What is a Stomach torsion/bloat?

The stomach is a sack-shaped organ, with one entrance (the esophagus) and one exit (the twelve-fingered intestine or small intestine). The stomach is actually released into the abdominal cavity and the abdomen is directly behind the bottom diaphragm.
If suddenly a lot of gas is produced in the stomach, and its so fast that the gas cannot go out of the body from behind or from the mouth, the stomach expand. If this expansion (dilation) runs very fast and intense, the stomach tends to like a balloon "take off" by all that gas.

The entry and exit of the stomach, however, remain in place, with the result that the stomach makes one rotation on its axis (torsion). Just by a dilation, the entry and exit of the stomach more or less pressed shut, but with a torsion that is certainly the case. The result is that nothing can go out of the stomach, while the gas simply building up.
The stomach, normally a soft bag, becomes a huge and very hard basketball.

IT IS EXTREMELY PAINFUL FOR THE DOG and, but the pain and swelling are usually seen in an advanced stage.

What are the possible consequences of a dilation or gastric torsion?

Because of the huge tension in the stomach the blood cannot flow through the blood vessels, so if the situation persists long enough the blood vessels will die. Also the stomach will give pressure through the diaphragm on the heart, causing troubles for the bloodflow of the heartmusckle and "heart attacks" may occur.

A torsion or dilatation affects a large number of organs:

Spleen:

The spleen is attached to the stomach, the spleen rotates with stomach rotates and the blood vessels are shut down. If this lasts too long clots appear in the blood vessels so the spleen dies.


In general, the abdominal organs:

The vessel that brings the blood from the back of the abdominal organs will also be pressed closed. The fluidity of the blood increases wich gives and acidic environment. There are all forms of micro clots and after some time this is causing DIC (diffuse intravascular coagulation).

Liver:

The liver receives its blood for 85% of the portal vein. This portal vein was pressed closed that  the liver gets less O2. The result is that different liver cells die. With these cells dying toxins are released into the bloodstream which may lead to shock.

Cardio-vascular:

As less blood from the abdomen goes to the heart we get what we call a hypovolemic shock. All the bodies have thereby less oxygen which in turn can lead to CIS.

Biochemical:

There is a metabolic acidosis with hypokalemia result. It means that the blood is getting too acidic with all the wastes in the bloodstream. This is also why the potassium is consumed and that leaves too little potassium in the blood. By low potassium arise heart arrytmieën, which could mean death for the dog.
All of these potential consequences are life threatening for the dog only if a veterinarian can is on time, the animal can survive this disease.

Which animals get a stomach torsion or a dilatation?

Especially large dog breeds such as Great Dane, Bernese Mountain Dog or German shepherd, are sensitive to a stomach torsion or dilatation.
Risk is eating a fair amount of food that may swell by absorption of water, as all dry dog foods do.
Gas will then arisen by movement, such as running or playing after the meal. If a dog once had has a dilatation, chances are that this could happen again.
Prevention is then an extreme necessity.

Secondary cause of dilatation/torsion:

Sometimes we see a dilatation/torsion from an other cause. For example a tumor in the intestines which give gases no free passage. If the gases cannot go through then the stomach will blow up like a balloon and it have all the symptoms of a torsion/dilatation.

What can I do to prevent a torsion/dilatation?

Divid the needed amount of food in 4 portions a day. Give it wet, and easily digestible food, so canned food or soaked chunks. Or better yet fresh meat, it is much easier to digest, and the dogs are not so thirsty after eating.
Don't let the animal drink too much water at once, but often smaller amounts spread over the day.
Always let the dog out about one hours before dinner and let him / her rest after dinner! So no feeding when the dog is panting after major effort and not too much water to drink.

There is also a relatively new method for the preventivly tying up a stomach by a laparosopical surgery (keyhole surgery type), but that does not mean that the stomach can not turn just not 100%, you also have an emergency situation but not an immediately life-threatening situation. A laparoroscopical surgergy must be performed by someone with experience of course, which is sometimes not easy to find, but also with this surgery there is a chance for complications, it is up to you whether you want to expose your dog to this.

How do we recognize a torsion/dilatation?

The dog seems cramped and painful, is oftens cry's and gives the idea that maybe he needs to go out, but he has no diarrhea, he is restless and does not know if he wants to lay down or stand, some dogs also wants to fomit but nothing is coming out. After a while, and sometimes after a few moments it is often clear that the abdomen, especially left behind the ribcage "swells" and becomes hard.


What to do?

A torsion/dilatation is an emergency! You should call immediatly your vet and report that you are coming with a possible gastric torsion.
The veterinarian will attempt to intubate the stomach through a tube, so he can empty and rinse  the stomach. If this fails, he can  decrease the pressure through a puncture with a needle.
If there is a torsion (is determined by an X-ray), the stomach will be reversed during an abdominal surgery and put down to the abdominal wall.
Any shock will be fought by infusion, the motility of the stomach is stimulated with medications and antibiotics and painkillers will be prescribed.

What are the prospects?

The risk of shock and other complications is rapidly increasing. The days after the acute illness is critical.
Even when the animal has survived the dilation and the surgery, the potential damage to the stomach and the heart, but also the liver and kidneys, may still cause life-threatening problems for the animal.
The rest its live the dog has become more sensitive than other dogs for a repeat of the torsion/dilatation.
The previously described preventive measures should therefore be applied consistently and permanently.

Depending on the findings before the intervention by the veterinarian (was the dog already in shock,  is there an irregular pulse due to heart damage?) and during the operation (is the stomach already dead, are the vessels of the spleen still alive, will the the heart of the dog tolerate the anesthesia ?), all these things will determind if the animals will and can survive this acute illness or not.
If a in previous surgery the stomach is put down, the chance of a dilated significantly narrowed, but is never entirely absent.

A golden rule for a torsion/dilatation: the quicker you discover it, the better! Go straight to a vet, better one time for a false alarm than one time to late.