GASTRIC DILATATION AND VOLVULUS (GDV): WALKING STOMACH
Gajendra S. Khandekar1, Santosh D. Tripathi2, Shahir V. Gaikwad2, Dishant Saini3*, Shalaka A. Chauhan2
Professor1, Assistant Professor2, PhD Scholar3
Department of Surgery and Radiology, Mumbai Veterinary College, MAFSU, Nagpur, Maharashtra, 400012
Department of Surgery and Radiology, Krantisinh Nana Patil College of Veterinary Science, Shirwal, MAFSU, Nagpur, 412801
Corresponding author email: dishantag95@gmail.com
Gastric dilatation and volvulus (GDV) is a rapidly progressing, life threatening, acute, emergency condition in deep chested dogs, characterised by a rapid accumulation of gas within the stomach It may progress to rotation of the stomach resulting in failure of eructation and pyloric emptying, increased gastric pressure and development of shock eventually leading to death. This multi-systemic condition can be rapidly fatal due to its ability to affect multiple organs and systems within a span of 2-3 hours of the volvulus which makes it a dangerous condition. It is a medical and surgical emergency that requires immediate intervention to reverse the pathophysiological effects occurring due to the gastric distention and its malpositioning. GDV is associated with severe fluctuations of the cardiovascular, respiratory, retial, and gastrointestinal physiology and if not treated promptly, these changes lead to the development of shock and the death of the patient. The syndrome involves various degrees of volvulus of the stomach, which causes intra-gastric accumulation of gas and increased intra-gastric pressure leading to decreased venous retum, portal hypertension, gastrointestinal tract ischemia, hypovolemia, hypotension and often cardiogenic shock Death is a certainty, if appropriate treatment is not given immediately. Acute gastric dilation with or without volvulus has been a frequent cause of high morbidity and mortality in pet animal practice since decades.
Factors which have been recognised as the cause of this life-threatening condition:
Such as age, breed, sex, body conformation, weight, nasal mite infestation, diet composition, feeding schedule, feeding behaviour etc.
Signs and Symptoms:
In a large number of cases, owners report, frothing from the mouth with the pet mating s unsuccessful attempts at vomiting, retching with a gradual increase in the size of the abdomen over a period of few minutes to 2 hours. These episodes are usually noted by vigilante pet owners after lending, especially in cases, where the dog has been fed on a sumptuous meal of rice, chapati, and various items during family function or after excessive intake of dry pet foods. The animal initially appears anxious, looking or biting at the abdomen, assuming the praying posture or stretching the abdomen. As the severity increases the animal is weak, recumbent and breathing heavily.
Diagnosis:
The diagnosis of GDV is made on history, signs and symptoms followed by physical examination accompanied with radiography if available. A typical double bubble appearance of the stomach on radiograph confirms the incidence of gastric dilation
A typical Double-bubble appearance of the stomach Management of GDV: GDV management can be divided into various phases:
Phase 1: The owner reports about the signs such as slight discomfort and distention of abdomen. During this phase, the owner should be instructed to keep the dog calm and quiet and to give oral antacids (Cinta), digene etc) along with carmicide liquid During this phase the dog may recover without developing GDV.
Phase 2:
There is continuous distention noted with increased levels of discomfort and retching. The dog should be taken to the nearest vet as the release of the distention may relieve the discomfort. The patient’s condition is stabilized by administration of isotonic fluids preferably Ringer’s Lactate (90 ml/kg hour), or hypertonic 7% saline (4 to 5 ml/kg over 5 to 15 minutes), or hetastarch (5 to 10 ml/kg over 10 to 15 minutes) or a mixture of 7.5% saline and hetastarch (dilute 23.4% saline with % hetastarch until you have a7.5% solution, administer at 4 ml/kg over 5 minutes) is administered Broad-spectrum antibiotics (e.g., cefazolin, ampicillin plus enrofloxacin) should be administered. If the animal is dyspnoea, oxygen therapy may be given by nasal insufflation or mask Gastric decompression should be performed by stomach tube or insertion of a large bore needle while shock therapy is initiated.
