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Also known as: '''''GDV

Also known as: '''''GDV

The most immediate effect is impairment of the gastric blood supply, leading to severe congestion of the gastric wall and infarction and ulceration of the gastric mucosa. Venous return to heart is reduced due to mechanical compression of the caudal vena cava by the distended stomach, leading to decreased cardiac output and hypovolaemic [[shock]]. Gastric distension also causes a mechanical impediment to movement of the diaphragm resulting in reduced tidal volume, hypoxia and hypercapnia.

The most immediate effect is impairment of the gastric blood supply, leading to severe congestion of the gastric wall and infarction and ulceration of the gastric mucosa. Venous return to heart is reduced due to mechanical compression of the caudal vena cava by the distended stomach, leading to decreased cardiac output and hypovolaemic [[shock]]. Gastric distension also causes a mechanical impediment to movement of the diaphragm resulting in reduced tidal volume, hypoxia and hypercapnia.

In addition to the above systemic effects, displacement of the stomach may lead to avulsion of the gastric branches of the splenic artery. Significant haemorrhage may occur as a result and this may lead to the development of ischaemia-induced gastric necrosis.  

In addition to the above systemic effects, displacement of the stomach may lead to avulsion of the short gastric branches of the splenic artery and of the left epiploic artery along the greater curvature of the stomach. Significant haemorrhage may occur as a result and this may lead to the development of ischaemia-induced gastric necrosis.  

==History and Clinical Signs==

==History and Clinical Signs==

The clinical signs of GDV are usually '''acute in onset''' and may follow a period of exercise and/or feeding of a large meal. Affected dogs typically display '''non-productive vomiting and abdominal distension'''. Acute onset restlessness, abdominal pain, hypersalivation and abdominal tympany are other common features of GDV. On physical examination, the dog may be collapsed or reluctant to stand. Signs of cardiovascular '''shock''' may be present including tachycardia, pale mucous membranes, prolonged capillary refill time and poor peripheral pulses. An irregular heart rate combined with pulse deficits indicates the presence of [[Arrhythmia|cardiac arrhythmias]].

The clinical signs of GDV are usually '''acute in onset''' and may follow a period of exercise and/or feeding of a large meal. Affected dogs typically display '''non-productive vomiting and abdominal distension'''. Acute onset restlessness, abdominal pain, hypersalivation and abdominal tympany are other common features of GDV. On physical examination, the dog may be collapsed or reluctant to stand. Signs of cardiovascular '''shock''' may be present including tachycardia, pale mucous membranes, prolonged capillary refill time and poor peripheral pulses. An irregular heart rate combined with pulse deficits indicates the presence of [[:Category:Arrhythmia|cardiac arrhythmias]].

==Diagnosis and Management==

==Diagnosis and Management==

Diagnosis is usually based on the '''patient's signalment and a history of unproductive vomiting and abdominal distension'''.  

Diagnosis is usually based on the '''patient's signalment and a history of unproductive vomiting and abdominal distension'''.  

===[[Fluid Therapy]]===

===[[:Category:Fluid Therapy|Fluid Therapy]]===

Initial emergency treatment should be aimed at managing the dog's '''hypovolaemic shock'''. It may be beneficial to provide oxygen supplementation whilst the dog is being stabilised.  

Initial emergency treatment should be aimed at managing the dog's '''hypovolaemic shock'''. It may be beneficial to provide oxygen supplementation whilst the dog is being stabilised.  

Large bore (16 or 18 gauge) catheters should be placed into the cephalic or jugular veins and a proportion of the '''shock dose of Compound Sodium Lactate''' (90ml/kg/h) should be administered intravenously based on the severity of the dog's clinical signs. Hypertonic saline or colloid fluids may be indicated in very large dogs or those who have not responded to a bolus dose of crystalloid fluids.  

Large bore (16 or 18 gauge) catheters should be placed into the cephalic or jugular veins and a proportion of the '''shock dose of Compound Sodium Lactate''' (90ml/kg/h) should be administered intravenously based on the severity of the dog's clinical signs. Hypertonic saline or colloid fluids may be indicated in very large dogs or those who have not responded to a bolus dose of crystalloid fluids.  

