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.