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.

The pattern of mortality in dogs with gastric dilatation and volvulus.

INTRODUCTION: The primary study objective was to characterize the pattern of in-hospital mortality in dogs with gastric dilatation and volvulus (GDV), with a focus on preoperative nonsurvival. MATERIALS AND METHODS: A retrospective review of medical records from a 10-year period was undertaken at a university teaching hospital. Data collected included signalment, physical examination parameters at hospital presentation, blood lactate concentration, and outcome. RESULTS: A total of 498 dogs were included. Overall, 319 (64.1%) survived to discharge and 179 (35.9%) were nonsurvivors. Of the nonsurvivors, 149 (31.3% of all dogs) were euthanized and 30 (6%) died. Of those dogs euthanized, the majority (n = 116) were euthanized at the time of hospital presentation prior to surgery (ie, without intent to treat). When dogs that were euthanized prior to surgery were excluded, 83.5% of dogs survived to discharge. Median group age was higher in those euthanized than in the group of dogs that survived to discharge. CONCLUSIONS: Preoperative euthanasia and hence nonsurvival without intent to treat accounted for the majority of GDV mortality in this study. Given the high rate of nonsurvival without intent to treat it is likely that efforts focused at disease prevention will ultimately affect a much greater improvement in overall disease mortality than those focused on improving treatment.

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.

[Closing gastroschisis: a distinct entity with high morbidity and mortality]. / Closing Gastroschisis: eine Sonderform der Gastroschisis mit hoher Morbidität und Mortalität.

PURPOSE: We correlate severe bowel damage in gastroschisis to the rare intrauterine event of narrowing of the abdominal wall around the protruding intestines. We describe this "closing gastroschisis" as a distinct entity. Prenatal ultrasound findings as gastric or bowel dilation were compared to the postnatal findings in order to find markers for an early in utero diagnosis of closing gastroschisis. Early diagnosis could prompt timely delivery to save the compromised bowel and avoid short gut syndrome. MATERIALS AND METHODS: We documented the pre- and postnatal course of our patients with gastroschisis from 2007 to 2009.  Closing gastroschisis was suspected antenatally and confirmed postnatally. We identified 5 out of 18 patients showing closure of the abdominal wall with varying degrees of bowel damage. Prenatal ultrasound findings were correlated to the postnatally confirmed extent of intestinal damage. RESULTS: We could not find consistent ultrasound markers for prenatal diagnosis of closing gastroschisis. In prenatal ultrasound three patients presented significant gastric dilation and then experienced severe courses postnatally due to segmental gut necrosis. One of these three died and the other two developed short gut syndrome. In one case progressive intraabdominal loop dilation with simultaneous shrinking of the extraabdominal loops occurred corresponding to closing gastroschisis with segmental midgut necrosis. CONCLUSION: Closing gastroschisis must be seen as a special form of gastroschisis. Extended intestinal damage is often life-threatening. In longitudinal observation dynamics of fetal ultrasound findings can lead to the diagnosis of closing gastroschisis. Progressive intraabdominal loop dilation is always highly suspicious and must lead to close follow-up and timely delivery.

Gastric distension is a contributing factor to pneumonia after pulmonary resection.

OBJECTIVES: The literature concerning relations between thoracic surgery and digestive motility is poor. The aim of our study was two-fold: (i) to show a link between thoracic surgery and gastric distension and (ii) between post-operative pneumoniae and gastric distension. METHODS: A retrospective analysis was conducted in 262 patients who had undergone a thoracotomy for lung resection between January and December 2007. Transverse diameter of the stomach was measured on chest X-rays performed on Day 0 and on Day 1. Gastric distension was defined as a ratio (R) D1/D0 higher than 1.3 (min: 0.5; max: 4.1). Three groups were defined: Group 1 (absence of distension) R < 1.3; Group 2 (moderate distension) 1.3 ≤ R < 2.3; Group 3 (major distension) R ≥ 2.3. International criteria of the Center of Disease Control were used to define pneumonia. Appropriate statistical tests were carried out. RESULTS: There were 73 women (27.9%) and 189 men (72.1%), ages ranged from 20 to 83 years (average: 59.9 years). As for gastric distension, 194 patients (74.04%) constituted Group 1, 53 (20.23%) Group 2 and 15 (5.73%) Group 3. Pneumonectomy significantly increased the incidence of gastric distension on Day 1 (P = 0.04). The side, mediastinal lymphadenectomy and personal medical past history of upper gastro-intestinal tract surgery had no statistically significant influence on the incidence of gastric distension. Univariate analysis showed that patients with gastric distension on D1 had significantly more infectious pneumonia on Day 5 (P < 0.0001): 16 (8.25%) patients in Group 1, vs 14 (26.41%) in Group 2 and 7 (46.67%) in Group 3. Furthermore, on Day 5, 33.33% (n = 8) of pneumectomies had pneumonia, against 12.18% (n = 29) of patients who had undergone another type of surgery (P = 0.01). On multivariate analysis, gastric distension was an independent predictive factor of infectious pneumonia on Day 5 (Group 3: odds ratio = 16.127 [4.267; 60 959], P < 0.0001). CONCLUSIONS: We established, in our cohort of patients, a link between pneumonectomy and gastric distension on Day 1 and infectious pneumonia on Day 5. A prospective multicentre study would be desirable to verify these data.

