Non-dietary risk factors for gastric dilatation-volvulus in large and giant breed dogs

Outcomes and complications of prophylactic incisional gastropexy in 766 dogs (2009-2019)

OBJECTIVE

To report the outcomes and complications associated with prophylactic incisional gastropexy performed in dog breeds at risk for GDV.

RESULTS

Seven hundred and sixty-six dogs underwent prophylactic incisional gastropexy of which 61 were electively performed at the time of castration or spay and 705 were adjunctively performed at the time of emergency abdominal surgery. All dogs had short-term follow-up, and 446 dogs (58.2%) had additional follow-up with a median long-term follow-up time of 876 days (range 58-4450). Only 3 dogs (0.4%) had a direct complication associated with the gastropexy site including hemorrhage causing hemoabdomen (2) and infection with partial dehiscence (1). No dogs with long-term follow-up experienced gastric dilatation (GD), gastric dilatation volvulus (GDV), or persistent GI signs following gastropexy. Results of this study found that complications directly associated with prophylactic gastropexy were rare and limited to hemorrhage causing hemoabdomen and infection with partial dehiscence. Transient postoperative GI signs may occur. Gastropexy malpositioning and bowel entrapment were not encountered. There was no occurrence of GD or GDV.

Preventive Health Care for Working Dogs

The goal of preventive care is to maintain and optimize health by averting preventable problems. Effective preventive care programs for working dogs must incorporate standard procedures applicable to dogs in general with additional elements pertinent to the more specific characteristics of breed, geographic location, living and working conditions, and physical and mental tasks required of the working dog. This article covers the basic essential preventive health guidelines for all working dogs as well as the specific breed, occupational, and regional considerations to be taken into account.

Operational Canine

Operational K9s encompass a unique population of working dogs that serve as a force multiplier in various civilian law enforcement, force protection, search and rescue, and humanitarian operations. These elite canines do not volunteer to serve, yet they are some of the most faithful and dependable operators in the field. They undoubtedly perform an invaluable service in today's society and are owed a tremendous debt of gratitude for their selfless service, loyalty, and sacrifices. This article describes the unique characteristics and occupational hazards that pertain to the community of Operational K9s.

Evaluation of a novel technique involving ultrasound-guided, temporary, percutaneous gastropexy and gastrostomy catheter placement for providing sustained gastric decompression in dogs with gastric dilatation-volvulus

OBJECTIVE

To evaluate the feasibility of ultrasound-guided, temporary, percutaneous T-fastener gastropexy (TG) and gastrostomy catheter (GC) placement for providing sustained gastric decompression in dogs with acute gastric dilatation-volvulus (GDV) and to compare findings with those of trocarization.

ANIMALS

16 dogs with GDV.

PROCEDURES

Dogs were randomly assigned to undergo gastric decompression by means of percutaneous trocarization (trocar group; n = 8) or temporary TG and GC placement (TTG+GC group; 8) with ultrasound guidance. The gastric volvulus was then surgically corrected, and the decompression sites were examined. Outcomes were compared between groups.

RESULTS

The proportion of dogs with successful decompression did not differ significantly between the TTG+GC (6/8) and trocar (7/8) groups; median procedure duration was 3.3 and 3.7 minutes, respectively. After the failed attempts in the TTG+GC group, the procedure was modified to include ultrasound guidance during T-fastener placement. The decrease in intragastric pressure by 5 minutes after trocar or GC insertion was similar between groups. For dogs in the TTG+GC group, no significant difference in intragastric pressure was identified between 5 and 60 minutes after GC insertion. Complications included inadvertent splenic or jejunal placement in 2 dogs (TTG+GC group) and malpositioned and ineffective trocar placement in 1 dog (trocar group). All dogs survived for at least 2 weeks.

CONCLUSIONS AND CLINICAL RELEVANCE

Ultrasound-guided, temporary, percutaneous TG and GC placement was safe and effective at providing sustained gastric decompression in dogs with GDV, suggesting that this technique would be ideal for dogs in which surgical delays are anticipated or unavoidable.

Retrospective analysis of 736 cases of canine gastric dilatation volvulus

OBJECTIVE

To identify factors influencing the survival of confirmed gastric dilatation volvulus (GDV) cases presented to a specialist referral and emergency hospital.

METHODS

Clinical records of confirmed GDV cases admitted to two specialist referral and emergency centres in Sydney (Animal Referral Hospital (ARH) Homebush and ARH Baulkham Hills) between July 1999 and July 2019 were searched.

RESULTS

A total of 736 GDV cases were reviewed, of which 460 dogs were surgically treated and 276 dogs were humanely killed. The survival rates of patients operated on by general surgeons and specialists were 81.7% and 88.7%, respectively. Both incisional gastropexy and belt-loop gastropexy were clinically effective in treating GDV, with no significant difference in survival rates. Intraoperative mortality rates for general surgeons and specialists were 7.0% and 2.9%, respectively. The odds of mortality in dogs operated on by general surgeons were 2.03 times those operated on by specialist surgeons. The odds of mortality in dogs presented between 3:00 and 9:00 am were 3.57 times those of dogs presented between 9:00 am and 9:00 pm. The odds of mortality in dogs where the duration from presentation to completion of surgery was more than 3 h were 2.53 times those of dogs where time lapsed was equal or less than 3 h.

CONCLUSION

The results suggested that admission time was statistically significantly related to the survival rate. Dogs operated on by specialist surgeons had a significantly higher survival rate compared to those operated on by general surgeons. Clinicians should aim to stabilise and complete surgical correction of GDV as soon as possible to decrease the mortality.

Evaluation of gastric motility in nine dogs before and after prophylactic laparoscopic gastropexy: a pilot study

BACKGROUND

The purpose of this study was to evaluate the effect of a prophylactic laparoscopic gastropexy on gastric motility in healthy large-breed dogs.

