DIAGNOSIS
GDV is often diagnosed based on a patient's history, signalment, and physical examination results. Radiographic evaluation
is required to confirm the diagnosis.
Signalment
GDV is most commonly seen in large- and giant-breed dogs. It can also be seen in small dogs and cats. Dogs from 10 months
to 14 years old have been affected. No sex predilections have been demonstrated.
Physical examination results
On physical examination, it is classic to find a large distended abdomen. On percussion, a tympanic sound is produced. Abdominal
palpation may be uncomfortable.
Patients with GDV progress through different degrees of shock that need to be recognized during the patient evaluation. First,
animals early in the syndrome present with clinical signs similar to those of hypovolemic shock because most of their blood
volume is restricted in the caudal vena cava and the portal vein. Thus, animals will exhibit:
- Tachycardia and tachypnea with normal femoral pulses
- Slow capillary refill times
- Pale mucous membranes
- Cold extremities.
With progression of the syndrome, patients will go into endotoxemic shock and will experience:
- Tachycardia and tachypnea with weak femoral pulses
- Injected mucous membranes
- Fever
- Slow capillary refill times.
Finally, patients will decompensate and exhibit:
- Severe hypotension
- Bradycardia
- Hypothermia
- White mucous membranes
- Cold extremities.
Laboratory findings
Early on in the disease progression, complete blood count results often reveal a stress leukogram with neutrophilic leukocytosis
and lymphopenia. Serum chemistry profile results may show evidence of hepatocellular damage and cholestasis with increased
alanine transaminase activity and total bilirubin concentration and azotemia. Hypokalemia may also be present.
Lactate is produced as a by-product of anaerobic metabolism and has been shown to be elevated in animals with GDV.17,18 In one study, a lactate concentration < 6.4 mmol/L at presentation, a decrease of lactate of 4 mmol/L or more after fluid
treatment and decompression, or a decrease in lactate of > 42.5% of the original value after fluid treatment and decompression
was associated closely with survival.18
Radiography
Radiography can help to differentiate between gastric dilatation and GDV. If radiography is necessary to determine the diagnosis,
do not perform it until the patient is stable.
1. A lateral radiograph of a dog in right lateral recumbency. The double bubble image of the stomach is characteristic of
GDV.
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Since the pylorus is displaced on the left side of the abdominal cavity in a dorsocranial position to the fundus, right lateral
recumbency radiography is required to be able to obtain the diagnostic double bubble image (Figure 1). The two bubbles are caused by the accumulation of air in the pylorus and the fundus. Free gas is present and may be seen
in the abdomen when the stomach has ruptured.
If gastric dilatation is present without volvulus, radiographs show a dilated stomach with dilated loops of jejunum.
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