Gastric dilatation-volvulus: Controlling the crisis - Veterinary Medicine
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Gastric dilatation-volvulus: Controlling the crisis
Although widely recognized, gastric dilatation-volvulus is still not fully understood. This overview provides up-to-date information on the possible causes, risk factors, diagnosis, and treatment of this life-threatening syndrome.


VETERINARY MEDICINE


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.
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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Source: VETERINARY MEDICINE,
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