Bloat (Gastric Dilatation Volvulus)
Bloat is a life threatening emergency that affects dogs in the prime of life. The mortality rate for this condition approaches 50 percent. Early recognition and treatment are the keys to survival.
The classic signs of bloat are restlessness and pacing, salivation, retching, unproductive attempts to vomit, and enlargement of the abdomen. The dog may whine or groan when you press on his belly. Thumping the abdomen produces a hollow sound.
Bloat develops suddenly, usually in a healthy, active dog. The dog may have just eaten a large meal, exercised vigorously before or after eating, or drank a large amount of water immediately after eating. There is no evidence that the protein or soy content in the diet contributes to bloat and research has shown that the majority of gas associated with bloat is due to swallowed air
During volvulus, the pylorus is pulled out of position and becomes displaced to the left of the gastroesophageal junction. This pinches off the dudodenum (stomach exit tube) and prevents fluid and air from escaping from the stomach through the pyloric canal. Simultaneously, the gastroesophageal junction becomes twisted and obstructed, preventing the dog from belching and vomiting. Gas and fluid are trapped in the closed off stomach , which becomes greatly distended as the material ferments. Interference with blood circulation results in necrosis of the wall of the stomach.
This sequence produces a number of other problems including acute dehydration, bacterial septicemia, circulatory shock, cardiac arrhythmias, gastric perforation, peritonitis, and death.
Unfortunately, not all cases of bloat have the typical signs. In early bloat, the dog may not appear distended, but the abdomen usually feels slightly tight. The dog appears lethargic, obviously uncomfortable, walks in a stiff legged fashion, hangs his head, but may not look extremely anxious or distressed. Early on it is not possible to distinguish dilatation from volvulus.
Late signs (those of impending shock) include pale gums and tongue, delayed capillary refill time, rapid heart rate, weak pulse, rapid and labored breathing, weakness, and collapse.
If the dog does not belch or vomit, the problem is not likely to be due to volvulus, but this can only be determined by a veterinary exam.
A diagnosis of dilatation or volvulus is best confirmed by X-rays of the abdomen. Dogs with simple dilatation have a large volume of gas in the stomach, but the gas pattern is normal. Dogs with volvulus have a "double bubble" gas pattern on the X-ray, with gas in two sections separated by the twisted tissue.
In all cases where there is the slightest suspicion of bloat, take your dog to a veterinary hospital immediately. The earlier bloat is caught, the more likely the dog is to survive.
It is important to keep the dog warm to help combat shock, a fatal condition. Wrap him in a warm blanket and turn on the heat in the car while you transport him to the vet. You can also put a drop a Karo syrup or honey on your pet's gums to help keep him conscious.
Gastric dilatation without torsion or volvulus is relieved by passing a long rubber or plastic tube through the dog's mouth and into the stomach. This is also the quickest way to confirm a diagnosis of bloat. As the tube enters the dog's stomach, there should be a rush of air and fluid from the tube bringing relief. The stomach is then washed out and the dog should not be allowed to eat or drink for the next 36 hours. The dog will need to be supported with intravenous fluids. If symptoms do not return, the diet can be gradually restored.
passing a stomach tube is a procedure normally done by a veterinarian. In extreme circumstances when professional help is not available, you may be asked to perform this procedure at home. If you live in a remote location where fast access to veterinary services is limited, you may wish to acquire a stomach tube and add it to your home emergency medical kit.
To pass the stomach tube:
- Mark the tube by measuring the distance from the dog's nose to the last rib,
- Lubricate the tube with K-Y or petroleum jelly. It is helpful to put a roll of adhesive tape in the dog's mouth to pass the tube through, so the dog can't bite down on the tube.
- Insert the tube behind one of the canine teeth and advance it into the throat until the dog begins to swallow. If the dog gags, continue to advance the tube. If the dog coughs, the tube has entered the trachea. Withdraw the tube a few inches and start again.
- If the tube will not pass into the stomach, discontinue further attempts, as it is possible to harm the dog.
If you are able to pass a tube, you should still try to reach a vet for follow-up treatment to prevent recurrence. Being able to pass a tube does not always rule out volvulus. Occasionally, the tube passes even though the stomach is twisted.
Emergency therapy is directed toward correcting shock and dehydration with intravenous fluids and corticosteroids. Antibiotics may be needed to control infection. Ventricular arrhythmias are common. They require heart monitoring and the use of anti-arrhythmic drugs.
If the dog has volvulus, emergency surgery is required as soon as the dog is able to tolerate the anesthesia. The goals are to reposition the stomach and spleen, or to remove the spleen and part of the stomach if these organs have undergone necrosis. Future recurrence can often be prevented by suturing the wall of the stomach to the abdominal wall (called gastropexy). This is an important step which keeps the stomach in position and prevents it from twisting.
Dogs who respond to non-surgical treatment have a 70 percent chance of having another episode of bloat. Some of these episodes can be prevented by following these practices:
- Divide the daily food into 3 meals spaced well apart.
- Do not feed your dog from a raised bowl. (raised food bowls were once recommended to avoid bloat, but research has shown that they make things much worse).
- Avoid feeding that has fat listed among the first 4 ingredients.
- Avoid foods that contain citric acid.
- Restrict access to water for one hour before and after meals.
- Never let your dog drink large amounts of water all at once.
- Avoid vigorous exercise on a full stomach.
- Be aware of the early signs and seek prompt veterinary attention if you ever suspect bloat.
Please contact your veterinarian if you think your pet may have this condition.
Show Sources & Contributors +
Dog Owners Home Veterinary Handbook
Publisher: Wiley Publishing, 2007
Authors: Debra M. Eldredge, Liisa D. Carlson, Delbert G. Carlson, James M. Giffen MD
The First Aid Companion for Dogs And Cats
Publisher: Rodale Inc, 2001
Authors: Amy D. Shojai, Shane Bateman DVM