Stomach bloat, torsion, and their deadly combination - Gastric Dilatation and Volvulus (GDV) - are conditions that all dog owners should be aware of, regardless of your dog's breed(s), age, or lifestyle. Awareness is truly crucial - again, for all dog owners.
Why do I keep stressing the importance of awareness for all dog owners when there are well-documented breed predispositions and known or suspected risk factors? For the very straightforward and irrefutable reason that awareness - as well as preparedness and prevention (the topics of the next two posts in this series) - saves lives. And while that life may not be that of your dog, it may very well be that of your friend's, neighbor's, or relative's dog… and isn't that important, too?
So, with that said… let's get on with this very important topic of canine bloat, torsion, and GDV. This will be a three-part blog series, with this first installment covering Awareness. Part two will be all about Preparedness, and part three will focus on Prevention. I hope you'll find this information both eye-opening and reassuring, and I hope you'll help those you know and love by sharing these posts with them.
Bloat, torsion, and GDV - what's the difference and why is it important?
While these terms are often used interchangeably by many people, knowing the difference between them is important, because they are different. But what's most important is that you recognize that all three conditions warrant veterinary evaluation and that all three can be fatal.
Bloat: The term "bloat" is mostly a generic term indicating an enlargement or swelling of the abdomen - where the abdomen is the enclosed compartment (or "cavity") between the chest (thoracic cavity) and the pelvis (pelvic cavity). Many pet owners will say "My dog looks bloated". Such a bloated appearance can be caused by any number of problems within the abdomen, including (but not limited to):
- Bleeding into the abdomen - as might occur with rat poison ingestion, trauma, certain types of cancer, or a multitude of other causes
- Fluid (other than blood) accumulation within the abdomen - as is often seen with liver failure, certain cancers, in many cases of heart failure, and in conjunction with a variety of other conditions
- Abdominal organ enlargement - the affected organ can be the liver, spleen, uterus, or any of the other abdominal organs… including, the focus of this blog series, the stomach
Of course, even the term "stomach bloat" isn't completely descriptive, as the cause of stomach bloat isn't always the same. You see, the stomach can bloat from a build-up of gas, fluid, ingesta/food, and even a combination of any or all of these three. While this may all seem like irrelevant minutia, it actually is important from a treatment standpoint, as gas bloat, for example, is often treated differently than food bloat.
As you can see from even just the partial list of potential causes for a "bloated appearance" of your dog's abdomen, this can be a very serious sign and one which should prompt immediate evaluation by a veterinarian. Even if the underlying cause or degree of distention wouldn't likely have proven fatal, it's still better to err on the side of caution. You're likely to appreciate the "peace of mind" and you're dog will likely appreciate the analgesia (pain relief) that the veterinarian will administer, if necessary.
Torsion: The term "torsion" basically means twisting or twisted. So here, in relation to stomach torsion, what this means is that the stomach, at either one or both ends, has twisted. In a stomach torsion, this degree of "twist" is less than that which completely obstructs the outflow of gas, liquid, or ingesta from the stomach. (If it completely obstructed such passage, that would be called a "volvulus" - see below.) The two ends of the stomach I referred to are the end nearer the mouth (the "oral end") where the stomach is connected to the esophagus, and the end further away from the mouth (the "aboral end") where the stomach is connected to the beginning part of the intestines. Torsion can compromise the blood flow to and from the affected organ, leading to a multitude of metabolic derangements and other problems.
There are any number of different structures within the body that can become "torsed", it's not just the stomach that can be affected. Animals, including people, can also have torsions of their intestines, spermatic cords, uterus, urinary bladder, and various other structures - including the spleen (which often occurs concurrently in cases of GDV, as I'll soon mention more about).
Again, suspected or known torsions, of the stomach or any other structure, must be evaluated by a veterinarian. They aren't only potentially fatal, they can be extremely painful, too.
Gastric Dilatation and Volvulus (GDV): This is the "big one" - the potentially rapidly-fatal one! The "Perfect Storm" of dog emergencies, if you will. Gastric Dilatation and Volvulus is basically the worst-case scenario combination of the aforementioned bloat and torsion. In cases of GDV the stomach is bloated (often with a combination of gas, fluid, and ingesta) and it is torsed, at both ends, to the point where outflow from the stomach is completely obstructed.
The distention of the stomach gets progressively worse, compromising not only it's own blood flow, but also, very importantly, the overall blood flow available to the heart, and therefore to the rest of the body. This results in a state of hypovolemic shock and myriad other problems, all requiring early and aggressive veterinary treatment, lest it be fatal.
Some of the most important secondary effects resulting from this decrease in blood flow include:
- Necrosis (death) of sections of the stomach wall - which can itself lead to rupture and spillage of stomach contents into the abdominal cavity
- A significant change in the acid-base balance - both at the level of the stomach and throughout the rest of the body
- The triggering, and out-of-control spiraling, of the body's natural inflammatory cascade - causing damage to a multitude of organs (including the heart). This is called Systemic Inflammatory Response Syndrome - or SIRS for short. The prognosis when SIRS sets in is not good.