METHODS

This was a prospective pilot study with nine healthy client-owned dogs. Each dog was its own control. Gastric motility was evaluated before and after laparoscopic gastropexy. Dogs were fed a standard diet three weeks before and after surgery. Gastric motility was measured before and 3 weeks after surgery. A wireless motility capsule (WMC) was used to measure gastric pH, intragastric pressure, temperature, frequency of contractions, motility index (MI) and transit time. Non-parametric statistical analysis was used to compare the paired data. Clients were contacted for follow-up information 2 years postoperatively.

RESULTS

Median frequency of gastric contractions was 1.3 (range, 0.6-1.9 contractions/min) before gastropexy and 1.0 (range, 0.3-2.6 contractions/min) after gastropexy (P = 0.820). Median MI was 49.2 (range, 23.7-96.6) before gastropexy and 28.1 (range, 12.2-148.9) after gastropexy (P = 0.652). Median gastric emptying time was 1140 (range, 486-1230 min) before gastropexy and 1110 (range, 306-2610 min) after gastropexy (P = 0.570). During the hour before the WMC passed through the pylorus, median MI was 72.2 (range, 48.2-549.3) before gastropexy and 52.9 (range, 15.20-322.8) after gastropexy (P = 0.734), and frequency of contractions was 1.1 (range, 0.9-4.1 contractions/min) before gastropexy and 1.2 (range, 0.5-3.0 contractions/min) after gastropexy (P = 0.652).

CONCLUSION

Motility in the stomach did not change in healthy dogs after prophylactic laparoscopic gastropexy. We conclude that preventive laparoscopic gastropexy does not induce gastroparesis.

Gastric dilatation and enterotoxemia in ten captive felids

CASE DESCRIPTION 10 large felids at 8 facilities were determined or suspected to have developed gastric dilatation with or without enterotoxemia over a 20-year period. Four felids were found dead with no premonitory signs. CLINICAL FINDINGS 4 felids (2 male snow leopards [Uncia uncia], 1 male Amur tiger [Panthera tigris altaica], and 1 male Sumatran tiger [Panthera tigris sumatrae]) were found dead or died before they could be evaluated. Six felids had hematemesis (1 male and 1 female African lion [Panthera leo] and 1 male jaguar [Panthera onca]) or abdominal distention and signs of lethargy with or without vomiting (1 male African lion, 1 male Malayan tiger [Panthera tigris jacksoni], and 1 female Sumatran tiger). Gastric dilatation was radiographically and surgically confirmed in the male Malayan and female Sumatran tigers and the jaguar. TREATMENT AND OUTCOME In 3 felids with an antemortem diagnosis, the gastric dilatation resolved with decompressive laparotomy but then recurred in 1 felid, which subsequently died. Three others died at various points during hospitalization. Although Clostridium perfringens type A was recovered from 3 of the 5 felids for which microbial culture was performed, and 2 felids had a recent increase in the amount fed, no single factor was definitively identified that might have incited or contributed to the gastric dilatation. CLINICAL RELEVANCE Gastric dilatation was a life-threatening condition in the large felids of this report, causing sudden death or clinical signs of hematemesis, abdominal distention, or vomiting. Even with rapid diagnosis and surgical decompression, the prognosis was poor. Research is needed into the factors that contribute to this emergent condition in large felids so that preventive measures might be taken.

Assessment of the Prevalence of Gastric “Gravel Sign” in Dogs with Acute Gastric Dilatation-Volvulus

Radiological examination of gastric “gravel sign” was retrospectively conducted in 60 dogs presented with acute gastric dilatation-volvulus (GDV) syndrome. Other radiographic findings including loss of peritoneal serosal detail, presence of radiopaque foreign bodies, gastric pneumatosis, splenomegaly, and megaesophagus, were also examined in these patients. “Gravel sign” was detected on the pre-operative radiographs of 17 dogs with acute GDV (28.3%), suggesting that these patients could be suffering from chronic partial gastric obstruction before examination. German Shepherd dogs were significantly over-represented in this group (10/17, 58.8%). Dogs with acute GDV showing “gravel sign” should be carefully investigated for the presence of underlying gastrointestinal processes that might be associated with chronic partial obstruction.

Diagnosis of chronic gastric instability using computed tomography in a Great Dane that progressed to gastric dilatation and volvulus: a literature review and case report

Chronic gastric instability (CGI) is part of the gastric dilatation and volvulus (GDV) complex and contributes to the pathophysiologic mechanism of volvulus. Clinical signs can be attributed to a flaccid and mobile stomach. This manuscript reviews the literature regarding CGI and presents a case where computerized tomography is utilized in combination with abdominal radiography to diagnose CGI in an 8 year old spayed female Great Dane. The patient presented for nonspecific clinical signs including hypersalivation, anorexia, and regurgitation, and was euthanized after failing medical management and developing acute abdominal pain. Necropsy revealed a distended stomach with 180^o rotation along its long axis. This case demonstrates that CGI and GDV share a continuum, and cases of CGI may progress to GDV without prophylactic surgical intervention.

Associations between gastric dilatation-volvulus in Great Danes and specific alleles of the canine immune-system genes DLA88, DRB1, and TLR5

OBJECTIVE To determine whether specific alleles of candidate genes of the major histocompatibility complex (MHC) and innate immune system were associated with gastric dilatation-volvulus (GDV) in Great Danes. ANIMALS 42 healthy Great Danes (control group) and 39 Great Danes with ≥ 1 GDV episode. PROCEDURES Variable regions of the 2 most polymorphic MHC genes (DLA88 and DRB1) were amplified and sequenced from the dogs in each group. Similarly, regions of 3 genes associated with the innate immune system (TLR5, NOD2, and ATG16L1), which have been linked to inflammatory bowel disease, were amplified and sequenced. Alleles were evaluated for associations with GDV, controlling for age and dog family. RESULTS Specific alleles of genes DLA88, DRB1, and TLR5 were significantly associated with GDV. One allele of each gene had an OR > 2 in the unadjusted univariate analyses and retained a hazard ratio > 2 after controlling for temperament, age, and familial association in the multivariate analysis. CONCLUSIONS AND CLINICAL RELEVANCE The 3 GDV-associated alleles identified in this study may serve as diagnostic markers for identification of Great Danes at risk for GDV. Additional research is needed to determine whether other dog breeds have the same genetic associations. These findings also provided a new target for research into the etiology of, and potential treatments for, GDV in dogs.

Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival

OBJECTIVE

To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs.

METHODS

The study used a cross-sectional design using emergency-care veterinary clinical records from the VetCompass Programme spanning September 1, 2012 to February 28, 2014 and risk factor analysis using multivariable logistic regression modelling.

RESULTS

The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses, giving a prevalence of 0·64% (95% Confidence interval: 0·58 to 0·70%). Compared with cross-bred dogs, breeds with the highest odds ratios for the diagnosis of presumptive gastric dilation-volvulus were the great Dane (odds ratio: 114·3, 95% Confidence interval 55·1 to 237·1, P<0·001), akita (odds ratio: 84·4, 95% Confidence interval 33·6 to 211·9, P<0·001) and dogue de Bordeaux (odds ratio: 82·9, 95% Confidence interval 39·0 to 176·3, P<0·001). Odds increased as dogs aged up to 12 years and neutered male dogs had 1·3 (95% Confidence interval 1·0 to 1·8, P=0·041) times the odds compared with entire females. Of the cases that were presented alive, 49·7% survived to discharge overall, but 79·3% of surgical cases survived to discharge.

CLINICAL SIGNIFICANCE

Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed.

Comparison of postoperative pain and inflammation reaction in dogs undergoing preventive laparoscopic-assisted and incisional gastropexy

This study compared the effects of postoperative pain and inflammation reaction after preventive laparoscopic-assisted gastropexy (LAG) and incisional gastropexy (IG) in 10 clinically normal Beagles. Surgical time, incision length, visual analog scale (VAS) score, University of Melbourne Pain Scale (UMPS) score, and plasma C-reactive protein (CRP), plasma cortisol (COR), and serum interleukin-6 (IL-6) levels were evaluated. The VAS and UMPS scores and COR and IL-6 levels were recorded at 0.5, 1, 2, 4, 8, 12, 18 and 24 hr after surgery. CRP level was recorded at 12, 24 and 48 hr after surgery. The VAS and UMPS scores showed no significant intergroup differences. Compared to IG, LAG had significantly lower surgical time (45 ± 9.91 min vs 64 ± 5.30 min; P<0.05), incision length (46 ± 8.21 mm vs 129 ± 19.49 mm; P<0.05), CRP level (12 hr after surgery; 4.58 ± 1.58 mg/dl vs 12.4 ± 1.34 mg/dl; P<0.01), and COR level (1 hr after surgery; 10.79 ± 3.07 µg/dl vs 15.9 ± 3.77 µg/dl; P<0.05). IL-6 levels showed no significant intergroup differences at any time point. However, LAG resulted in lower IL-6 levels than did IG at all postoperative time points. Neither procedure resulted in significant surgical complications. LAG produced lower surgical stress than did IG, suggesting that LAG is a safe, minimally invasive, and highly useful technique for preventing canine gastric dilatation-volvulus. Nevertheless, since this study used experimental models, its usefulness should be evaluated in future cases.

Temporary percutaneous T-fastener gastropexy and continuous decompressive gastrostomy in dogs with experimentally induced gastric dilatation

OBJECTIVE To evaluate a percutaneous, continuous gastric decompression technique for dogs involving a temporary T-fastener gastropexy and self-retaining decompression catheter. ANIMALS 6 healthy male large-breed dogs. PROCEDURES Dogs were anesthetized and positioned in dorsal recumbency with slight left-lateral obliquity. The gastric lumen was insufflated endoscopically until tympany was evident. Three T-fasteners were placed percutaneously into the gastric lumen via the right lateral aspect of the abdomen, caudal to the 13th rib and lateral to the rectus abdominis muscle. Through the center of the T-fasteners, a 5F locking pigtail catheter was inserted into the gastric lumen and attached to a device measuring gas outflow and intragastric pressure. The stomach was insufflated to 23 mm Hg, air was allowed to passively drain from the catheter until intraluminal pressure reached 5 mm Hg for 3 cycles, and the catheter was removed. Dogs were hospitalized and monitored for 72 hours. RESULTS Mean ± SD catheter placement time was 3.3 ± 0.5 minutes. Mean intervals from catheter placement to a ≥ 50% decrease in intragastric pressure and to ≤ 6 mm Hg were 2.1 ± 1.3 minutes and 8.4 ± 5.1 minutes, respectively. After catheter removal, no gas or fluid leakage at the catheter site was visible laparoscopically or endoscopically. All dogs were clinically normal 72 hours after surgery. CONCLUSIONS AND CLINICAL RELEVANCE The described technique was performed rapidly and provided continuous gastric decompression with no evidence of postoperative leakage in healthy dogs. Investigation is warranted to evaluate its effectiveness in dogs with gastric dilatation-volvulus.

Gastric Dilatation and Volvulus in Brown Bear (Ursus arctos)

Gastric dilatation and volvulus is a life-threatening condition characterized by rapid accumulation of food and gases that cause displacement and distension of the stomach. The large and giant, deep-chested breeds of dogs are at higher risk for developing the gastric dilatation and volvulus. Uncommonly, it can also develop in cats, but it is also described in free-range polar bears.

