Gastric Dilation-volvulus Research Articles

Effects of the Administration of Different Buffered Balanced Crystalloid Solutions on Acid–Base and Electrolyte Status in Dogs with Gastric Dilation–Volvulus Syndrome: A Randomized Clinical Trial

ObjectiveTo investigate the effect of three different buffered balanced crystalloid solutions on acid–base status and electrolyte concentrations in dogs with gastric dilation–volvulus (GDV) syndrome. MethodsThe study design was a prospective, randomized clinical trial of 40 dogs. The dogs were randomly assigned to one of three groups according to the fluid used: Hartmann's solution (H), Plasmalyte (PL), and Ringerfundin (RF). Hemoglobin, albumin, lactate, electrolyte, and acid–base parameters were determined before fluid administration (T0) and at the end of surgery (T1). Results were assessed by one-way ANOVA, Fisher's exact test, the Wilcoxon signed-rank test, the Kruskal–Wallis test, and a linear mixed-effect regression model. A significance level of 0.05 was used in all analyses. ResultsBicarbonate and base excess (BE) levels increased and chloride concentration decreased in the PL group; in contrast, strong ion difference apparent (SIDapp) decreased and chloride concentration increased in the RF group. The mixed-effect model confirmed a significant interaction between the type of solution and time on the changes in bicarbonate, BE, anion gap (AG), SIDapp, and chloride levels. Clinical significanceSignificantly different effects in acid–base parameters were observed in dogs after intravenous administration of H, PL, and RF. However, clinical significance of these changes is lacking, requiring further investigation in a larger randomized controlled clinical trial.

Assessment of hemostasis in dogs with gastric-dilation-volvulus, during resuscitation with hydroxyethyl starch (130/0.4) or hypertonic saline (7.5%).

To compare the impact of an IV bolus of hydroxyethyl starch 130/0.4 (HES) or hypertonic saline 7.5% (HS) on hemostasis in dogs resuscitated for gastric-dilation-volvulus (GDV). Open-label, parallel-group randomized clinical trial. Twenty-three client-owned dogs. Dogs affected by GDV and shock were randomly assigned to receive HES at 10mL/kg or HS at 4mL/kg every 15 minutes. Blood samples were collected for blood gas analysis, PCV, total plasma protein, albumin, standard coagulation profile, and thromboelastometry (ROTEM) at baseline (T0) and at the end of bolus (T1). To assess the differences between the 2 groups at T1, Student's t-test or Wilcoxon rank-sum test was used. To evaluate the differences between T0 and T1, ANOVA for paired data or Wilcoxon matched-pairs signed-ranks test was used. P<0.05 was considered significant. Hemostasis was evaluated by means of prothrombin time, activated partial thromboplastin time, fibrinogen, and ROTEM. The study included 13 dogs in the HES group and 10 dogs in the HS group. Differences were found between groups at T1: increase in clotting time (P=0.018) and decrease in fibrinogen level (P=0.021) in the HS-treated group. Between T0 and T1, there were differences for the HES group: increase in clot formation time (P=0.046), decrease in maximum clot firmness (P=0.002) in ex-TEM profile, and decrease in maximum clot firmness (P=0.0117) in fib-TEM profile. Between T0 and T1, the following differences were noted for the HS group: increase in clotting time (P=0.048) and clot formation time (P=0.0019), decrease in maximum clot firmness (P=0.031) and α angle (P=0.036) in ex-TEM profile, decrease in α angle (P=0.036) in in-TEM profile, and decrease in maximum clot firmness (P=0.017) in fib-TEM profile. In dogs affected by GDV, HES or HS infusion caused a similar tendency toward hypocoagulability, with few differences between the 2 groups.

Observations and analysis of risk factors for GDV in a single institution: a case-control study

Objective To evaluate/ determine the risk factors for dogs presented with Gastric Dilation- Volvulus (GDV) to a referral veterinary centre and to compare the results with those currently reported in veterinary literature. Materials and Methods The observational case-control study comprised a population of 215 dogs that attended the referral centre between 2000 and 2018. Medical records were searched for GDV and those matching the criteria were manually reviewed. A questionnaire was completed by the owners of the dogs involved in the study (both case and control populations) in order to gain further information that could be considered relevant to GDVs. In particular, information included the dogs’ behaviour and the dogs daily activities. Results The study included 115 cases of GDV and 115 controls. Out of the GDV dogs 13% (15/115) were small breed dogs and the remaining 87% (100/115) either large or giant breeds. The following risk factors for developing a GDV have been identified: Purebred dogs over 3 years old and either large of giant breeds, weighing &gt; 30 kg. Foreign body ingestion, diarrhoea, and grass consumption were also associated to increase the likelihood in developing GDV. Behavioural temperament was not associated with developing GDV. Clinical Significance The findings support previously identified risk factors in the development of GDV, but characteristics related to the dogs temperament warrant further investigation. Knowledge of these results will further allow clinicians to make evidence‐based recommendations to owners in attempting to prevent GDV in dogs. Furthermore this paper confirms that the risk of GDV in certain breeds and in certain conditions is always high and that GDV is still an extremely current disease.

Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs

Gastric dilation-volvulus (GDV) syndrome in dogs is associated with complex metabolic, acid-base, and electrolyte abnormalities. The aim of this study was to evaluate previously analyzed factors (lactate and BE) in combination with other acid-base parameters (pH, pCO2, bicarbonate, base excess [BE], anion gap [AG], and strong ion difference) and electrolyte concentrations and to evaluate their association with the incidence of gastric necrosis and outcome in dogs with GDV. A retrospective study in 75 dogs with gastric dilation-volvulus syndrome, University veterinary teaching hospital. Medical records were reviewed including signalment, history, initial plasma lactate, acid-base parameters, and electrolyte concentrations, surgical findings and outcome. The overall mortality was 18.7%. In dogs with gastric necrosis, higher initial plasma lactate (median 5.84 vs. 3.36 mmol/L) and AG (20.7 vs. 16.55 mmol/L) and lower pH (7.29 vs. 7.36), bicarbonate (18.7 vs. 22.9 mmol/L), and BE concentration (−8.1 vs. −1.85 mmol/L) were found compared to dogs without gastric necrosis. Anorganic phosphorus was the only electrolyte investigated for which a significant difference was noted between dogs with and without gastric necrosis (1.93 vs. 1.39 mmol/L). The initial plasma lactate concentration (3.36 mmol/L vs. 9.68 mmol/L) and AG (16.8 vs. 20.95 mmol/L) were lower in survivors than nonsurvivors. Survivors had higher pH (7.35 vs. 7.27), bicarbonate concentrations (22.9 vs. 17.35 mmol/L), and BE (−1.9 vs. −9.55 mmol/L) compared to nonsurvivors. Anorganic phosphorus was ultimately the only electrolyte with a significant difference between survivors and nonsurvivors (1.4 vs. 1.84 mmol/L). A multivariate logistic regression model of combination lactate, pH, bicarbonate, BE, AG, and anorganic phosphorus identified pH ≤7.331 and bicarbonate as factors independently associated with gastric necrosis. Similarly, pH ˃7.331, bicarbonate and anorganic phosphorus were independently associated with outcome. Higher initial plasma lactate, AG and anorganic phosphorus levels, and lower pH, BE and bicarbonate concentrations were found in GDV dogs with gastric necrosis. Similarly, initially higher plasma lactate, AG and anorganic phosphorus concentrations, and lower pH, BE and bicarbonate were found in GDV dogs who required euthanasia or who died after surgery. Of these parameters, pH and bicarbonate were strongly and independently associated with gastric necrosis, and pH, bicarbonate and phosphorus were independently associated with outcome.

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

To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs. 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. 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. Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed.

Are Dogs That Are Fed from a Raised Bowl at an Increased Risk of Gastric Dilation Volvulus Compared with Floor-Fed Dogs?

&lt;p&gt;There are only two studies that study the effect of raised feeders on the risk of Gastric Dilatation Volvulus (GDV) and their findings conflict. Only one study found a significant effect of feeder height, with large and giant breeds fed from a raised feeder being at an increased risk of GDV floor fed dogs. However, these authors found that, where the feeder was raised, the height of the feeder that increased the GDV risk was affected by the size of the dog. Large breed dogs were more likely to develop a GDV if fed from a bowl ≤ 1 foot tall, whereas giant breed dogs were more likely to develop a GDV if fed from a bowl &amp;gt; 1 foot tall. No studies found that feeding from a raised feeder reduced the risk of GDV relative to feeding from the floor. Therefore, the safest option in the absence of further evidence is to advise that owners of ‘at risk’ dogs feed from a feeder on the floor. This may not reduce the risk of GDV, but there is no evidence to suggest that it will increase the risk. &lt;/p&gt;&lt;br /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/oa-icon.jpg" alt="Open Access" /&gt; &lt;img src="https://www.veterinaryevidence.org/rcvskmod/icons/pr-icon.jpg" alt="Peer Reviewed" /&gt;

Elective gastropexy with a reusable single-incision laparoscopic surgery port in dogs: 14 cases (2012-2013).

