This is one of the biggest emergency situations we see in dogs, but often treatment is sought too late for the pet.  If you notice any of the following symptoms in your dog, then IMMEDIATE veterinary care is needed.  This condition is life threatening in a matter of hours.

You have probably heard of the term bloat, but what exactly does bloating mean?  There are several terms we use in veterinary medicine to describe different levels of bloating.  Gastric dilitation (GD) is when the stomach becomes distended with gas but is still in a normal position, though it can be distended up to several times its normal size.  Gastric dilitation and volvulus (GDV) is when the stomach has become so distended with gas that is rotates, cutting off blood supply and effectively trapping the gas inside the stomach. With no outlet for the gas through either the esophagus or into the intestinal tract, the gas continues to put pressure on the stomach, causing immense abdominal pain. 

When the stomach distends with air and twists on itself, then several things happen.  First, this cuts off the blood supply to and from the stomach.  Dogs quickly go into circulatory shock because the blood cannot travel from the stomach back to the heart and around through the body again.  The stomach tissue will also be in danger of dying without a constant blood supply and because it is so distended with gas.  Tissue necrosis (death) is a common secondary complication of GDV, and sometimes entire sections of the stomach have to be removed during surgery because the tissue is no longer healthy.  Second, because this condition is excruciatingly painful, a dog affected with GDV will have a very high heart rate, which then causes arrhythmias to develop, which can be life threatening as well.  Dogs that are not treated for GDV will die painfully in a matter of a few hours.

The hallmark symptom of GDV is unproductive retching - continuing to try to vomit but nothing comes up.  A dog that is in early stages of bloating can display any of the following symptoms:

• Nausea (licking lips)
  
• Pacing and panting
• Abdominal pain
• Distended look to abdomen

If your dog is trying to vomit but is unable to, or if the stomach looks distended, take your dog immediately to the veterinarian!

GDV is a surgical emergency, but first the dog needs to be stabilized, so veterinarians have treatment started at the same time they are explaining this condition to the owners.  The three stabilizing procedures all need to be done immediately and at the same time, so most of the staff is needed in this emergency situation to help save the dog's life. 

The first step is to decompress the stomach, which is done by either inserting a stomach tube (if possible) or using an instrument called a trochar to pierce the stomach through the body wall.  Decompressing the stomach has several benefits: 1) it helps restore blood flow to and from the stomach by relieving some of the pressure the gas buildup is causing,  2) it reduces some of the pressure the gas is putting on the stomach, hopefully preserving as much healthy stomach tissue as possible, and 3) it relieves pain for the dog.  In some cases, it is not possible to decompress the stomach until the dog in in surgery.

The next step is to establish immediate intravenous fluid administration to help treat circulatory shock.  Two large catheters are placed in both front legs and IV fluids are given at high rates to help protect the heart. 

The third step is to get an ECG to monitor for any heart arrhythmias.  Medications can be given to help offset these arrhythmias.  This is also used to establish a prognosis for the owners.  About 40% of dogs with heart arrhythmias at the time of presentation will not make it through the surgery. 

Finally, surgery is needed to fix the rotated stomach.  In surgery, the stomach is untwisted and all of the stomach wall is examined for any places of necrosis, or unhealthy tissue.  These are removed.  The spleen is also examined because it can rotate with the stomach and may need to be removed.  Then a gastropexy is performed, where the stomach is attached to the body wall surgically, preventing any bloating from happening in the future.  Without this procedure, most dogs will bloat again. 

There are certain breeds of dogs that are more at risk for developing GDV than others.  Any deep chested, large or giant breed dog is at high risk.  The most common dogs presented for bloating are:

• Great Dane
• Saint Bernard
• Weimeraner
• Doberman Pinscher
• Irish Setter
• Standard Poodle
• Greyhound

Other factors that increase the risk of bloating are:

• Dogs that eat rapidly (because they gulp a lot of air during feeding)
• Dogs that eat one large meal per day rather than have split feedings
• Feeding from a raised bowl
• Being thin or underweight
• Moistening dry foods (especially those that list citric acid as a preservative)
• Male dogs are at higher risk
• Older dogs are at higher risk (>7 years old)
  

There are several ways to help reduce your dog's chances of bloating.  These are:

1. Decrease any risk factors your dog may have.  If you have a fast eater, you may need to alter your feeding schedule to slow down your dog.  If you feed once a day, start splitting meals into twice daily feedings.  Do not feed from a raised bowl.  Do not let your dog exercise directly after eating.
2. Have a prophylactic gastropexy performed.  This can be done at the time of spaying and neutering, or as an additional surgery later on.  This tacks the stomach down to the body wall to prevent any future bloating from occurring.  Though there are risks associated with the surgery just like with any other major abdominal surgery, this is generally a safe procedure that can benefit your large or giant breed dog long term.  You can discuss the benefits and risks with your veterinarian and decide if this preventative surgery is right for you and your pet.