A case of gastric dilatation and volvulus in a brown bear (Ursus arctos) is described in this paper. This case was characterized by lack of any previous symptoms, sudden death, as well as macroscopic findings during necropsy - twisted distended stomach, congested displaced spleen and necrotic gastric wall. According to the available data this is the first described case report of the gastric dilatation and volvulus in brown bear (Ursus arctos).

Trends in popularity of some morphological traits of purebred dogs in Australia

BACKGROUND

The morphology of dogs can provide information about their predisposition to some disorders. For example, larger breeds are predisposed to hip dysplasia and many neoplastic diseases. Therefore, longitudinal trends in popularity of dog morphology can reveal potential disease pervasiveness in the future. There have been reports on the popularity of particular breeds and behavioural traits but trends in the morphological traits of preferred breeds have not been studied.

METHODS

This study investigated trends in the height, dog size and head shape (cephalic index) of Australian purebred dogs. One hundred eighty-one breeds derived from Australian National Kennel Council (ANKC) registration statistics from 1986 to 2013 were analysed. Weighted regression analyses were conducted to examine trends in the traits by using them as outcome variables, with year as the explanatory variable and numbers of registered dogs as weights. Linear regression investigated dog height and cephalic index (skull width/skull length), and multinomial logistic regression studied dog size.

RESULTS

The total number of ANKC registration had decreased gradually from 95,792 in 1986 to 66,902 in 2013. Both weighted minimal height (p = 0.014) and weighted maximal height (p < 0.001) decreased significantly over time, and the weighted cephalic index increased significantly (p < 0.001). The odds of registration of medium and small breeds increased by 5.3 % and 4.2 %, respectively, relative to large breeds (p < 0.001) and by 12.1 % and 11.0 %, respectively, relative to giant breeds (p < 0.001) for each 5-year block of time.

CONCLUSIONS

Compared to taller and larger breeds, shorter and smaller breeds have become relatively popular over time. Mean cephalic index has increased, which indicates that Australians have gradually favoured breeds with shorter and wider heads (brachycephalic). These significant trends indicate that the dog morphological traits reported here may potentially influence how people select companion dogs in Australia and provide valuable predictive information on the pervasiveness of diseases in dogs.

Prophylactic Gastropexy Incorporating a Gastrotomy Incision in Dogs: A Retrospective Study of 21 Cases (2011-2013)

The objective of this retrospective study was to report any complications associated with incorporating a gastrotomy incision into a right-sided incisional prophylactic gastropexy. The medical records of dogs that underwent a gastrotomy for the removal of gastric foreign material and had a prophylactic right-sided incisional gastropexy performed at the gastrotomy site between April 2011 and February 2013 were reviewed. Two wk postoperative recheck examination and suture removal reports were reviewed and owners were contacted via phone and e-mail for long-term follow-up. In total, 21 cases were reviewed, 19 with long-term follow-up. No complications of the surgery were reported. We concluded that a prophylactic right-sided incisional gastropexy could successfully be performed incorporating the gastrotomy site without significant complications.

Recurrent gastric dilatation and intestinal dysmotility possibly resulting from autonomic neuropathy in a Great Dane

A 5 yr old female spayed Great Dane was presented for recurrent episodes of gastric dilatation, intestinal dysmotility, and one episode of gastric rupture. Numerous hematologic, radiographic, and endocrine diagnostic tests were performed with no identifiable underlying cause. Many risk factors have been identified for gastric dilatation and most were present in this Great Dane. A number of symptomatic treatments, aimed primarily at altering the gastrointestinal tract flora and motility were tried, but failed to influence the clinical course of the disease. The dog continued to worsen, experienced more frequent episodes of gastric dilatation, and developed generalized muscle atrophy. Biopsies were collected from the biceps femoris and triceps brachii muscles. A pattern of denervation atrophy was evident in both muscles, consistent with polyneuropathy. The owners elected humane euthanasia and a necropsy was performed. A striking finding at necropsy was severe loss of myelinated fibers with extensive endoneurial fibrosis in the vagus nerve, consistent with an autonomic neuropathy. Autonomic neuropathy is a previously unexplored cause of gastric dilatation and intestinal dysmotility in dogs. These findings should open new directions for exploring pathogenic mechanisms for gastric dilatation in this species.

Gastric dilitation-volvulus in a Red Panda (Ailurus fulgens)

A 10-year-old male red panda presented acutely with symptoms of shock due to acute abdominal distress and respiratory compromise. Abdominal ultrasound confirmed a severely distended stomach for which passage of an orogastric tube for relief was unsuccessful. Intra-operatively, the stomach was found to be distended and torsed around its long axis supporting the diagnosis of Gastric dilitation-volvulus (GDV). The animal arrested and died intra-operatively and was submitted for necropsy with lesions supportive of the diagnosis of GDV. No risk factors for GDV were found to correlate between the panda and those described in domestic dogs. This case suggests that red pandas can be susceptible to this condition in captive settings.

Efficacy of Incisional Gastropexy for Prevention of GDV in Dogs

Incisional gastropexy (IG) is routinely performed as either a prophylactic procedure to prevent occurrence of gastric dilatation-volvulus (GDV) or at the time of surgical correction of GDV to prevent recurrence. Despite its common use, the long-term efficacy of the IG procedure has not been reported. The hypothesis of this study was that IG performed either during surgical treatment of GDV or as a prophylactic measure would effectively prevent GDV. Medical records of 61 dogs undergoing IG following either gastric derotation for treatment of GDV or as a prophylactic procedure were evaluated retrospectively. Median follow-up time for all dogs was 717 days (range, 49–2,511 days). Of the 61 dogs, 27 had prophylactic IG performed. The remaining 34 dogs presented for GDV and had an IG performed during surgical treatment of GDV. No dog experienced GDV after IG. Recurrence of gastric dilatation (GD) alone was noted in 3 of 34 patients (8.8%) undergoing IG during surgery for GDV and in 3 of 27 patients (11.1%) treated prophylactically with IG. This study confirmed the efficacy of IG for the long-term prevention of GDV in dogs.

