How many times does stomach torsion occur in dogs. Causes and treatment of gastric volvulus

What is gastric torsion?

Gastric volvulus is an acute surgical pathology that can lead to the death of the animal within 4-8 hours. In dogs of large and giant breeds, such as Great Danes, Mastiffs, Alabai, German and East European Shepherds ....

The stomach is fixed by highly mobile ligaments. In a filled state, the stomach of dogs of these breeds weighs about 4-6 kg. That is, we can imagine a 6 kg kettlebell hanging on movable rubber bands.

And now, the dog, immediately after eating, makes a sharp movement, for example, somersaults over his back, the stomach twists around its axis and its volvulus occurs. In the process of digestion of food masses, a large amount of gases is formed in the stomach, which simply burst its walls, disrupting blood circulation. Also, against the background of a volvulus of the stomach, blood stagnation occurs in the spleen. It increases dramatically in size and can simply tear!

How to understand that a dog has a stomach twist?

Immediately after a meal or a walk, the dog suddenly becomes ill: it cannot lie down, takes unnatural postures, vomiting may occur, increased salivation, the stomach swells sharply, when tapping on the stomach, a tympanic sound is heard (like on a drum), shortness of breath. Without veterinary care, the animal dies within 2-3 hours.

If we are not sure that the dog has a problem, should we wait and see, or should we urgently go to the clinic?

It is worth coming to the clinic urgently in any case.! It's better to be a false alarm than a waste of time. The prognosis for recovery is better, the sooner the animal begins to receive proper care.

How does the doctor make the correct diagnosis?

Diagnosis is based on examination and radiography.

On examination, the animal has severe pain in the epigastric region, the abdomen is distended, salivation, shortness of breath, pale mucous membranes, forced posture. On x-ray, the stomach is greatly stretched, occupies most of the abdominal cavity, a characteristic bridge is visible.

What can be confused with gastric torsion?

Gastric volvulus may be confused with acute gastric dilatation. This pathology is similar in symptoms and course, and also requires urgent help from a veterinary surgeon.

How is stomach upset treated?

Volvulus of the stomach, as well as acute dilatation of the stomach, is a kind of test for the speed and coherence of any veterinary team.

First of all, the animal is removed from the state of shock and prepared for an emergency operation.

The anesthesiologist gives anesthesia, and the veterinary surgeon tries to insert a gastric tube into the dog. In case of acute gastric dilatation, this is obtained and a complete gastric lavage is carried out. If the probe does not pass into the stomach, then a complex surgical operation is required, during which the stomach is turned over to its natural position, washed out and sewn to the abdominal wall. If the spleen is not viable, a splenectomy is performed.

Even with timely and properly provided veterinary care, the animal may die. Therefore, we monitor such patients for at least a day in a surgical hospital.

That is, if my dog has the symptoms described above, I need to urgently go to the nearest veterinary clinic?

Before going to the veterinary clinic, you must definitely call there and find out: is there a veterinarian surgeon on site, x-rays, and whether operations are currently underway.

The network of veterinary clinics Vysota is equipped with modern digital x-rays, hospitals and operating rooms.

Also, professional veterinary surgeons work here, able to cope with surgical pathology of any complexity.

Gastric volvulus in dogs is not a rare pathology; it is often diagnosed in friends of our four-legged animals. Moreover, it arises unexpectedly, develops rapidly, and the owner has only a few hours to deliver the pet to the veterinary clinic, otherwise the animal will die. How does such a dangerous pathological condition manifest itself, and what methods are used to treat it?