OBJECTIVE To describe the technique, clinical findings, and short-term outcome in dogs undergoing laparoscopic-assisted incisional gastropexy with a reusable single-incision surgery port. DESIGN Retrospective case series. ANIMALS 14 client-owned dogs. PROCEDURES Medical records of dogs referred for elective laparoscopic gastropexy between June 2012 and August 2013 were reviewed. History, signalment, results of physical examination and preoperative laboratory testing, surgical procedure, duration of surgery, postoperative complications, duration of hospital stay, and short-term outcome were recorded. All patients underwent general anesthesia and were positioned in dorsal recumbency. After an initial limited laparoscopic exploration, single-incision laparoscopic-assisted gastropexy was performed extracorporeally in all dogs via a conical port placed in a right paramedian location. Concurrent procedures included laparoscopic ovariectomy (n = 4), gastric biopsy (2), and castration (7). Short-term outcome was evaluated. RESULTS Median duration of surgery was 76 minutes (range, 40 to 90 minutes). Intraoperative complications were minor and consisted of loss of pneumoperitoneum in 2 of 14 dogs. A postoperative surgical site infection occurred in 1 dog and resolved with standard treatment. Median duration of follow-up was 371 days (range, 2 weeks to 1.5 years). No dogs developed gastric dilation-volvulus during the follow-up period, and all owners were satisfied with the outcome. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that single-incision laparoscopic-assisted gastropexy with a reusable conical port was feasible and effective in appropriately selected cases. Investigation of the potential benefits of this reusable port versus single-use devices for elective gastropexy in dogs is warranted.

Evaluation of single port access gastropexy and ovariectomy using articulating instruments and angled telescopes in dogs

To describe in dogs, a technique for single port access gastropexy and ovariectomy (SPAGO) using a commercially available multitrocar port and to evaluate short-term outcome. Retrospective case series. Dogs (n = 18). A commercially available multitrocar port was inserted into the abdomen lateral to the rectus abdominis muscle and 2-5 cm caudal to the right rib. Dogs were tilted 45° in both left and right recumbency and bilateral ovariectomy performed using articulating graspers, a bipolar vessel sealing device and a 30° telescope. The laparoscopic assisted incisional gastropexy was performed after ovariectomy at the multitrocar port insertion site by grasping the antral portion of the stomach with a 10 mm DuVall forceps and suturing the seromuscular layer of the antral region of the stomach to the transversus abdominis muscle. Eighteen dogs (median weight, 34.5 kg; range, 14.7-59.2 kg) met the inclusion criteria. Median surgical time for SPAGO was 65 minutes (range, 50-225 minutes). Intra-operative complications included, incorrect multitrocar port placement location (n = 3) and mild hemorrhage from a splenic laceration (1) All dogs recovered from surgery and were discharged from the hospital. Single port access gastropexy and ovariectomy is a feasible procedure to provide prophylaxis against gastric dilation-volvulus and a simultaneous means of sterilization in female dogs. Careful and accurate initial multitrocar port insertion is necessary to have optimal operative viewing as well as to reduce the chances of inadvertent splenic laceration.

Predisposing Factors for Colonic Torsion/Volvulus in Dogs: A Retrospective Study of Six Cases (1992–2010)

The purposes of this retrospective study were to review cases of colonic torsion/volvulus between July 1992 and August 2010 and to determine if any predisposing factors exist for the development of this condition. Six dogs were diagnosed with colonic torsion/volvulus during the study period. Four dogs had a history of previous gastric dilation-volvulus (GDV) with prophylactic gastropexy. Three of six dogs diagnosed with colonic torsion/volvulus had large intestinal entrapment and strangulation around the gastropexy site at the time of surgery. The history, clinical signs, physical examination, and radiologic findings were not specific for colonic torsion/volvulus in any dog. Early exploratory laparotomy was indicated to confirm the diagnosis and perform surgical correction of the affected bowel segments. Three of five dogs that underwent surgery had a left abdominal wall colopexy performed. All five dogs that underwent surgery in this study survived postoperatively. One patient was euthanized without surgical intervention. Results suggest that colonic torsion/volvulus should be considered in any large-breed dog with nonspecific gastrointestinal clinical signs and a history of previous gastropexy. Early recognition and prompt treatment of this condition may result in a good outcome.

Gastric dilation–volvulus syndrome in dogs

GASTRIC dilation–volvulus (GDV) is a challenging but rewarding condition to treat. Appropriate decision making and management can help to achieve a success rate of up to 95 per cent in...

