Controversies in Gastric Dilatation-volvulus Syndrome

There is a wide spectrum of presentation of dogs with gastric dilatation-volvulus syndrome (GDV). Astute and educated owners may pick up on subtle clinical signs such as mild abdominal distension and increased salivation. However, often the dog is not brought in until more overt signs are present. Diagnosis and emergency treatment of GDV are often performed based off of a high index of suspicion from signalment, presentation, and physical examination findings (i.e. a large or giant deep-chested dog with high anxiety and restlessness, non-productive retching and hypersalivation, signs of cardiovascular compromise, and abdominal distension or tympany).

STABILIZATION

Circulatory support is paramount. This is commonly initiated before attempts at gastric decompression. Crystalloid fluid therapy (90ml/kg) is instituted with baseline parameters checked after every quarter-dose. These parameters include heart rate, pulse quality, capillary refill time, packed cell volume, and total protein. Gastric decompression can be achieved through orogastric intubation or gastric trocharization. For orogastric intubation, a large bore gastric tube is selected and a length is measured from the dog’s nose to the last rib. A roll of 2” tape is placed in the dog’s mouth and the tube is gently passed through the tape roll and into the dog’s esophagus. Passage can be facilitated by using a small amount of lubricant on the end of the tube. Changing the position of the dog (from sternal to sitting to standing to standing with feet elevated) can often help get the tube through the cardia into the stomach. Once in the stomach, the other end of the tube should be submerged in a bucket of water to roughly estimate successful gas decompression. The stomach is then lavaged with warm water until the fluid returns back clear. Retrieval of large amounts of blood or necrotic tissue may suggest gastric necrosis. If an orogastric tube is unable to be passed, gastric trocharization may be performed. This should be performed with extreme care to avoid inadvertent laceration of the spleen. Trocharization is classically performed with a 14- or 16-gauge needle on the right side, but in the individual patient, it should be performed at the point of greatest tympany.

DIAGNOSTICS

In anticipation of surgery, a minimum database should be performed. There are no classic findings on complete blood count and biochemical profile for dogs with GDV, but a stress leukogram, mildly elevated liver enzymes, and altered serum electrolytes are not uncommon findings. An activated clotting time should be performed prior to surgery as a baseline and to screen for possible DIC. More complete evaluation of clotting may be indicated in dogs that are unstable, have platelet counts less than 100,000, or have evidence of petechiae or ecchymosis. Serum lactate concentration has been evaluated as a preoperative predictor of mortality. Lactate levels > 6.0mmol/L have been associated with gastric necrosis and an increased mortality rate. More recently it has been shown that decreasing trends in serum lactate levels following initial stabilization are associated with improved survival. […]