Phase 3:
In this phase the patient is very restless (gastric volvulus), whining & panting, salivating copiously tries to vomit every 2-3 mins, stands with legs apart and head hanging down, spleen becomes engorged gums dark red shock begins to develop, heart rate 80-100 beats/min, temperature raised. (104°F). In this phase stabilizing the patient’s condition is the initial objective by administration of isotonic fluids (90 ml/kg hour), hypertonic 71% saline (4 to 5 ml/kg over 5 to 15 minutes), hetastarch (5 to 10 ml/ kg over 10 to 15 minutes) or a mixture of 7.5% saline and hetastarch (dilute 23.4% saline with 6% hetastarch until you have a 7,5% solution, administer at 4 ml/kg over 5 minutes) is administered, Broad spectrum antibiotics (e.g., cefazolin, ampicillin plus enrouxacin) should be admit dyspnoea, oxygen therapy may be given by nasal insufflation or mask Surgery should be perforated as soon as the animal’s condition has been stabilized, even if the stomach has been decompressed Rotation of an undistended stomach interferes with gastric blood bow and may petmate gastric necrosis. Upon entering the abdominal cavity of a dog with GDV, the structure noted is the greater omentum, which usually covers the dilated stomach Intraoperative manipulation of the cardia usually allows the tube to be passed into the stomach without difficulty. If adequate decompression in still not achieved or an a not available, a small gastrotomy incision can be performed to remove the gastric contents, although this should be avoided if possible. Gastropexy techniques much as Muscular flap (incisional) gastropexy or circumcostal gastropexy or tube gastropexy can be performed to prevent the reoccurrences of this life-threatening condition in pets. Even with appropriate treatment, mortality rates for dogs undergoing surgery because of GDV ranges from 15% to 33%. GDV has a high mortality rate and dogs that have sustained damage to the stomach, spleen or heart are at a high risk of mortality. The morbidity rates with GDV in dogs after surgery are high and post-operative complications are more likely to occur Even after corrective surgery for GDV, reoccurrence rates are more and complications such as ischemia-reperfusion injury (IRI), hypotension, cardiac arrhythmias, Acute kidney injury (AKI), gastric ulceration, electrolyte imbalances, and pain are possible. In addition, early identification of the patients in need for re exploration owing to gastric necrosis, abdominal sepsis, or splenic thrombosis is crucial Despite appropriate medical and surgical treatment, the reported mortality rate in dogs with GDV has been reported to be 10%-28%. Dogs with GDV, that are affected with gastric necrosis or develop AKI have a higher mortality rate. In the light of the above pathophysiological and surgical condition a preventive technique such as”gatropexy necessary to prevent reoccurrence of GDV. In a comparison between animals that received gastropexy and those that did not, the one-year mortality due to GDV and GDV related comes was 19% and 71% respectively. An effective gastropexy decreases the reoccurrence of GDV from as high as 80% to less than 5%.
The goal of gastropexy is to create a permanent adhesion between the pyloric antrum and the right abdominal wall. This permanent adhesion prevents the rotation of the stomach even if the stomach distends with gar Prophylactic gastropexy is a low-risk procedure because it is performed at a time when the metabolic derangements, associated with GDV are not present Hence, gastropexy should be considered in high-risk animals that have a known predisposition to it. This procedure can be performed at the same time as other routine abdominal surgeries such as ovariohysterectomy, cryptorchidectomy etc.
Conclusion:
Gastric dilation with or without volvulus can be a fatal condition in pets. Quick recognition of the clinical signs and symptoms can help in managing this condition without much problem. However, in cases with progressive signs of deterioration, surgery should be performed at the earliest to save the pet Prophylactic gastropexy either by open method or laparoscopically assisted technique can be done in large breed deep chested dogs to prevent such episodes in pets.