Gastrointestinal Disease in Exotic Small Mammals

Exotic small mammal medicine is a relatively new specialty area within veterinary medicine. Ferrets, rabbits, and rodents have long been used as animal models in human medical research investigations, resulting in a body of basic anatomic and physiologic information that can be used by veterinarians treating these species. Unfortunately, there is a paucity of veterinary articles that describe clinical presentation, diagnosis, and treatment options of gastrointestinal (GI) disease as it affects exotic small mammals. Although there is little reference material relating to exotic small mammal GI disease, patients are commonly presented to veterinary hospitals with digestive tract disorders. This article provides the latest information available for GI disease in ferrets (Helicobacter mustelae gastritis, inflammatory bowel disease [IBD], GI lymphoma, systemic coronavirus, coccidiosis, and liver disease), rabbits (GI motility disorders, liver lobe torsion, astrovirus, and coccidiosis), guinea pigs (gastric dilatation volvulus [GDV]), rats (Taenia taeniaeformis), and hamsters (Clostridium difficile). Both noninfectious diseases and emerging infectious diseases are reviewed as well as the most up-to-date diagnostics and treatment options.

Comparison of Hb-200 and 6% hetastarch 450/0.7 during initial fluid resuscitation of 20 dogs with gastric dilatation-volvulus

OBJECTIVE

To compare the use of polymerized stroma-free bovine hemoglobin (Hb-200) and 6% hetastarch 450/0.7 (HES 450/0.7) in 0.9% saline during fluid resuscitation of dogs with gastric dilatation-volvulus (GDV).

DESIGN

Prospective, randomized clinical case series.

SETTING

Private specialty and referral clinic.

ANIMALS

Twenty client-owned dogs presenting with GDV.

INTERVENTIONS

Dogs presenting with GDV and abnormal perfusion parameters first received rapid IV infusion of a buffered isotonic replacement crystalloid (15 mL/kg) and IV opioids. Patients were then randomized to receive either Hb-200 (N = 10) or HES 450/0.7 (N = 10). Balanced isotonic replacement crystalloids (10-20 mL/kg IV) were rapidly infused along with either Hb-200 or HES in 5 mL/kg IV aliquots to meet resuscitation end points.

MEASUREMENTS AND MAIN RESULTS

Resuscitation was defined as meeting at least 2 of 3 criteria: (1) capillary refill time 1-2 seconds, pink mucous membrane color, strong femoral pulse quality; (2) heart rate (HR) ≤ 150/min; or (3) indirect arterial systolic blood pressure (SBP) > 90 mm Hg. HR, SBP, packed cell volume, hemoglobin, glucose, venous pH, bicarbonate, base excess, anion gap, and colloid osmotic pressure were compared at hospital entry and within 30 minutes post-resuscitation. Compared to the HES group, the Hb-200 group required significantly less colloid (4.2 versus 18.4 mL/kg) and crystalloid (31.3 versus 48.1 mL/kg) to reach resuscitation end points (P = 0.001). Time to resuscitation was significantly shorter in the Hb-200 group (12.5 versus 52.5 min).

CONCLUSIONS

Dogs with GDV receiving Hb-200 during initial resuscitation required smaller volumes of both crystalloid and colloid fluids and reached resuscitation end points faster than dogs receiving HES 450/0.7 (P = 0.02).

Evaluation of splenectomy as a risk factor for gastric dilatation-volvulus

OBJECTIVE

To evaluate whether dogs undergoing splenectomy had an increased risk of gastric dilatation-volvulus (GDV), compared with a control group of dogs undergoing enterotomy.

DESIGN

Retrospective case-control study.

ANIMALS

219 dogs that underwent splenectomy for reasons other than splenic torsion (splenectomy group; n = 172) or enterotomy (control group; 47) without concurrent gastropexy.

PROCEDURES

Medical records were reviewed for information on signalment, date of surgery, durations of surgery and anesthesia, reason for splenectomy, histopathologic findings (if applicable), whether gastropexy was performed, duration of follow-up, and date of death (if applicable). Follow-up information, including occurrence of GDV, was obtained via medical records review and a written client questionnaire.

RESULTS

Reasons for splenectomy included splenic neoplasia, nonneoplastic masses, infarction, traumatic injury, and adhesions to a gossypiboma. Incidence of GDV following surgery was not significantly different between dogs of the splenectomy (14/172 [8.1 %]) and control (3/47 [6.4%]) groups. Median time to GDV for the 17 affected dogs was 352 days (range, 12 to 2,368 days) after surgery. Among dogs that underwent splenectomy, sexually intact males had a significantly higher incidence of GDV (4/16) than did castrated males and sexually intact or spayed females (10/156). Incidence of GDV among sexually intact male dogs did not differ between groups.

CONCLUSIONS AND CLINICAL RELEVANCE

Results did not support a recommendation for routine use of prophylactic gastropexy in dogs at the time of splenectomy. Other patient-specific risk factors should be assessed prior to recommending this procedure.

An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs

OBJECTIVE

To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area.

DESIGN

Internet-based, cross-sectional study.

ANIMALS

2,551 privately owned dogs.

PROCEDURES

A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed.

RESULTS

Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV.

CONCLUSIONS AND CLINICAL RELEVANCE

In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.