Gastric dilation‐volvulus syndrome in dogs 1. Pathophysiology, diagnosis and stabilisation

GASTRIC dilation‐volvulus syndrome (GDVs) comprises acute gastric dilation (GD), acute gastric dilation‐volvulus (GDV) and chronic gastric volvulus. This article, the first of two reviewing the management of GDVs in dogs,...

Benefits of prophylactic gastropexy for dogs at risk of gastric dilatation–volvulus

The lifetime probability of death from gastric dilation–volvulus (GDV) for five dog breeds was estimated based on published breed-specific longevity and GDV incidence. These breeds were Great Dane, Irish Setter, Rottweiler, Standard Poodle and Weimaraner. Lifetime risk (95% CI) of GDV in these breeds ranged from 3.9% (0–11.2%) for Rottweiler to 36.7% (25.2–44.6%) for Great Dane. A decision-tree analysis for prophylactic gastropexy—using lifetime probability of death from GDV and expected cost savings for veterinary services as outcome measures—was undertaken to determine the preferred course of action in several dog breeds. Prophylactic gastropexy was the preferred choice of action for all breeds examined, with the reduction in mortality (versus no gastropexy) ranging from 2.2-fold (Rottweiler) to 29.6-fold (Great Dane). Assuming a prophylactic gastropexy costs US$ 400, the procedure was cost-effective when the lifetime risk of GDV was ≥34%. The maximum and minimum estimated breakeven costs for the gastopexy procedure ranged from US$ 20 (Rottweiler) to US$ 435 (Great Dane). The cost-effectiveness of prophylactic gastropexy was most sensitive to the cost of treating GDV (US$ 1500). Prophylactic gastropexy raises ethical issues that need to be considered by veterinarians and dog breeders.

Análise retrospectiva de 34 casos de dilatação vólvulo gástrica em cães (1995-2000)

Um estudo retrospectivo de 34 cães com síndrome de dilatação vólvulo-gástrica foi realizado. A idade, raça, procedimentos cirúrgicos e as taxas de mortalidade foram analisados. A raça mais acometida foi o Fila Brasileiro (47,1%) e a idade média dos cães, 8,4 anos. Todos os animais foram submetidos à laparotomia com reposicionamento e descompressão do estômago. A gastrotomia foi realizada em 38,2% dos animais. Dos oito casos com evidência macroscópica de necrose gástrica, sete sofreram ressecção (20,6% dos casos). A gastropexia foi realizada em 61,8%; a esplenectomia, em 23,5% dos cães. A taxa geral de mortalidade verificada foi de 44, I%, sendo 75% nos animais com evidências macroscópicas de necrose gástrica. A grande maioria dos óbitos ocorreu nos dois primeiros dias do pós-operatório. Nos casos em que a gastrotomia e, especialmente, a gastrectomia parcial e esplenectomia foram realizadas, houve um aumento na taxa de mortalidade. A idade não influenciou a taxa de mortalidade.

The Effect of 360° Gastric Volvulus on the Blood Supply of the Nondistended Normal Dog Stomach

Eighteen dogs were divided into three groups, each containing three volvulus and three control dogs. The stomachs of the volvulus dogs were rotated 360°, sutured in position, and kept decompressed by a Foley catheter placed in the fundus. Control dogs underwent the same manipulation, except that the stomach was replaced to normal position. One dog in each group was evaluated at 4, 8, and 12 hours. Evaluation consisted of SC46 microsphere injection to determine percent cardiac output to various stomach regions, and gross and microscopic changes in the stomach and other tissues drained by the portal system. Cardiac output to the control stomachs exceeded the volvulus stomachs by fivefold. Time was not a significant factor. Edema was present throughout the volvulus stomach. The most severe histologic changes, such as hemorrhage, were seen in the greater curvature of volvulus stomachs. Other portal tissues were grossly and histologically normal. Three additional dogs were evaluated 1 week after creation and reduction of a 12 hour volvulus; the stomachs were normal indicating reversibility of pathologic changes. This study demonstrates abnormal blood flow in rotated nondistended stomachs. Anatomic repositioning should take place as soon as possible in the treatment of gastric dilation volvulus.

OPERATIVE TECHNIQUES AND RECURRENCE RATES ASSOCIATED WITH GASTRIC VOLVULUS IN THE DOG

Numerous surgical procedures have been attempted to correct the immediate emergency associated with the gastric dilation-volvulus syndrome in the dog. These surgical procedures included anatomical repositioning alone, gastropexy, gastrotomy with an occasional partial gastrectomy, pyloric surgery, pharyngostomy tube, and splenectomy. None of these procedures has been shown to totally prevent recurrence of gastric volvulus.