Changes

===Radiography===

===Radiography===

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 dorso-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.

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 dorso-cranially positioned pylorus to the left of the midline. The stomach will appear compartmentalised (the classic 'double bubble' pattern) 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.

==Other diagnostic tools===

===Other diagnostic tools===

Plasma lactate concentration has been reported to have a strong link with the patient's prognosis due its association with gastric necrosis and systemic hypovolaemia. A plasma lactate greater than 6 mmol/L is associated with a poor prognosis.  

Plasma lactate concentration has been reported to have a strong link with the patient's prognosis due its association with gastric necrosis and systemic hypovolaemia. A plasma lactate greater than 6 mmol/L is associated with a poor prognosis.  

Electrocardiography (ECG) is essential as cardiac arrhythmias may occur in up to 40% of dogs with GDV. Most arrhythmias are ventricular in origin and occur within 36 hours of admission. Ventricular tachycardia is the most common rhythm disturbance seen but many other arrhythmias may occur.

Electrocardiography (ECG) is essential as cardiac arrhythmias may occur in up to 40% of dogs with GDV. Most arrhythmias are ventricular in origin and occur within 36 hours of admission. Ventricular tachycardia is the most common rhythm disturbance seen but many other arrhythmias may occur.

==Treatment==

==Treatment==

Once the patient has been stabilised, the volvulus should be surgically reduced via a cranioventral midline laparotomy. In a ventral midline approach, the first visible structure encountered with a clockwise rotation of the stomach is the ventral leaf of the omentum. The spleen may be displaced from the left side of the abdomen to the right (ventral) side.  

Once the patient has been stabilised, the volvulus should be surgically reduced via a cranioventral midline laparotomy. The first visible structure encountered with a clockwise rotation of the stomach is the ventral leaf of the omentum. The spleen may be displaced from the left side of the abdomen to the right (ventral) side.  

 

The aims of surgery include gastric decompression and repositioning, assessment of the abdominal organ viability, removal of necrotic tissue and gastropexy. Gastropexy (can perform incisional, tube, belt-loop and circumcostal techniques) to prevent recurrence.

The aims of surgery include gastric decompression and repositioning, assessment of the abdominal organ viability, removal of necrotic tissue and gastropexy. Gastropexy (can perform incisional, tube, belt-loop and circumcostal techniques) to prevent recurrence.