Bloat: The Mother of All Canine Emergencies


Mar 13, 2014
New Hampshire
Bloat is the nontechnical term for gastric dilatation and volvulus (GDV), a condition in which the stomach rotates around itself to become twisted. The stomach can twist halfway (a 180-degree torsion), all the way leading to a 360-degree torsion, or anywhere in between. Once twisted, the stomach becomes stuck, and fluid and gas cannot exit. A dog cannot vomit, as the entrance to the stomach (the cardia) is obstructed, and nothing can leave the stomach via the intestines, because the exit (pylorus) is also blocked.

Due to this twisting, the stomach rapidly fills with fluid and gas, leading to abdominal distention. As the stomach quickly expands, blood vessels supplying it rupture and lead to hemorrhage. The massive stomach pushes on the diaphragm, making it hard for the dog to breathe. It also causes pressure on the caudal vena cava, which brings deoxygenated blood from the body back to the heart. Without blood circulating, shock occurs rapidly.

Bloat Symptoms in Dogs
The symptoms of bloat are classic and include restlessness, discomfort, pacing, abdominal distention, gagging, salivating, and non-productive retching.

The earliest signs may be as subtle as increased drooling and pacing/restlessness. Frequently, this occurs soon after a meal, especially if the meal is followed by exercise. Certain breeds are more likely to develop bloats such as Great Danes, Standard Poodles, and Dobermans, but any breed can bloat. Sex does not seem to be related.

Bloat is an immediate emergency. The longer the stomach stays twisted, the more damage is done. If twisted long enough, the stomach tissue will die and rupture, leading to spillage of stomach contents into the abdomen.

If you suspect your dog is bloated, an emergency trip to the veterinarian is a necessity. Do not wait overnight to see your veterinarian in the morning. The sooner that GDV is addressed, the better the chances for recovery.

Stomach Decompression for Dogs
Before surgery, your veterinarian will likely try to decompress the stomach – that is, relieve the gas buildup in the stomach. This can be done in one of two ways. The first is to pass a tube down the esophagus into the stomach – an older but still accepted method. It can often be done in an awake patient. This rapid decompression can help buy time for the twisted stomach. In some rare cases, passing a tube can untwist the stomach, but the procedure also poses the risk of puncturing through the twisted stomach entrance (cardia).

Another method of decompression is called trocarization. In this technique, large gauge needles are inserted through the skin into the stomach to relieve the air. This is currently the more commonly used approach because it is quick, doesn’t require multiple staff members, and can be very effective. It poses a much lower risk to the dog, but is not without risk altogether: it’s possible to lacerate the spleen during this procedure.

There is a great video online of a veterinarian performing trocarization on a Bernese Mountain Dog with GDV.

Surgery for Bloat
The goal in a GDV is to stabilize the patient as quickly as possible before surgery. A GDV can be successfully treated only with surgical intervention. This often puts the veterinarian and owner in a very difficult spot. Decisions must be made quickly and with decisiveness to allow for the best outcome. GDV surgery can be very costly, and most dogs will remain in the hospital for two to three days post-operatively. The prognosis is dependent on each dog and how long the torsion has been present. In general, survival rates for the surgery are high.

Your veterinarian will take your dog to surgery as soon as possible. This should not be done until the patient is as stable as can be expected. To some extent, full treatment of shock is impossible until the stomach is de-rotated in surgery. The patient’s condition should be optimized. This means stabilizing blood pressure, bringing heart rate down to normal or near normal, controlling pain, and decompressing the abdomen either via stomach tube or trocarization.

In surgery, your veterinarian will open the abdomen, identify the twisted stomach, and then de-rotate it. Once de-rotated, the stomach is checked for damage. In some cases, part of the stomach tissue has died and must be removed. The spleen will be checked next. It lies alongside the stomach and shares some blood vessels. When the stomach twists, the spleen does as well. Damage to those blood vessels can lead to a damaged spleen. In some cases, the spleen must also be removed.

Once the stomach and spleen are addressed, the stomach is sutured to the right body wall. This is called a gastropexy. This will prevent the stomach from rotating again in 90 percent of cases. However, in about 10 percent of cases, a dog can still develop a bloat. It is imperative to always monitor your dog for the symptoms of bloat, even when they have undergone gastropexy.

There are several different techniques for gastropexy. The most common is the incisional. This is when an incision is made into the outer layer of the stomach (serosa) and a matching one made on the wall of the body. The two are then sutured together, holding the stomach in place.

Surgery generally lasts about an hour to an hour and a half.

Bloat Prevention
Much research has been devoted to this topic. The causes for GDV are poorly understood. At various times, an array of different recommendations have been made to prevent bloat, including the use of raised food dishes, the avoidance of raised food dishes, avoiding exercise after meals, and feeding smaller, more frequent meals rather than one large meal. More recent research has identified a possible link between motility disorders and GDV. At this time, unfortunately, there are no hard and fast rules for preventing bloat.

Prophylactic gastropexy is strongly recommended for the highest risk breed, the Great Dane, as some estimates show one in three will experience GDV. This can be done at the time of spay for females. It can also be done laparoscopically for males at practices that offer this modality.

Standard Poodles, Rottweilers, Irish Setters, and Weimaraners are also considered at-risk breeds for which prophylactic gastropexy should be considered. In other breeds, the benefits versus risks of preventative gastropexy are less clear. But one thing is certain:

No matter what type of dog you own, if you observe the classic symptoms of bloat – restlessness, discomfort, pacing, abdominal distention, gagging, salivating, and non-productive retching – you need to get your dog to a veterinary emergency room ASAP.

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Loving cats forever
Jul 23, 2017
That is a great article Linda. My sister has a Labrador/Chow Chow mix. She knows 70-pound dogs can bloat by eating too fast, so she prevents it by putting dry food in a slow feeder. It is like a maze so the dog (also named Daisy) can't just gobble up the kibbles as quickly as possible.