoring. It is imperative that you make sure that your veterinarian is familiarized with the proper procedures before his/her skills are needed. If your veterinarian is not receptive to or is offended by your queries, then it may perhaps be time for you to find a more responsive veterinarian.

Symptoms
Early signs of bloat may include restlessness, excessive drooling, abdominal pain, retching, and/or non-productive attempts to vomit. The dog may vomit foamy mucous, or a mucousy foam may be evident around the lips. A more advanced sign of bloat is characterized by abdominal distension (enlarged abdomen). Other signs may include pale mucous membrane (evident by pale gum colour), and prolonged capillary refill time (detected by pressing the gum with your fingertip and judging the speed at which gum colour returns to pink after you stop pressing.) Some people have reported early detection by observing abnormal behavior, such as not wanting to move around; or laying down in a curled up position, etc, when the dog would normally run around and play. During this early phase, stomach enlargement may not be visually evident yet. Bloat can usually be detected when you make the dog stand up and gently feel his/her abdomen. The abdomen should feel soft and tapered inward when the dog is relaxed. If the abdomen feels hard, or sounds hollow (like a drum) when you tap it gently with your hand, then your dog is probably bloating or even torsioning. If you're not sure, get the dog in to the veterinarian (or at least call) right away just in case, it's better to be safe than sorry.

Emergency Treatment of Suspected GDV
The first thing to remember in any emergency situation is to remain calm; your dog's life will depend on your clear thinking and quick actions.
1. Whenever possible, call your vet and warn them that you'll be bringing in a bloat case so that they can save precious time by making the necessary preparations while you're on your way. Be sure to indicate your approximate arrival time because some clinics close at set hours regardless of your situation.
2. If you're not close to your vet (or if someone else can drive), and your dog's stomach is distended, you may want to initiate emergency first aid by gently passing a well-lubricated tube to decompress the stomach. If you do not have a tube readily available, some people have reported success with the use of a garden hose (with the ends cut off), lubricated with water. Always pass a tube down slowly and gently--push it down an inch or so at a time, and only after the dog has swallowed, without gagging, the section you have already pushed in. NEVER force a tube down as you can do severe damage to the internal organs! If tube passage is unsuccessful due to internal obstruction, then it means the stomach has probably twisted. Get to the hospital as quickly as possible.
3. It is important that the veterinarian first treat the dog for shock with intravenous fluid and drug therapy. The veterinarian may also start a continuous electrocardiogram (EKG) to monitor cardiac functions.
4. Generally, the initial goals of emergency veterinary treatment of GDV are to decompress the stomach and to restore and support the dog's blood circulation. If the stomach is twisted, the veterinarian may have to determine the location of the stomach and cut an opening into the stomach through the side of the body to release the gas.
5. The second step is to determine (by X-rays either before or after decompression) whether simple dilation (bloat) or GDV (bloat with torsion) has occurred. This is very important because simple dilation can often be managed without emergency surgery, but if the stomach has twisted, emergency surgery may be required to reposition the stomach.

Prevention
There are no sure-fire ways to prevent or predict GDV, but here is a list of suggestions:
1. Feed 2 or 3 smaller meals daily (as opposed to 1 large meal).
2. Any changes in the diet should be made gradually, over a period of a week.
3. Vigorous exercise, excitement and stress should be avoided from 1 hour before to 2 hours after meals.
4. Excessive drinking should also be avoided.
5. Avoid feeding food that are known to cause flatulence (gas), e.g. soy, beans, peas, onions etc.