Clinical results and complications of preventive laparoscopic assisted gastropexy in 17 dogs: preliminary study

In terms of GDV prevention, a number of non-surgical measures are recommended. However, the only truly reliable method is gastropexy, most often as part of a surgical treatment of GDV. Gastropexy may be performed preventively either during laparotomy indicated for another reason than GDV, or newly laparoscopically, as independent preventive gastropexy. Preventive laparoscopic assisted gastropexy (PLAG) was performed in 17 patients at the Department of Surgery and Orthopaedics of the Small Animal Clinic at the University of Veterinary and Pharmaceutical Sciences in Brno. Clinical results and complications of PLAG were evaluated 3-12 months after surgery. The most frequent clinical finding of PLAG was a skinfold at the site of gastropexy immediately after the surgery (n = 8; 47%), or still on day 12 after the surgery (n = 1; 6%). As for PLAG complications, in one case a seroma formation was found at the site of gastropexy (6%); in two patients iatrogenic perforation of the splenic capsule (12%) occurred, which in one case gave reason to converting laparoscopy into laparotomy (6%). In none of the patients, death, gastropexy failure, GDV development, dehiscence, infection of or haemorrhage from the surgical wound were noted. Laparoscopic assisted gastropexy appears as a reliable and miniinvasive surgical method of GDV prevention and it may be recommended for high-risk breeds of dogs.

Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003-2007)

OBJECTIVE

To test whether an initial plasma lactate ≥ 6.0 mmol/L is associated with the presence of macroscopic gastric wall necrosis and overall survival in dogs presenting with gastric dilatation-volvulus (GDV). Additionally, if no association was identified we sought to identify a different predictive initial plasma lactate concentration and to examine whether serial plasma lactate concentrations provide better prediction of survival.

DESIGN

Retrospective study over a 5-year period (2003-2007).

SETTING

Urban private referral small animal teaching hospital.

ANIMALS

Eighty-four client-owned dogs with a diagnosis of GDV and plasma lactate measurements.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

There was no statistically significant relationship found between survival and the presence of macroscopic gastric wall necrosis with the initial plasma lactate ≥ 6 mmol/L. There was a significant relationship between the initial plasma lactate >2.9 mmol/L for predicting necrosis and <4.1 mmol/L for predicting survival to discharge. Forty dogs that had an increased initial plasma lactate (>2.5 mmol/L) also had a subsequent plasma lactate measured within 12 hours of presentation, with 37/40 dogs surviving and 70% of these surviving dogs having the subsequent lactate decrease by ≥ 50% within 12 hours. The 3/40 that died failed to decrease their plasma lactate by ≥ 50% from the initial blood lactate.

CONCLUSION

The results of this study indicate that an initial presenting plasma lactate concentration ≥ 6.0 mmol/L is not predictive of macroscopic gastric wall necrosis or survival in dogs presenting with GDV. A decrease in plasma lactate concentrations ≥ 50% within 12 hours may be a good indicator for survival. Limitations to the study include its retrospective nature, the small number of patients, and the number of dogs that were euthanized rather than allowed to progress to a natural outcome.

A survey of diseases of working farm dogs in New Zealand

AIMS

To record the incidence of specific diseases affecting working farm dogs; identify any apparent breed predispositions; determine the most important causes of loss from death, euthanasia, or retirement of the dog; and identify potential interventions that could reduce the incidence of disease.

METHODS

A national questionnaire-based cross-sectional study was conducted to identify the incidence of specific diseases, and circumstances of trauma affecting working farm dogs that presented to rural veterinary practices over a 12-month period, between April 2008 and April 2009. The practices were convenience-sampled on the basis of geography and size.

RESULTS

Sixty-six practices were approached, and veterinarians from 30 practices agreed to participate, with representation from all major rural regions of New Zealand. Data were provided on 2,214 presentations, excluding revisits, of which 51% were for Huntaways and 39% Heading dogs. Trauma was identified as a cause of injury in 848 (38%) visits. Huntaways were apparently over-represented in cases of constipation, gastric dilatation-volvulus (GDV), theriogenological problems, laryngitis, hip dysplasia, and degenerative lumbosacral disease. In contrast, Heading dogs were over-represented among cases of multiple ligamentous injury of the stifle, disruption of the gastrocnemius or Achilles tendon, tarsal injuries, and hip luxation. Traumatic injury involved injury by stock (20%), automotive incidents (19%), transit across fence lines (16%), and dog bites (12%). Loss occurred following 10% of visits, of which trauma was known to be involved in 32%. The most important non-traumatic causes of loss were GDV, degenerative joint disease, mammary neoplasia and diseases involving the female reproductive tract, cardiac disease, and poisoning.

CLINICAL RELEVANCE

Several important diseases appear amenable to intervention through nutrition, neutering, or behavioural modification, including constipation, GDV, theriogenological problems, dog-bite injuries, and laryngitis. Altering modes of transit across fence lines has the potential to reduce large numbers of serious orthopaedic injuries to working farm dogs.

Gastric dilatation–volvulus associated with diaphragmatic hernia in three cats: Clinical presentation, surgical treatment and presumptive aetiology

Three cats were examined because of acute dyspnoea and sudden abdominal enlargement. In all cats, radiographs revealed gastric dilatation–volvulus (GDV) and diaphragmatic hernia. Cardiovascular shock and dyspnoea were treated by intravenous fluid-therapy, oxygen administration and relief of diaphragmatic pressure by means of stomach decompression and in one case placing the patient in an inclined position. Gastric decompression was performed by needle gastrocentesis, placement of a rhino-gastric tube, or a combination of these. Diaphragmatic herniorrhaphy was performed in either case; one cat also underwent gastropexy. The immediate postoperative period resolved uneventfully and the cats were doing well at follow-up. Feline GDV is a rare event in which diaphragmatic hernia may be a predisposing factor.

