Friday, 23 January 2009

Bloat (Photos Warning)

Had a busy night on Wednesday first a caesarean, a fast clean in theatre and a GDV/spleenectomy. The German Shepherd was a lucky dog. The owners thought that he had some fluid in his abdomen as he looked big and was retching.
The collection driver took one look got the dog into the van, verbal permission for starting treatment and got back to us fast. Bloat is a killer and every time l think people know about it l realise that there is someone that doesn’t.

Bloat or give it the fancy titles used, GDV, Gastric Dialated Volvulus, Gastric Torsion, Gastric Dilatation. This little gem has one outlook if not treated, a very nasty painful death. Bloat can affect any breed of dog however it is very rare that it will affect the small breeds. Usually it is the large or deep chested breeds. Amongst them Great Danes, Mastiffs, German Shepherd, Weimaraner. It is easier to say if you have a large breed dog then it carries a risk of GDV.

Several reasons seem to apply to why bloat happens but no one is really sure. Hereditary is defiantly a part of the reason. Some sort of chemical imbalance, exercise after a meal so there is a lot of lots of puffing sucks in air, enough goes to the stomach for problems to start. Often dogs that are fed one large meal a day are at higher risk and several smaller meals a day is often the better way to feed. Post GDV that is always the meal regime recommended.

The dog’s abdomen will look “bloated” as it fills with air which does not escape. The stomach does one of 2 things. It either twists or the entry and exit sphincters close off trapping air and food in the stomach. The food starts to ferment and produces more gas with no way out.
Dogs start to retch but nothing except sometimes froth may come up, known as unproductive retching/vomiting. Dogs will often cry as it is very painful.
As the stomach gets bigger it presses on the main blood supply as well as twisting other blood vessels and the body goes into shock. The blood supply cut off to the stomach which starts to die as necrosis sets in.
Sometimes as in the case the other night the spleen becomes caught up in the torsion and had to be removed as it became damaged. The spleen is full of blood when removed, last nights one was about 4 times normal size so there is a possibility of blood transfusion being needed.

Recognising the signs of bloat is easy dealing with it if you are used to it is easy. The emergency clinic l work at has what has been assessed as having the highest GDV case load in the country and there a GDV is a messy and backbreaking, because it is the big dogs that get them standard op. To give an idea there was a blot in Monday night and one in Wednesday.
The general vet practices go pale at the thought of a GDV it is the big ugly scary unknown operation, probably the one vets and vet nurses dread the most. In fact if they are unlucky they will get 1 a year.

Quick idea of protocol is:
1) Give strongest painkiller available to the practice
2) Place 2 iv catheters of the biggest bore you can. May not be possible as veins are in such a state but one must be placed.
3) Take bloods although may not be run (checked).
4) Place dog onto fluid and waz in the first 2* litres at high speed. (*Amount based on animal size)
5) A size 14G 2" catheter to decompress if needed by inserting into the stomach, this buys time for examination, lowers some of the pain and compression on blood vessels.
6) An ET tube and oxygen etc must be handy, they can collapse during decompress
7) An x-ray conscious or under GA can be taken or jump that and start to place stomach tube.
8) Other drugs as the vet deems needed.
Assuming the tube goes in then it is a dilatation if not under GA then needs a GA (general anaesthetic:
A) Have an empty bucket (stomach gunk to go into)
B) A bucket of water and a funnel
C) Pour water into stomach tube to flush stomach
D) Lots of incontinence sheets around op theatre
E) A step to stand on when pouring water, need to hold it high, then jump off stool and aim at end of tube at bucket. May need to jiggle tube and rock dog to get contents out and repeat for as long as it takes stool>>pour>> bucket>>stool>>pour>>bucket...
This in theory is easy but the vet wants things passed over or you need to check the patient and the tube falls out of the bucket and floods everywhere.
You slip getting off the stool, try not to fall and damage yourself on walls, tables or whatever and drop the tube which adds more smelly slodge to the walls and floor.
The paperwork you are trying to keep the op details on gets wet and of course not only rips but is impossible to write on properly.

