CPD ACCREDITED ARTICLE
Article sponsored by Petcam®
Patients with GDV progress through different degrees
of shock that need to be recognised during the patient
evaluation.
Animals early in the syndrome present with clinical signs
similar to those of hypovolaemic shock because most of
their blood volume is restricted in the caudal vena cava
and the portal vein.
Thus, animals will exhibit:
• Tachycardia and tachypnoea with normal femoral
pulses
• Slow capillary refill times
• Pale mucous membranes
• Cold extremities.
With progression of the syndrome, patients will go into
endotoxaemic shock and will experience:
• Tachycardia and tachypnoea with weak femoral
pulses
• Injected mucous membranes
• Fever
• Slow capillary refill times.
Finally, patients will decompensate and exhibit:
• Severe hypotension
• Bradycardia
• Hypothermia
• White mucous membranes
• Cold extremities.
Laboratory findings
Early on in the disease progression, complete blood
count results often reveal a stress leukogram with neutrophilic leukocytosis and lymphopenia. Serum chemistry profile results may show evidence of hepatocellular
damage and cholestasis with increased alanine transaminase activity and total bilirubin concentration and azotemia. Hypokalaemia may also be present.
Lactate is produced as a byproduct of anaerobic metabolism and has been shown to be elevated in animals
with GDV.17,18 In one study, a lactate concentration <
6.4 mmol/L at presentation, a decrease of lactate of 4
mmol/L or more after fluid treatment and decompression, or a decrease in lactate of > 42.5% of the original
value after fluid treatment and decompression was associated closely with survival.18
Radiography
Radiography can help to differentiate between gastric
dilatation and GDV. If radiography is necessary to determine the diagnosis, do not perform it until the patient is
stable.
Since the pylorus is displaced on the left side of the abdominal cavity in a dorsocranial position to the fundus,
right lateral recumbency radiography is required to be
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Fig 1. A lateral radiograph of a dog in right lateral recumbency. The
double bubble image (boxing glove) of the stomach is characteristic of GDV.
able to obtain the diagnostic double bubble image (Figure 1). The two bubbles are caused by the accumulation
of air in the pylorus and the fundus. Free gas is present
and may be seen in the abdomen when the stomach has
ruptured.
If gastric dilatation is present without volvulus, radiographs show a dilated stomach with dilated loops of jejunum.
Emergency Treatment
Emergency medical treatment of hypovolaemic shock
and gastric decompression is required before surgically
treating GDV.
Treating shock
Place venous catheters of the largest gauge possible in
the cephalic veins or jugular vein to deliver shock doses
(90 ml/kg) of intravenous fluid. Deliver isotonic fluids in
increments of one-fourth of the shock dose, and evaluate
the patient's response after each one-fourth bolus. Adjust
the rate and volume of fluids administered according to
the assessment of several clinical parameters: heart rate,
pulse, mucous membrane color, capillary refill time, and
central venous pressure. Colloids at a dose of 4 ml/kg are
recommended during hypovolaemic shock treatment.19
Blood gas and electrolyte evaluations are required before acid-base and electrolyte imbalance corrections are
attempted. A dog presented with a GDV can be either
alkalotic or acidotic, hypokalaemic or normokalaemic.14
Gastric decompression
Gastric decompression is attempted first with an orogastric tube after initiating fluid therapy. The amount of
gastric distention, the patient's level of compliance, and
the degree of volvulus are factors that contribute to the
ability to pass the tube. The difficulties or easiness of
passing the tube does not have a diagnostic value for the