It is important to evaluate the '''viability of the stomach''' carefully (tissue thickness and colour should be assessed and vessels palpated for pulsations - in questionable areas a stab incision should be made and observed for signs of bleeding). If necrotic tissue is not properly identified and then incorporated into the closure wound, this may subsequently breakdown - resulting in peritoneal contamination.

It is important to evaluate the '''viability of the stomach''' carefully (tissue thickness and colour should be assessed and vessels palpated for pulsations - in questionable areas a stab incision should be made and observed for signs of bleeding). If necrotic tissue is not properly identified and then incorporated into the closure wound, this may subsequently breakdown - resulting in peritoneal contamination.

'''Splenic damage''' due to avulsion or torsion may require partial or complete splenectomy. If complete torsion has occurred it is important perform a complete splenectomy '''before''' derotating the spleen. Failure to do so will result in the release of ischemic toxins and thrombi into the circulation on de-rotation. If avulsion or torsion is incomplete (and no thrombi are present) the organ should be re-positioned and then allowed to settle before assessing for viability. Again splenectomy is easier to perform with stapling equipment.

'''Splenic damage''' due to avulsion or torsion may require partial or complete splenectomy. If complete torsion has occurred it is important perform a complete splenectomy '''before''' derotating the spleen. Failure to do so will result in the release of ischemic toxins and thrombi into the circulation on de-rotation. If avulsion or torsion is incomplete (and no thrombi are present) the organ should be re-positioned and then allowed to settle before assessing for viability. Lack of viability may appear as dark areas indicating ischaemia or infarction. Again splenectomy is easier to perform with stapling equipment. Splenectomy may also be indicated if any masses are present on the spleen or if haemorrhage cannot be controlled.

Many types of gastropexy have been described including the belt-loop, tube and circumcostal techniques. However the most commonly used in GDV surgery is the '''incisional gastroplexy''' as it is simple to perform and has low levels of complications. This technique involves making a partial thickness incision in both the pyloric antral region and adjacent right abdominal wall and suturing the two incisions together. The use of tube gastrostomy is associated with a higher morbidity rate due to alteration of gastric motility and development of cellulitis around the tube.

Many types of gastropexy have been described including the belt-loop, tube and circumcostal techniques. However the most commonly used in GDV surgery is the '''incisional gastroplexy''' as it is simple to perform and has low levels of complications. This technique involves making a partial thickness incision in both the pyloric antral region and adjacent right abdominal wall and suturing the two incisions together. The use of tube gastrostomy is associated with a higher morbidity rate due to alteration of gastric motility and development of cellulitis around the tube. The circumcostal technique produces reliable adhesions but is technically difficult to perform and can result in [[Pneumothorax|pneumothorax]]. Midline abdominal closure gastropexy should be avoided as this means that any future abdominal incision may penetrate directly into the stomach if the surgeon is not warned.

The abdomen should be '''lavaged''' prior to closure.

The abdomen should be '''lavaged''' prior to closure.

{{Learning

{{Learning

|flashcards = [[Small Animal Soft Tissue Surgery Q&A 02]]<br>[[Small Animal Emergency and Critical Care Medicine Q&A 09]]}}

|flashcards = [[Small Animal Soft Tissue Surgery Q&A 02]]<br>[[Small Animal Emergency and Critical Care Medicine Q&A 09]]

|literature search = [http://www.cabdirect.org/search.html?q=((title:(GDV)+AND+od:(dogs)))+OR+((title:(gastric)+AND+title:(dilat*)+AND+title:(volvulus)))  Gastric Dilatation and Volvulus publications]

|literature search = [http://www.cabdirect.org/search.html?q=((title:(GDV)+AND+od:(dogs)))+OR+((title:(gastric)+AND+title:(dilat*)+AND+title:(volvulus)))  Gastric Dilatation and Volvulus publications]

}}

}}

{{review}}

{{review}}

[[Category:Stomach_and_Abomasum_-_Pathology]][[Category:Gastric Diseases - Dog]]

[[Category:Stomach_and_Abomasum_-_Pathology]][[Category:Gastric Diseases - Dog]]

[[Category:Expert_Review - Small Animal]]

[[Category:Expert_Review - Small Animal]]