Nutritional risks to large-breed dogs: from weaning to the geriatric years

Distinctive risk factors for disease are identifiable throughout life stages of large- and giant-breed dogs. From weaning to maturity, improper nutrition is linked to developmental skeletal diseases. As large dogs mature, skeletal diseases and obesity can lead to osteoarthritis. These dogs are difficult to manage when orthopedic or osteoarthritic disease affects mobility and quality of life, thereby increasing the risk of early death. Gastric dilatation and volvulus is another disease that is leading cause of death in large- and giant-breed dogs. Management of health, including proper nutrition, exercise, and weight control, provides the best opportunity for successful aging of large- and giant-breed dogs.

Risk factors associated with short-term outcome and development of perioperative complications in dogs undergoing surgery because of gastric dilatation-volvulus: 166 cases (1992–2003)

OBJECTIVE

To evaluate risk factors associated with death and development of perioperative complications in dogs undergoing surgery for treatment of gastric dilatation-volvulus (GDV).

DESIGN

Retrospective case series.

ANIMALS

166 dogs.

PROCEDURES

Records of dogs with confirmed GDV that underwent surgery were reviewed. Logistic regression was performed to identify factors associated with development of complications (ie, hypotension, arrhythmias, gastric necrosis necessitating gastrectomy, disseminated intravascular coagulation, peritonitis, sepsis, postoperative dilatation, postoperative vomiting, and incisional problems) and with short-term outcome (ie, died vs survived to the time of suture removal).

RESULTS

Short-term mortality rate was 16.2% (27/166). Risk factors significantly associated with death prior to suture removal were clinical signs for > 6 hours prior to examination, combined splenectomy and partial gastrectomy, hypotension at any time during hospitalization, peritonitis, sepsis, and disseminated intravascular coagulation. Partial gastrectomy was not a significant risk factor for death but was for peritonitis, disseminated intravascular coagulation, sepsis, and arrhythmias. Age, gastrectomy, and disseminated intravascular coagulation were risk factors for development of hypotension. Use of a synthetic colloid or hypertonic saline solution was associated with a significantly decreased risk of hypotension.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that the prognosis for dogs undergoing surgery because of GDV is good but that certain factors are associated with an increased risk that dogs will develop perioperative complications or die.

Gastric Dilatation–volvulus as Complication after Surgical Removal of a Splenic Haemangiosarcoma in a Dog

An 8-year-old crossbreed dog presented after one episode of acute collapse due to rupture of a splenic haemangiosarcoma. Following splenectomy the dog recovered well. Two days after discharge the dog re-presented because of gastric dilatation-volvulus (GDV) that eventually led to his death. Splenectomy to remove a voluminous splenic tumour may predispose to GDV and dogs may benefit from concurrent prophylactic gastropexy.

Gastric ulceration subsequent to partial invagination of the stomach in a dog with gastric dilatation-volvulus

CASE DESCRIPTION-An 8-year-old castrated male German Shepherd Dog was evaluated because of abdominal distension, retching, and vomiting. CLINICAL FINDINGS-Gastric dilatation-volvulus was suspected on the basis of the dog's signalment, history, clinical signs, and results of clinicopathologic analyses and abdominal radiography. Celiotomy was performed, and gastric dilatation-volvulus was confirmed along with splenomegaly. Gastric invagination was performed over an area of gastric necrosis. The dog was reevaluated 21 days later after an episode of collapse. Findings of physical examination and clinicopathologic analyses were suggestive of internal hemorrhage. Abdominal ultrasonography and subsequent celiotomy revealed severe gastric ulceration at the gastric invagination site, splenic torsion, and a focal splenic infarct. TREATMENT AND OUTCOME-Splenectomy and gastrectomy of the necrotic tissue were performed. The dog was discharged from the hospital, and the owner was instructed to administer gastroprotectants and feed the dog a bland diet. The dog was reported to be healthy 3.25 years after surgery. CLINICAL RELEVANCE-Findings suggest that complications associated with the gastric invagination procedure include severe gastric ulceration that may require subsequent surgery. Prolonged treatment with gastroprotectants following gastric invagination surgery may be necessary to avoid gastric ulceration in dogs.

Liver lobe torsion in dogs: 13 cases (1995-2004)

OBJECTIVE

To determine history, results of diagnostic testing, surgical findings, complications, and outcome for dogs with liver lobe torsion (LLT).

DESIGN

Retrospective case series.

ANIMALS

12 dogs (1 with 2 episodes).

PROCEDURE

Signalment, clinical signs, clinicopathologic findings, radiographic and ultrasonographic findings, surgical and histologic findings, complications, and hospitalization time were evaluated.

RESULTS

The most common clinical signs were nonspecific abnormalities (eg, vomiting, lethargy, and anorexia) of acute or chronic duration. All dogs were large-breed dogs (median body weight, 37.2 kg [82 lb]). Biochemical abnormalities included high alanine amino-transferase (n = 12) and aspartate aminotransferase (11) activities. Results of abdominal ultrasonography were supportive of the diagnosis in 5 of 8 cases. Affected lobes included the left medial lobe (n = 4), left lateral lobe (3), papillary process of the caudate lobe (2), caudate lobe (1), and right lateral lobe (1). Exploratory celiotomy and liver lobectomy were performed in 12 of 13 cases, and in 11 of those 12 cases, the dog survived.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that development of nonspecific clinical signs of vomiting, lethargy, and anorexia in conjunction with high serum hepatic enzyme activities and mature neutrophilia in a medium-sized or large-breed dog should increase the index of suspicion for LLT. Abdominal ultrasonography with Doppler assessment may be useful in establishing the diagnosis. The long-term outcome for dogs that survive the hospitalization period is excellent.

