Twisted Stomach: Symptoms to look out for
Posted 14 January 2015 12:00 AM by John Foster
Most of a vet’s duty out of hours is not truly an emergency for the dog’s sake, but in the eyes of the owner it often is. There may not be much for the owner to see like bleeding or vomiting, but any departure from normal behaviour is enough to set alarm bells ringing. That’s all fair and proper; the night or weekend emergency service expects to be presented with borderline cases and holds the view they are better dealt with than to be left to worsen or see a serious problem missed.
And so it is for a swollen stomach, properly referred to as ‘bloat’ in its simplest primary form. More complicated and it becomes gastric torsion/twist or the gastric dilatation-volvulus complex (GDV). The term ‘complex’ is used to cover off all the side effects arising from what can only be termed an internal medical disaster.
At whatever point on the scale of worsening signs this is definitely not one to miss. Allowed to become more complicated over time combined with medical sequelae there comes a time when recovery in unlikely; the internal damage to stomach, spleen and upper small intestine and from supervening shock to the rest of the cardiovascular system means of those dogs that die 70% will do so within 4 days, whatever is heroically done for them.
GDV primarily affects large barrel- or deep-chest dogs; Great Danes, Dobermans, German Shepherd Dogs, Saint Bernards and others are most often seen to suffer from the complex. It isn’t restricted to the large or giants, even the small round-chest Dachshund can suffer like its larger cousins.
Bloating appears as the first sign; a distended abdomen, attempts to be sick without result other than a small amount of foam, instant depression with a literal hang-dog expression, hunch-backed and an inability to get comfortable must invoke alarm bells. Because dilatation of the stomach is the precursor to its rotation due to its shape and anatomic suspension very soon both exits for gas and food escape are twisted off. The degree of twist varies from case to case; it can be a simple 90 degree, a worsening 180 degree or in the extreme case a 360 degree twist. Understandably, even the slightest twist occludes the blood supply to and from the stomach, so that the 360 twist is a dire if not a terminal come-to-pass.
GDV is not a case to try and deal with at home; any delay due to that approach will ensure the chances of recovery with few medical sequelae are almost impossible. The order of the day is to inform the vet service of the signs, load the dog in the car and take the fastest route to the surgery. This article is not designed to detail the veterinary approach to dealing with the case, suffice it to say intensive care is started immediately on admission and on an increasing scale of intervention the accumulated gas must be relieved and the stomach untwisted. The correction of the twist may not be undertaken immediately due to the degree of shock having to be corrected, but that’s down to the fine judgement of the vet in charge.
As to probable cause there have been a number of theories, not all standing the test of time. At one point blame was attached to the feeding of dry foods or their contaminations by fungi or bacteria releasing gas or toxins once ingested. Temperament and the tendency for the individual, since it is an individual’s susceptibility, causing excess stomach acid secretion or malfunctions in stomach muscle activity are higher on the list of possibilities. At present there seems a strong link with large or giant dogs with equally large or giant appetites having the habit of gorging their food only once a day. The dog expects the feeding moment is near, for it has an innate species’ sense of time, encouraging hunger to increase, saliva swallowing to occur, air to be swallowed and acid to enter the upper small intestine giving rise to further discomforts. The final straw is the swallowing of food, both wet and dry, without chewing and the mixing with saliva, all several pounds in weight and all in seconds, flat.
The majority of cases seen by vets occur at night or late evening within an hour or two of the sole meal of the day given on return home of the owner or given late in the impression the dog will settle better for the night if fed just before bed. This very late feeding routine is the most concerning because when the family retire to bed leaving the dog downstairs the essential first signs are missed. The eventual awareness that all is not well is the late stage groans and sounds of dry retching, by when the condition may have passed into the acute point of no return.
So, part of the remedy is to be watchful, change from once a day feeding of a large amount of food and make the meal times plus 2 hours within the family’s normal activity period. For the recurrent ‘bloater’ there are medical remedies supplied by the vet that act as very worthy preventives in combination with routine change.