Gastric Dilatation-Volvulus (GDV) is a LIFE THREATENING URGENT MEDICAL EMERGENCY !!!

GDV is a condition primarily affecting large, deep-chested dog breeds, such as Great Danes, Boxers, German Shepherd, Cane Corso, Mastiffs etc to name a few. It involves rapid accumulation of gas and fluid in the stomach (gastric dilatation), which can progress to volvulus (torsion), where the stomach twists along its axis, leading to severe pathophysiological consequences.

Pathophysiology:

Gastric Dilatation (Bloat):

• The stomach rapidly distends with gas and ingesta due to aerophagia (swallowing air), delayed gastric emptying, or fermentation.
• As the stomach expands, it compresses surrounding organs and blood vessels, leading to increased intra-abdominal pressure.

Volvulus (Torsion):

• The stomach rotates on its mesenteric axis, typically clockwise (viewed from caudal to cranial), between 180° and 360°.
• The pylorus and duodenum become displaced dorsally and to the left, while the fundus and greater curvature move ventrally and to the right.
• This rotation occludes the cardia and pylorus, trapping gas and ingesta.

Pathophysiological Consequences:

Vascular Compromise:

• The torsion compresses the gastric veins, leading to venous congestion, ischemia, and gastric wall necrosis.
• Severe cases involve splenic torsion, causing infarction and further hemodynamic instability.

Systemic Shock:

• Compression of the caudal vena cava decreases venous return (preload), reducing cardiac output and causing hypovolemic and cardiogenic shock.
• Systemic inflammatory response syndrome (SIRS) can develop due to ischemia and bacterial translocation.

Metabolic Disturbances:

• Lactic acidosis results from tissue hypoxia.
• Electrolyte imbalances (hypokalaemia, hypocalcaemia) can exacerbate cardiac dysfunction.

Clinical Presentation:

• Sudden abdominal distension (tympanic and non-productive retching)
• Restlessness, hypersalivation, and abdominal pain
• Tachycardia, weak pulses, pale mucous membranes, and prolonged CRT (signs of shock)
• Dyspnoea due to diaphragmatic compression

Diagnosis:

• Radiography (Right Lateral View):
  • Classic "double-bubble" or "Popeye arm" sign, indicating compartmentalization of the stomach.
• Bloodwork:
  • Elevated lactate (>6 mmol/L) suggests ischemic damage.
  • Stress leukogram, electrolyte derangements, and metabolic acidosis.

Treatment:

Immediate Stabilization:

• Aggressive IV fluid resuscitation (shock doses of crystalloids or colloids).
• Decompression via orogastric intubation or percutaneous trocarisation to relieve pressure.

Surgical Correction (Gastropexy):

• Exploratory laparotomy to decompress, reposition, and assess gastric viability.
• Resection of necrotic stomach tissue if needed.
• Permanent gastropexy (incisional, belt-loop, or laparoscopic-assisted) to prevent recurrence.

Prognosis:

• Without treatment: 100% mortality.
• With surgery and early intervention: 80-90% survival, though recurrence rates without gastropexy exceed 50%.

Prevention:

• Feeding smaller, frequent meals
• Avoiding vigorous exercise post-feeding
• Prophylactic laparoscopic gastropexy in high-risk breeds

GDV is an urgent surgical emergency, requiring rapid intervention to prevent fatal circulatory collapse and organ necrosis.