This disease is due to the fact that, unlike the human stomach, the dog's stomach is very loosely fixed, in addition, it is located horizontally. All this greatly increases the risk of twisting of the organ around the esophagus and contributes to the development of associated complications. Such a disease has not yet been fully studied, but experts still identify a number of factors that provoke gastric volvulus:

Dimensions, body weight and age of the dog. In large, massive individuals, there is a more intense stretching of the internal ligaments, so they quickly lose their elasticity. They are not able to fix the filled organ in the desired position, which leads to its twisting.
Unbalanced Diet. Dogs, in fact, are predators, which many owners forget about, including a lot of cereals and vegetables in their menu, or they feed the dog with low-quality dry food. Both are wrong, since 70-75% of the pet's diet should consist of meat ingredients. The dog does not receive the necessary components and begins to eat more, which increases the load on the digestive tract. The walls of the stomach are strongly stretched, thinned, their elasticity decreases.
Irregular, infrequent meals. Dogs fed once a day or less frequently are at risk for gastric volvulus.
Fast eating. Pets that actively, practically without chewing, eat food, swallow a lot of excess air, which causes the organ to expand.
Walking immediately after feeding. If the owner feeds the pet and immediately leads him outside, then the stomach, filled with undigested food, can stretch and twist when the dog is actively moving.
Heredity. If the puppy's parents suffered from a similar pathology, then it may later appear in him.
stressful situations. According to statistics, anxious, restless dogs that have suffered a nervous shock are more likely to suffer from bloat.

More often, gastric volvulus develops in representatives of large and giant breeds: bullmastiffs, Dobermans, Labradors, etc.

Symptoms of gastric torsion in dogs

The pathology develops so quickly that within an hour or two the dog has severe symptoms:

the general condition deteriorates sharply (with activity after feeding);
the pet is anxious, constantly fiddling in search of a more comfortable position that can reduce pain symptoms;
frequent bouts of vomiting with copious secretion of salivary mucosal fluid, which do not stop after emptying the stomach;
the volume of the abdominal cavity increases rapidly, when listening, strong gas formation can be determined, but there are no sounds of intestinal activity;
there is a blue or pallor of the conjunctiva, nasal mucosa, mouth, genitals;
shortness of breath appears;
body temperature drops;
due to the fact that the pathology leads to squeezing of blood vessels and nerve trunks, it is more and more difficult for the dog to rise.

The owner, who discovered such a condition of the pet, unfortunately, will not be able to help him in any way. Here it is important not to get confused and take him to the veterinary clinic as soon as possible.

Diagnostic methods

First of all, the veterinarian examines the dog, probes the peritoneum. After he collects an anamnesis, interviewing the owner, especially important information is what the dog ate, how long ago and how much.

As the main diagnostic method, an x-ray of the peritoneum is prescribed. Usually this is enough to identify the violations that have arisen. In some clinics, ultrasound is performed instead of X-ray.

It is possible to confirm the occurrence of gastric volvulus if a gastric tube is inserted. Excess gases exit through the tube, filling the stomach, which provides short-term relief. But gas accumulation continues, and after a while the abdominal cavity swells again. This is a clear sign of gastric obstruction.

Naturally, such a procedure requires certain skills, so it must be carried out by a specialist.

Treatment of gastric torsion

No pills and physiotherapy can save the animal from this pathological condition. An operation is required. And the sooner the volvulus is diagnosed and the four-legged patient is operated on, the more likely it is that the pet will recover.

The intervention is carried out urgently, in some cases, surgeons make a puncture of the abdominal wall to release excess air and reduce pressure on the organ.

The operation includes the following steps:

the surgeon cuts a small section of the abdominal wall;
the twisted organ is given a normal position;
fixes the stomach using a special technology that does not allow the organ to wrap itself in the future - suturing it to the abdominal wall;
using a probe, the specialist empties and rinses the affected organ;
if in the process of surgical manipulation dead tissues are found, then their excision is required;
at the end, the abdominal cavity is washed with antiseptic agents, examined for bleeding;
at the end of the procedure, if the surgeon is satisfied that there are no complications, he closes the incision.

After surgery, a four-legged patient is prescribed a series of tests and ultrasound to identify possible disorders in the functioning of the digestive tract. If pathologies were found, then the doctor deals with their treatment. In certain situations, after surgery, the patient needs parenteral nutrition.

