Changes

The clinical signs of GDV are usually acute in onset and may follow a periood of exercise and/or feeding of a large meal. Affected dogs typically display non-productive vomiting and abdominal distension. 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. Abdominal tympany is often displayed and the animal may be painful.

The clinical signs of GDV are usually acute in onset and may follow a periood of exercise and/or feeding of a large meal. Affected dogs typically display non-productive vomiting and abdominal distension. 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. Abdominal tympany is often displayed and the animal may be painful.

==Diagnosis==  

==Diagnosis and Management==

Diagnosis is usually based on the patient's history of unproductive vomiting and abdominal distension and signalment (i.e. a large breed dog). Abdominal radiography may be beneficial in confirming a diagnosis of GDV and distinguishing between GDV and gastric dilatation. Radiography should not be carried out until gastric decompression has been performed and intravenous fluids have been started. A radiograph performed in right lateral recumbency shows a dorsally and cranially positioned pylorus to the left of the midline. The stomach will appear compartmentalised with a soft tissue strip separating the two compartments. The oesophagus may appear dilated with air or fluid. Evidence of air in the abdomen indicates that perforation has occurred and requires an exploratory surgical procedure. Loss of contrast in the abdomen may indicate peritonitis or haemoabdomen.

 

===Fluid therapy===

Diagnosis is usually based on the patient's signalment and a history of unproductive vomiting and abdominal distension. Initial emergency treatment should be aimed at managing the dog's hypovolaemic shock. 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.  

 

Following a period of aggressive fluid therapy, gastric decompression should be performed. A lubricated large-bore stomach tube is premeasured (from nostril to last rib)and marked. It is then introduced into the oesophagus and should not be advanced beyond the marked point. It is important to mimimise stress when this procedure is carried out. Sedation is not usually required but suitable drugs for this include Butorphanol, Fentanyl or Diazepam. It the animal is resistant to orogastric intubation or becomes stressed, trocharizing the most tympanic area caudal to the ribs with a 14 to 16 gauge catheter. This may allow susequent completion of orogastric intubation for further decompression.

 

Analgesia in the form of a pure opioid should be provided (e.g. Fentanyl or Morphine).  

 

 

Abdominal radiography may be beneficial in confirming a diagnosis of GDV and distinguishing between GDV and gastric dilatation. Radiography should not be carried out until gastric decompression has been performed and intravenous fluids have been started. A radiograph performed in right lateral recumbency shows a dorsally and cranially positioned pylorus to the left of the midline. The stomach will appear compartmentalised with a soft tissue strip separating the two compartments. The oesophagus may appear dilated with air or fluid. Evidence of air in the abdomen indicates that perforation has occurred and requires an exploratory surgical procedure. Loss of contrast in the abdomen may indicate peritonitis or haemoabdomen.

===Haematology===

===Haematology===

==Treatment==

==Treatment==

===Anaesthesia===

===Anaesthesia===

Anaesthesia must be carried out with care even after the patient has been stabilised. There are limited protocols but included [[Opioids#Fentanyl|fentanyl]] and [[Benzodiazepines#Diazepam|diazepam]] bolus or titrated [[Propofol|propofol]]. Maintenance can be achieved with the use of [[Isoflurane|isoflurane]] and [[Sevoflurane|sevoflurane]] in oxygen however [[Nitrous Oxide|nitrous oxide]] should be avoided due to third spacing. Regular routine monitoring of urine production, blood pressure, [[Blood Pressure#Central Venous Pressure|central venous pressure]], PCV, total solids, blood gas and serum electrolytes. High rates of fluids should be used to maintain tissue perfusion and arterial [[Blood Pressure|blood pressure]].

Anaesthesia must be carried out with care even after the patient has been stabilised. There are limited protocols but included [[Opioids#Fentanyl|fentanyl]] and [[Benzodiazepines#Diazepam|diazepam]] bolus or titrated [[Propofol|propofol]]. Maintenance can be achieved with the use of [[Isoflurane|isoflurane]] and [[Sevoflurane|sevoflurane]] in oxygen however [[Nitrous Oxide|nitrous oxide]] should be avoided due to third spacing. Regular routine monitoring of urine production, blood pressure, [[Blood Pressure#Central Venous Pressure|central venous pressure]], PCV, total solids, blood gas and serum electrolytes. High rates of fluids should be used to maintain tissue perfusion and arterial [[Blood Pressure|blood pressure]].