Once the stomach is empty and the bucket and op theatre are full of smelly fermenting brown sludge the vet may do one of two things. Wake the patient up and arrange when it is better to do an elective gastropexy. This is an operation to suture the stomach to the abdominal wall to stop it twisting in the future. Or he will go in and do the op there and then. It is surgeon’s choice. There is a high probability that the dilatation may occur again and may turn into the dreaded torsion.

If the tube will not advance then the patient is prepped for surgery. The vet is threatened with castration via his throat if he tries to scrub before helping shift the dog from prep to op theatre. You would be surprised how many try this ploy and it is always the male ones.
Once the patient is “unzipped” the vet will then untwist the stomach manually. They may need to carry out a spleenectomy if the spleen is involved. Then flushing as per A to E is carried out.
If the stomach is badly damaged the necrotic dead black part is removed. This is done after the flushing so that stomach contents do not flood the abdomen.
Finally a gastropexy is carried out.
Once closed and cleaned they are back in critical care. General fluid therapy is continued, monitoring needs to be kept for heart arrhythmias that can occur and an eye on blood loss. Blood transfusions may be needed.

A long hard clean in a filthy op theatre it is amazing where the gunk gets to and it sticks like glue where it is thin and in other areas is a slimey drippy ick. Think l will go do human nursing they do not have this at 3:15am.

Intestines the thick red sausages the spleen is the black wadge on the right of them, everything is massively swollen.

The spleen when removed l laid it out for the photo, hard to see size but it is about 3 to 4 times the size it should be.


joker the lurcher said...

eek! i must show this to my husband - he often feeds the dogs before they go out for a walk. how long before exercise should they be fed? they have a car ride of about 10 minutes to where he takes them but that is probably not enough?

dickiebo said...

Oh ta! And I was gonna have liver for dinner today. Not now, thanks!! lol.

Dave the Dog said...

Yes, a nasty condition. A friends working Shepherd Police Dog died of it quite a few years back. He was heart broken.
I did have to smile at the last two paragraphs though!

Auntie Jane said...

This post brought back painful memories of Cleo, a GSD I had. Now waiting at the Rainbow Bridge for me (I hope).

After a feed I noticed her tummy beginning to swell... Rang my vet and met him at the surger... 10 minutes down the road.

He had to operate on her and stitched her tummy back. She lived to nearly 15. Then, I used to feed once a day... Now I feed twice a day and watch the dogs closely for about an hour afterwards.

I only have Border Colies now and I haven't heard of one getting bloat? But I always make sure they don't start to play or jump around after a meal... to be safe.

A friend of my son's had a lovely Dobie who go bloat. He didn't know what was happening so he rang my son. Luckily, my son lived round the corner and guessed what was wrong. He rang our vet and drove over to pick the dog up and rush her to the surgery...

But unfortunately, it was too late. I think the owner didn't notice for quite a while after feeding that she wasn't well. It was so sad.

My advice, like you, is to feed twice a day with no exercise or games for at least an hour after a meal.

I would also add that a dog should be watched or kept an eye on for that time after a meal. It is always better to be safe than sorry, as it is a killer in so many cases.... and the dog will be in agony.

Vetnurse said...

Joker it varys l would look at a good 2 hour break after eating before giving a walk and then not go silly. It takes at least 4 hours for the stomach to empty. I would more walk before feed have a silly time a good rest at least an hour or so to calm down then feed. That is not to say that a dog would never get a bloat as it is also often linked hereditary it may just happen. Be sensible and watch for danger signs if you were at all worried ring a vet and see them.

hehehe sorry Dickiebo l did warn you. The good news is it was a spleen and not a liver.... if that is a help?

Well it is true Dave l is swopping jobs!.
I managed to get out of the prep area clean as well because the aux wanted to blast her ghetto noise out and as l wanted to go home we swopped. :-))

Fi from Four Paws and Whiskers said...

Great post on a difficult topic... A clinic I was associated with had some clients who used to feed their GS dogs and then lock them alone in their kennels at night. Over a period of time they lost two of their dogs... both arriving at the clinic in the morning, too late to save. You would have thought they would have changed habits when they lost the first one... the hardest part was they reacted in anger, grief, whatever, by screaming at the clinic staff and threatening to sue them for losing a second dog. Was distressing for all of them....

PC Plastic Fuzz said...

We lost our first dog to bloat. So sad. She managed to get in to a bag of food and, well, you can guess the rest. Poor baby.