The duration of the recovery and rehabilitation period is due to many factors - the severity of the disease, the presence of complications and other ailments, the age characteristics of the dog. Young animals rehabilitate much faster than their older counterparts. Usually the animal is in the hospital for 2-3 days, in a complicated condition it takes about 4-5 days to recover.

The pet must fast for two days, his stitches are processed daily. The wound left after the operation is closed with a bandage. To avoid the development of infection, the dog is prescribed antibacterial agents, in addition, the doctor may recommend taking supportive and antiemetic medications. The suture material is removed after 10-14 days.

What can be confused with this condition?

Signs of volvulus are similar to those of acute gastric dilatation. Only in the second pathological condition does the organ not twist, it only swells due to accumulated gases. In case of acute expansion, it is enough to use a probe, less often gases are released by puncture of the walls of the stomach - a specialist pierces the organ with a sharp needle, and gases exit through the holes.

Procedures save the patient from unpleasant manifestations. This violation is not dangerous, but very often a volvulus develops following such a pathology, so the dog needs to be examined.

Gastric volvulus is a severe pathology, the development of which is much easier to prevent than after sending a four-legged pet to the operating table. The owner should take care of the proper, nutritious nutrition of the dog, adhering to certain rules, and ensure good living conditions. Particular attention should be paid to older animals, because it is much more difficult for them to cope with various kinds of diseases.

Torsion of the stomach is rare, as a powerful ligamentous apparatus that fixes the cardiac and pyloric parts prevents its development.

Relaxation of the ligaments and convergence of the legs of the gastric loop contributes to torsion. Such relaxation can be congenital or acquired.

With the relaxation of the ligamentous apparatus and the overflow of the stomach with contents, the pylorus approaches the cardial part. Then there is a similarity with the conditions of inversion of the ileocecal angle or sigmoid colon, when their extreme points approach. Increased peristalsis with close "legs" or a sudden increase in intra-abdominal pressure (lifting weight, falling, trauma) usually leads to the development of gastric torsion.

The inversion can be around its transverse and longitudinal axis, along and counterclockwise. Most often it occurs counterclockwise, around the transverse axis of the organ.

Volvulus can be complete when the cardial and pyloric parts of it are closed, and partial when these parts remain open. Partial volvulus in most patients is observed with diaphragmatic hernias, when the stomach moves into the chest cavity, and with the shape of the stomach, called the hourglass.

When turning around the transverse axis, the transverse colon remains downward from the stomach, and when turning around the longitudinal axis passing through the cardia into the pylorus, it is thrown upward from it.

Symptoms of gastric torsion

In the clinical course of gastric torsion, two main phases should be distinguished: the first, when the torsion has not yet reached 180 ° and there is no complete closure of the cardiac and pyloric parts of the stomach; and the second, when the volvulus reaches 180° and complete closure of these gastric parts occurs.

The disease in most patients begins suddenly (severe abdominal pain, sometimes collapse, vomiting, bloating). When the volvulus reaches 180°, vomiting stops and painful hiccups set in. The patient usually takes a semi-sitting position, the pains intensify, anxiety appears, shortness of breath, the pulse is small and frequent, intense thirst and immediate vomiting after several sips of water. An attempt to insert a probe mostly fails, and probing is permissible only at the initial stage of the process.

When viewed in the upper abdomen, a spherical protrusion is determined. Visible peristalsis is usually absent. On palpation, there is a slight soreness in the area of the protrusion, which is palpated as a tense ball. An X-ray examination shows a high position of the diaphragm and the presence of a large gas bubble with a horizontal liquid level.

For the correct recognition of this disease, it is necessary to remember the possibility of gastric volvulus, which greatly facilitates the diagnosis.

Various sections of the gastrointestinal tract are very rarely, but twisted. In 0.2% of cases, this occurs in the stomach. It rotates 180-360° along the transverse or longitudinal axis. The first variant is diagnosed 3-4 times more often. The incidence of gastric volvulus syndrome (SGS) does not depend on gender. In 20% of cases, the disease occurs in infants.