The Effect of Ingredients in Dry Dog Foods on the Risk of Gastric Dilatation-Volvulus in Dogs

Using dry dog food label information, the hypothesis was tested that the risk of gastric dilatation-volvulus (GDV) increases with an increasing number of soy and cereal ingredients and a decreasing number of animal-protein ingredients among the first four ingredients. A nested case-control study was conducted with 85 GDV cases and 194 controls consuming a single brand and variety of dry food. Neither an increasing number of animal-protein ingredients (P=0.79) nor an increasing number of soy and cereal ingredients (P=0.83) among the first four ingredients significantly influenced GDV risk. An unexpected finding was that dry foods containing an oil or fat ingredient (e.g., sunflower oil, animal fat) among the first four ingredients were associated with a significant (P=0.01), 2.4-fold increased risk of GDV. These findings suggest that the feeding of dry dog foods that list oils or fats among the first four label ingredients predispose a high-risk dog to GDV.

Climatic conditions as a risk factor in canine gastric dilatation-volvulus

Canine acute gastric dilatation-volvulus (GDV) is a life-threatening condition of multifactorial origin. The risk of developing GDV is influenced by a variety of factors, including breed, age, gender, temperament, diet and management. A relationship between seasonal variations and the frequency of GDV has been previously documented although no association was found with any specific climatic event. Variables in weather conditions within a defined geographic region were investigated in a retrospective study of 287 client-owned dogs diagnosed with GDV between 1992 and 1999. Monthly incidences were evaluated and differences in atmospheric temperature, humidity and pressure between days in which GDV cases were observed and days in which no case was presented were examined. Although temperature was significantly associated with the occurrence of GDV, the difference in temperatures between days with and days without GDV cases was so small that it is unlikely to be of clinical relevance. Moreover, no significant association was found between GDV occurrence and atmospheric pressure or humidity, and a seasonal variation in GDV incidence was not observed.

Diet-Related Risk Factors for Gastric Dilatation-Volvulus in Dogs of High-Risk Breeds

A nested case-control study was conducted among 1634 dogs with complete diet information in a 5-year prospective study to determine diet-related risk factors for gastric dilatation-volvulus (GDV). Cases included 106 dogs that developed GDV; controls included 212 dogs without GDV that were frequency matched to cases by year of GDV onset. Proportionate energy consumed from major food types and from carbohydrates was determined. Dogs were categorized as consuming either a low volume or high volume of food based on the median number of cups of food fed per kg of body weight per meal. Dogs fed a larger volume of food per meal were at a significantly (P&lt;0.05) increased risk of GDV, regardless of the number of meals fed daily. For both large- and giant-breed dogs, the risk of GDV was highest for dogs fed a larger volume of food once daily.

Gastric dilatation-volvulus in dogs

Gastric dilatation-volvulus (GDV) is a disease in which there is gross distension of the stomach with fluid or gas and gastric malpositioning. It causes pathology of multiple organ systems and is rapidly fatal. It is common in large- and giant-breed dogs. The disease appears to have a familial predisposition. Thoracic depth/width ratio also appears to predispose dogs to GDV. Implicated dietary factors include dietary particle size, frequency of feeding, speed of eating, aerophagia and an elevated feed bowl. A fearful temperament and stressful events may also predispose dogs to GDV. Abdominal distension, non-productive retching, restlessness, signs of shock, tachypnoea and dyspnoea are possible clinical signs. Initial treatment includes treatment of shock and gastric decompression. Surgical treatment should be performed promptly. There are no studies comparing the use of different anaesthetic agents in the anaesthetic management of GDV. Pre-medication with an opioid/benzodiazepine combination has been recommended. Induction agents that cause minimal cardiovascular changes such as opioids, neuroactive steroidal agents and etomidate are recommended. Anaesthesia should be maintained with an inhalational agent. Surgical therapy involves decompression, correction of gastric malpositioning, debridement of necrotic tissue, and gastropexy. Options for gastropexy include incisional, tube, circumcostal, belt-loop, incorporating, and laparoscopic gastropexy. Expected mortality with surgical therapy is 15-24%. Prognostic factors include mental status on presentation, presence of gastric necrosis, presence of cardiac arrhythmia and plasma lactate levels. Prophylactic gastropexy should be considered in dogs identified as being at high risk.

Gastric dilatation-volvulus syndrome in dogs

Gastric dilatation-volvulus is a medical and surgical emergency that principally affects large-breed dogs. Surgical treatment should be undertaken as soon as the patient has been stabilized with fluid therapy and decompression. A gastrectomy might be required if the stomach is becoming necrotic. A gastropexy is required to prevent recurrence.

Prospective evaluation of laparoscopic-assisted gastropexy in dogs susceptible to gastric dilatation

OBJECTIVE

To determine long-term outcome associated with laparoscopic-assisted gastropexy in prevention of gastric dilatation-volvulus (GDV) in susceptible dogs and to evaluate use of laparoscopy to correct GDV.

DESIGN

Prospective study.

ANIMALS

25 client-owned large-breed dogs.

PROCEDURE

23 dogs susceptible to GDV were referred as candidates for elective gastropexy. These dogs had a history of treatment for gastric dilatation, clinical signs of gastric dilatation, or family members with gastric dilatation. Laparoscopic-assisted gastropexy was performed. One year after surgery, abdominal ultrasonography was performed to evaluate the attachment of the stomach to the abdominal wall. Two dogs with GDV were also treated with laparoscopic-assisted derotation of the stomach and gastropexy.

RESULTS

None of the dogs developed GDV during the year after gastropexy, and all 20 dogs examined ultrasonographically had an intact attachment. Another dog was euthanatized at 11.5 months for unrelated problems. Two dogs with GDV successfully underwent laparoscopic-assisted gastropexy after the stomach was repositioned.

CONCLUSIONS AND CLINICAL RELEVANCE

Laparoscopic-assisted gastropexy resulted in a persisting attachment between the stomach and abdominal wall, an absence of GDV development, and few complications. Dogs with a high probability for development of GDV should be considered candidates for minimally invasive gastropexy. Carefully selected dogs with GDV can be treated laparoscopically.