- A triggering, and out-of-control spiraling, of the body's blood clotting system. This is called Disseminated Intravascular Coagulation - or DIC for short. The prognosis once DIC sets in is so dire that the more common name for DIC throughout the veterinary field is "Death Is Coming".
As you have hopefully realized, GDV is truly a very acute and severe emergency situation! Fortunately, with prompt recognition and appropriate care, the outcome of GDV cases is often quite good. However, with delay in recognition and/or the initiation of appropriate care, even if it's just what you might consider a "small delay", these cases are typically fatal. As I'll highlight again in the subsequent posts in this series, GDV is not an emergency where you want to wait until after dinner to take your dog to the vet. And it's certainly not one where you want to wait until the morning to "see your regular vet" or to "see if your dog is still acting abnormal" before taking them to the vet.
Hopefully you're now wondering - "Are my dogs at risk?"
The short answer to that question is "yes". But it is relative, and the "short answers" are often not the best.
While every dog owner should be aware of GDV, it is true that there are certain dogs - either because of their breed, lineage, general disposition, or possession of one or more of the other "predisposing factors" - that are at higher risk of suffering from it. If your dog fits any of these descriptions, be sure to pay even stricter attention to this series of blog posts (and be sure to review them often). But again, what's most important here is to appreciate that any breed and any size of dog can suffer from GDV - so every dog owner should be aware!
Predisposed Breeds: The higher risk breeds tend to have "deeper" or "barrel shaped" chests, and they tend to be the larger and giant breeds. The list below includes some of the dog breeds that are considered to be at increased risk for developing GDV, please note that it is not an exhaustive list. You should also note that mixes containing these breeds should be considered at increased risk for this condition, too. The list provided below is in alphabetical order and has nothing to do with a breed's relative risk.
- Basset Hound
- Bernese Mountain Dog
- Doberman Pinscher
- German Shepherd
- Gordon Setter
- Great Dane
- Irish Setter
- St. Bernard
- Standard Poodle
Risk Factors: Certain personality attributes or husbandry practices may lead to an increased risk, for any dog (regardless of breed), to suffer from GDV. Sadly, given the currently limited nature of many of the studies conducted on GDV, it's difficult to say with complete certainty which factors do and do not increase a dog's risk for developing GDV. Though there's certainly stronger supportive evidence (or "evidence") for some factors than others. However, given the critical and rapid nature of this condition, I'd suggest that it's always best to err on the side of caution and try to avoid even those factors which may increase your dog's risk. (*Note: The American Kennel Club's Canine Health Foundation (AKC CHF) has recently launched The Bloat Initiative, in an effort to improve education and research into this devastating disease - so keep fingers crossed and "watch this space".)
- Having a "first degree" relative with a history of GDV (this would be a parent or littermate dog)
- Larger size (dogs over 100# are at increased risk)
- Advancing age (risk goes up as your dog ages)
- A previous episode of GDV (*unless the "pexy" has been performed - see more about this in the subsequent series installments)
- Feeding one large meal per day
- Nervous, anxious, aggressive, or otherwise fast eating
- Feeding from an elevated bowl (this used to be thought to decrease risk, but may actually increase it)
- Feeding dry food only
- Exercise too close to eating
- Drinking large volumes of water following exercise
Well, I know that's a lot to digest (no pun intended - honestly). So, this concludes the "Aware" installment of this 3-part blog series on canine bloat, torsion, and Gastric Dilatation and Volvulus. I hope you are now fully AWARE of these conditions and the important point that any dog can suffer from GDV. There's still lots more to cover and learn, including the signs you may see if your dog is suffering from a life-threatening case of GDV! Those signs, and a whole lot more, are covered in Part 2: "Be Prepared". So please continue following along and read on.
A special "thank you" to my friend and fellow veterinarian, Dr. Ryan Cavanaugh, DVM, DACVS for his editorial review of this post. Dr. Cavanaugh is a highly-respected, board-certified specialist member of the American College of Veterinary Surgeons. He is currently a surgical specialist at VCA's Alameda East Veterinary Hospital in Denver, Colorado. Along with his expertise in routine and advanced surgical procedures, Dr. Cavanaugh has been recognized as one of the leaders in the field of surgical oncology. You can read his full bio here.
A special, heart-felt "thank you" also goes out to Ann Rinkenberger and her family. They kindly allowed me to use the image of their beautiful dog, Casey, at the outset of this post. The Rinkenberger family sadly lost Casey to GDV/Bloat five years ago (almost to the day), on Feb. 13, 2008. Mrs. Rinkenberger was happy to let me use the photo of Casey in the hope that it, along with this series of blog posts, might help someone, even if just one person, be aware, prepared, and preventive when it comes to this devastating condition. I truly believe that it will - and I hope it does so for far more than just one person or family. Please help by spreading the link to this post, and also by reading Mrs. Rinkenberger's personal account of Casey's battle with GDV/Bloat.
I do hope that you've found this post informative and easy to follow. Please share your thoughts, feedback, and any personal experiences you've had with these conditions in the comments section below. And, very importantly, please don't forget to share this information with your dog-owning friends and family, too. Hopefully they'll never need it, but they'll sure thank you for it if they do.
Be aware. Be prepared. Be Preventive! ™
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