Causes of stomach twist

Certain conditions are required for the SLS:

severe vomiting;
full stomach;
excessive physical effort;
injury to the abdomen;
long ligaments holding the stomach.

SSG is possible in persons with diagnoses: "tumor process in the stomach, its atony and peptic ulcer". Diaphragm disease is a predisposing factor.

According to the etiology of SSG, it can be:

idiopathic. It is observed in 60-70% of cases. The reason is a weak ligamentous apparatus, which is why, with a full stomach, the pylorus and cardia come together.
Congenital or acquired. It depends on the deviations that led to the condition in which the stomach became excessively mobile.

Symptoms of LSZH

The degree of torsion, the rate of development of the disease, the age of the patient - all this affects the symptomatology of LSJ.

2 phases are possible:

When the torsion is less than 180° and the lumen between the cardiac and pyloric lumen is not closed.
Torsion over 180° and there was a complete closure of the gastric sections.

The clinical picture of the acute form of the disease is characterized by a sharp onset. In a person:

quickly (in 30-50 minutes) and suddenly the stomach swells;
repeated vomiting begins, which does not bring relief;
there is a discharge of gases;
there are increased noises in the epigastric region;
breathing problems appear, as well as signs of heart failure;
pain shock develops due to intense paroxysmal pains radiating to the back and chest.

The condition may worsen due to gastric rupture and gangrene, peritonitis, and necrotic processes that may occur in the spleen, pancreas, or omentum. Taking a few sips of water ends, as a rule, with regurgitation and growing thirst. Death can occur due to respiratory distress, heart failure and general poisoning of the body. Lethal outcome occurs in 30-50% of cases. With a complication in the form of necrosis of the gastric wall, mortality increases to 60%.

With torsion at an angle of less than 180 °, a chronic form of SFJ is possible with a milder course, belching, and pain after meals.

Diagnosis

Thanks to a bright clinic in the form of tension in the muscles of the anterior part of the abdomen and swelling of its upper half, splashing noise and tympanitis, it is possible to make an accurate diagnosis of "acute gastric volvulus". In the acute form of the disease, signs of intoxication, severe metabolic disorders, and hemodynamic disorders are observed.

The chronic form is less pronounced. X-rays provide information about what happened. It is carried out immediately to clarify the diagnosis. The picture shows how barium sulfate can only penetrate to the entrance to the dilated organ, and the left dome of the diaphragm is too high. Due to the obstruction of the stomach, all attempts to enter the probe are unsuccessful.

In the absence of defects in the diaphragm, the diagnosis of the disease in the longitudinal region is difficult. Laboratory diagnostic data are non-specific, despite the fact that amylase and alkaline phosphatase have elevated levels.

Treatment of gastric torsion

If the motor function of the stomach is not impaired, and this can only happen in the chronic form of the disease, drug treatment is possible. In acute SSG, urgent hospitalization is indicated, as well as an operation in which, in order to avoid rupture of the stomach, a puncture is performed using a probe to empty the gastric cavity. Next, the surgeon straightens the volvulus and examines the adjacent organs.

If there are no destructive changes, in order to avoid relapse and for decompression, gastrostomy (creation of an artificial entrance to the stomach) and anterior gastropexy (fixation of the stomach by suturing its anterior wall directly to the anterior abdominal wall) are performed. Some surgeons believe that both interventions are necessary, while others believe that a gastrostomy or gastropexy should be performed at the end of the operation.

With necrosis, a partial or complete gastrectomy (removal of the stomach) is possible. Today, laparoscopy is also used in the treatment of the chronic form of SJS.

SLJ classification

There are the following types of disease:

Depending on its course:

spicy. With a frequency of occurrence less than that of the chronic form. Occurs on both axes;
intermittent (intermittent);
chronic. Occurs as a result of the rotation of the body along the transverse axis.

From start time:

less than 4 hours;
4 to 6 hours;
longer than 6 hours.

According to the development of complications:

without complications;
with complications in the form of pulmonary and heart failure, bleeding, necrosis of the gastric wall, organ rupture.

