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Bloat in dogs

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					                                         Bloat in dogs

Several times a week I receive a phone call from someone whose dog has died of bloat.
Usually my role is to provide a sympathetic ear and assure the callers that there was nothing
they could have changed to prevent the incident. Our current knowledge of bloat does not
allow us to identify specific events that trigger an acute episode in susceptible dogs, although
some form of “stress” was probably involved. One of our long-term research objectives is to
better define what constitutes stress for dogs and to measure their physiological response to
it. However, the primary goal of the research is to determine why some dogs are more
susceptible to bloat than others, i.e., what are the risk factors for bloat. This has led to studies
of the physical conformation of dogs, their diet, vaccination histories, and even to new ways
to evaluate a dog’s temperament and personality.

The overall bloat fatality rate approaches 30% for dogs with a dilated, rotated stomach.
Approximately half of the dogs that die with a rotated stomach will do so before veterinary
medical or surgical treatment is obtained. Dogs may be found dead or die on the way to the
hospital, or may be euthanized by the veterinarian because of their poor prognosis or the
owner’s financial considerations. In contrast, dogs properly treated have [greater than] 80%
probability of surviving a bloat episode and then leading a normal life. Veterinarians over the
past 2 decades have reduced dramatically the postoperative fatality rate from gastric
dilatation-volvulus (GDV) from [greater than]50% to [less than]20% by using improved
therapy for shock, safer anesthetic agents, and better surgical techniques.

Too often, however, owners of dogs that died of bloat tell me that they had recognized that
the dog had a serious problem and rushed the dog to a veterinarian, only to be told that it was
probably only a “belly ache,” or that the dog’s stomach was dilated, but not rotated.
Sometimes the veterinarian recognized dilatation, but not a rotation (volvulus, torsion),
passed a stomach tube to relieve the pressure, and sent the dog home. Or the dog was
diagnosed as having dilatation and rotation, and a stomach tube was passed to relieve the
pressure, but surgery (gastropexy) to permanently correct the rotation was delayed, either
because the dog was thought to be too ill to withstand the surgery, or the veterinarian was not
adequately equipped or prepared at the time to perform the operation. The latter may occur if
the veterinarian is in the midst of busy office hours or if — especially at night — there is
insufficient technical help available to properly perform the surgery, which requires careful
administration of anesthesia, appropriate fluid therapy, and close monitoring of the dog’s
vital signs.

Numerous clinical reports from Europe and the United States show that gastropexy to prevent
gastric rotation should be performed as soon as possible following stomach decompression on
all dogs with gastric dilatation, whether or not the stomach is thought to be rotated at the
time. The recurrence rate of gastric volvulus in dogs treated for bloat conservatively, i.e.,
without surgery, approaches 100%, whereas the recurrence rate following gastropexy is [less
than]5%. The stomach of a dog that has had a gastropexy can still dilate, but it is unlikely to
rotate, so if dilatation does occur after gastropexy, it can probably be treated conservatively.

What does all this mean to you? If your dog suddenly develops a distended abdomen, appears
uncomfortable, and gets progressively worse, rush the dog to a veterinarian, preferably one
equipped to do emergency surgery. Gastric distention is a life-threatening condition, even if
the stomach has not rotated. Immediate decompression is required to relieve pressure on
blood vessels and to restore circulation to the heart, because shock can occur within minutes
of the first clinical signs. Fluid therapy is indicated to treat shock, and drugs may be needed if
the heart rhythm is irregular. This should be followed as soon as possible by surgery to
reposition and immobilize (gastropexy) the stomach before it is irreversibly damaged. The
best indicators of how well the dog will do postoperatively are its physical condition (state of
shock) prior to surgery and the appearance of the stomach during surgery (since dead or
dying stomach tissue implies a very poor prognosis). Intensive monitoring is usually required
for several days postoperatively in case complications occur.

If you suspect your dog has bloat, but the veterinarian dismisses it as a minor problem,
inquire about radiographs to rule out GDV. If dilatation with or without volvulus is diagnosed
and the stomach is decompressed, either by passing a stomach tube or by piercing the
stomach with a large needle (trochar) passed through the body wall, the dog should be
considered as a candidate for immediate surgery, unless its condition is too unstable to
tolerate anesthesia. If the veterinarian recommends that surgery be delayed for any other
reason, seek a second opinion immediately. Delay in surgery will increase the chance of the
stomach rotating if it hasn’t already, or will decrease the chance of the dog surviving if
rotation has occurred.

Following is an excerpt of a letter that illustrates some of these points. “I noticed Kelly [an
Irish Setter] attempting to vomit with nothing coming up. Grass? Chicken bone? I watched
her and we continued to walk. She was happy and greeted people, wagging her tail, … and
had fun. We went home and Kelly went upstairs where she attempted to vomit several times.
I immediately called my vet. Kelly and I arrived at the veterinarian’s office within five
minutes of the phone call. I told the veterinarian that Kelly had vomited two or three times
with nothing coming up. I said that she looked a little broad around the ribs. The veterinarian
did a physical examination and concluded that Kelly’s problem was just a “stomach ache.” …
I was directed to give her Pepto Bismol®. I took Kelly home and she lay down on the bed.
About 45 minutes later she went out to the back yard. When I went out 10 minutes later, I
found her bloated up. I grabbed her, took her back to the veterinary hospital, but she died on
the operating table.” (Comment: There is no guarantee that if radiographs had been taken
during the first veterinary visit, Kelly’s outcome would have been different. However,
radiographs might have confirmed the presence of gastric dilatation or volvulus, and thus the
need for immediate gastric decompression and surgery.) Be prepared — Teamwork between
you and your veterinarian is your dog’s best hope when it comes to bloat.

				
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posted:7/11/2012
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