Forecast and prevention of SSG

The anamnesis data and visual assessment of the macroscopic picture of the SFJ allow the doctor to accurately predict the outcome of the pathological condition.

As a rule, there is an acute uncomplicated form of the disease lasting less than 4 hours. This variant of LSJ has a favorable prognosis, but only if an adequate treatment tactic was chosen by the doctor, and the surgical intervention was performed without surgical errors.

Problems begin if more than 6 hours have passed since the onset of the disease. Although there were cases when the stomach ruptured, an hour after the onset of torsion, and situations when everything ended well after 12 hours from the moment the first symptoms appeared.

Severe complications are more likely to occur if the blood supply to the stomach wall is upset. With complicated variants of LSJ, the prognosis is cautious, and sometimes unfavorable.

Prevention of gastric torsion is absent due to the low incidence of this disease.

The dog's stomach is a single-chamber, curved pouch, positioned so that its widest part is directed forward. It narrows towards the back. The entrance of the esophagus into the stomach is quite wide, funnel-shaped, which is why the dog regurgitates food so easily, the exit from the stomach is much narrower. Both the entrance and exit of the stomach are provided with locking muscles (pylorus). The shape of the stomach varies greatly and depends on the degree of its filling, on the degree of filling and stretching of the intestine, etc. The capacity of the stomach also varies - from 0.6 to 8 liters, averaging about 1 liter in a dog weighing 10 kg. The cavity of the stomach is lined with a mucous membrane, which contains countless glands that produce gastric juice. This juice dissolves some food components and prepares them for further breakdown and absorption in the intestines. In a healthy dog's stomach, food is processed very quickly and quickly removed from it - when examining a stomach with a normally functioning pylorus, one observes the removal of the contrast agent after 10 minutes and after about 2 hours the stomach should empty.

An empty stomach is located in the left hypochondrium. Its anterior surface is adjacent to the liver and diaphragm, the posterior - to the intestinal loops. Like all carnivores, the dog's stomach is capable of very large stretches and, if full, can reach the lower abdominal wall. The expansion of the stomach occurs due to the increase in its left half, which at the same time acquires a spherical shape. In the correct position, the stomach is held by the gastric ligaments, which in many breeds of dogs are quite weak. In addition, dogs lack the gastrocolic ligament.

The mechanism of occurrence of gastric volvulus

Option acute expansion-inversion ...

Acute dilatation refers to sudden massive swelling (swelling) of the stomach, whether it is due to a large volume of food and liquid or due to a strong accumulation of gases. In many cases, the dilation goes away on its own after vomiting, or the contents pass into the duodenum. But sometimes, as a result of poor contraction of the stomach, due to walls stretched from puppyhood or due to spasm of the pylorus (exit from the stomach into the intestines), the cause of which can be pain shock, fright or nervous stress, too cold or hot food, not digested food stays in the stomach. Microorganisms (cocci, lactic acid bacteria, etc.) that have got along with food, as a result of the interaction of hydrochloric acid of gastric juice with bicarbonate of soda from saliva and juice of the small intestine, cause the release of a large amount of gases. The accumulation of fermentative gases contributes to the occurrence of tympania (metiorism). Due to the large bend, the pylorus shifts to the left (=torsion). At this point, the stomach rotates clockwise around the esophagus (=intestinal volvulus), the spleen moves ventrally to the right. Access to the stomach is completely closed and finally does not allow gases to escape.

Inversion-expansion option ...

When the stomach is full or overflowing with food, its walls are stretched, and the ligaments that should support it are weak, then with a sharp movement or sudden braking on the run, or even just turning over on the back of a relaxed dog in a dream, the stomach can shift and wrap. If twisting occurs, the contents of the stomach will not be able to pass into the intestines and the gases released will inflate the stomach to an incredible size.

In both cases, distension of the stomach in itself is usually not fatal, but during volvulus, under the pressure of gases, the portal vein is compressed and the activity of the diaphragm is inhibited, blood vessels can be clamped and the blood supply to the heart and other internal organs will stop. Cardiac volume decreases, blood pressure drops, oxygen supply throughout the body decreases, and in the absence of timely assistance, this can lead to death. Sometimes everything happens so quickly and with such a clear violation of cardiac activity that it is more like a heart attack.

Symptoms (clinical signs)

Appear after a heavy meal. The dog shows anxiety, salivation increases, urge to vomit occurs. There is an increasing increase in the abdomen behind the ribs, with a light blow to the stomach, an “empty sound” is heard, like a drum, increasing shortness of breath, shallow breathing. Tachycardia (increased heartbeat) is increasing, the heart rate is more than 80-100 beats per minute. Anxiety is replaced by stiffness, cautious movements, lethargy. In the initial stage, dark red gums, over time, as cardiopulmonary insufficiency increases, the gums turn white or turn blue. Weakness grows, the dog collapses...

Diagnostics

First aid.

Timely and competent assistance can save the life of your dog. Intensive therapy consists in reducing the pressure in the stomach to reduce its distension, in eliminating the cardio-pulmonary insufficiency of the dog and relieving the pain shock.

- The first and most urgent measure is to puncture the stomach. A special hollow needle is inserted through the dog's skin from the side, the stomach wall is pierced with it, and gases are released through it.
Careful depressurization of the stomach can prevent volvulus and only dilatation will be presented in the dog.
.-The dog is in so much pain from the bloat that he won't notice the pain of the needle prick, remember that this procedure can save your dog's life.
- Transport animal to veterinarian immediately/POSSIBLE CAUSES AND RISK FACTORS

Why is it so?

The etiology of gastric torsion syndrome has not been fully elucidated. Doctors have not come to a consensus about the causes of this formidable disease. Many experts single out one of the components of the syndrome, the so-called acute expansion of the stomach, into a separate disease. Others, and not without reason, consider the expansion of the stomach only the initial stage of its volvulus. Let's try to figure out the reasons.

1. Although the specific gene "responsible" for this disease has not been determined, a strong hereditary link has been established, since the likelihood of gastric volvulus increases significantly if the parents or close relatives of this dog were exposed to this disease.

2., weight and physique of the dog. The dog's bulk and body type are two important factors that increase the risk of gastric volvulus. Massiveness and "looseness" predetermine the weakness and sprain of the ligaments, which are not able to keep the full stomach in the correct position.
3, temperament and psyche, or all diseases from the nerves.
Acute gastric dilatation and volvulus were more common in dogs described by their owners as "fearful," "impressive," or "nervous." Friendly, trusting and happy dogs are very rare among patients with this diagnosis.
4, violation of mineral metabolism (this is the opinion of both domestic and foreign researchers). The development of the disease is facilitated by disturbances in both phosphorus-calcium and potassium-sodium metabolism in the body.
5, Puppy Breeding Errors, there is a clear relationship between feeding puppies with large amounts of cheap food and the incidence of gastric dilatation and volvulus in these dogs as adults. Due to the breeder's desire to save money or because of his ignorance, puppies, freshly weaned from their mother, abruptly switch to a low-nutrient and indigestible food. Negligent breeders transfer puppies, due to lack of time, to 3 meals a day, instead of 4-5 meals a day. Daily overflow of the puppy's stomach leads to stretching of its walls. The volume of the stomach increases and gradually its walls become flabby (atony), poorly reduced. As a rule, dogs raised from such puppies eat much more than a normal stomach can hold and are the main risk group for gastric volvulus. In addition to purely mechanical stretching of the walls of the stomach, the foundation is laid for all kinds of disorders of mineral metabolism. Improper feeding from childhood lays a "time bomb" in the life of an adult dog.
6, eating disorders. Feeding and walking, and even more so the working use of animals, should be “separated” in time by at least one and a half to two hours. Too often a patient with gastric volvulus enters the clinic after exercise, which was preceded by abundant feeding.