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.

Mortality and morbidity due to gastric dilatation-volvulus syndrome in pedigree dogs in the UK.

OBJECTIVES: To estimate breed-specific risk of death due to, and prevalence of, gastric dilatation-volvulus (GDV) in UK pedigree dogs. METHODS: Data were available on the reported cause of and age at death and occurrence of and age at diagnosis of disease from the 2004 purebred dog health survey. A total of 15,881 dogs of 165 breeds had died in the previous 10 years; GDV was the cause of death in 65 breeds. There were 36,006 live dogs of 169 breeds of which 48 breeds had experienced > or =1 episodes of GDV. Prevalence ratios were used to estimate breed-specific GDV mortality and morbidity risks. RESULTS: Gastric dilatation-volvulus was the cause of death for 389 dogs, representing 2.5% (95% CI: 2.2-2.7) of all deaths reported and the median age at death was 7.92 years. There were 253 episodes in 238 live dogs. The median age at first diagnosis was five years. Breeds at greatest risk of GDV mortality were the bloodhound, Grand Bleu de Gascogne, German longhaired pointer and Neapolitan mastiff. Breeds at greatest risk of GDV morbidity were the Grand Bleu de Gascogne, bloodhound, otterhound, Irish setter and Weimaraner. CLINICAL SIGNIFICANCE: These results suggest that 16 breeds, mainly large/giant, are at increased risk of morbidity/mortality due to GDV.

A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs.

Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

Outcomes of pregnancies with fetal gastroschisis.

OBJECTIVE: To describe pregnancy outcomes with fetal gastroschisis, including the associations of prenatal ultrasound findings with neonatal surgical complications and other morbidities. METHODS: This was a review of pregnancies complicated by fetal gastroschisis and delivered from January 1998 through June 2006. The last ultrasonogram before delivery was reviewed to determine stomach dilatation, bowel dilatation, or abnormalities of amniotic fluid volume. Neonatal records were reviewed to determine type of closure and any bowel complications. RESULTS: There were 66 pregnancies with gastroschisis, 1 per 2,000 deliveries. There were three stillbirths and three neonatal deaths. Delayed closure was necessary in 49% who underwent surgery. Birth weight below the third percentile, which occurred in 38%, was associated with need for delayed closure, 64% compared with 25% without growth restriction, P<.001, but was not associated with longer hospital stay or neonatal death. Fetal gastroschisis was diagnosed by prenatal ultrasonography in 58 cases. Bowel complications requiring surgery were more frequent when ultrasonography had demonstrated stomach dilatation (five cases), 60% compared with 10%, P=.002. Fetuses with defects so large that no normal ventral wall could be visualized ultrasonographically (three cases) were at increased risk for neonatal death, 100% compared with 0%, P<.001. CONCLUSION: Ultrasound findings associated with adverse outcome in fetal gastroschisis included stomach dilatation and a defect so large that no normal ventral wall could be visualized. Fetal growth restriction was common, and such infants were more likely to require delayed gastroschisis closure. Despite more than 90% survival, morbidity with gastroschisis remains high. LEVEL OF EVIDENCE: II.

Evaluation of lidocaine treatment and risk factors for death associated with gastric dilatation and volvulus in dogs: 112 cases (1997-2005).

OBJECTIVE: To determine clinical features, outcome, risk factors for death, and efficacy of IV administration of lidocaine as a prophylactic treatment for ischemic reperfusion injury in gastric dilatation and volvulus (GDV) in dogs. DESIGN: Retrospective case series. ANIMALS: 112 dogs with GDV. PROCEDURES: Data pertaining to breed; time lag to admission; clinical, clinicopathologic, and surgical findings; lidocaine treatment; and postoperative complications were assessed for association with outcome. RESULTS: German Shepherd Dogs (28.6%) and Great Danes (17%) were significantly over-represented. Risk factors for death included time lag (> or = 5 hours vs < 5 hours) from onset of clinical signs to admission (46.0% vs 11.3%), rectal temperature (< or = 38 degrees C vs > 38 degrees C [< 100.4 degrees F vs > 100.4 degrees F]) at admission (40.0% vs 14.9%), presence or absence of ARF (67.0% vs 23.3%), presence or absence of suspected gastric wall necrosis (59.3% vs 16.0%), and untreated gastric wall necrosis, compared with treated gastric wall necrosis (100% vs 47.6%). Overall mortality rate was 26.8%; no significant differences were detected in mortality rate or postoperative complications between dogs that received lidocaine IV prior to surgical intervention (52.0%) and dogs that did not (48.0%). Mean +/- SD hospitalization time was longer in the lidocaine treatment group (3.5 +/- 1.9 days vs 2.5 +/- 1.4 days). CONCLUSIONS AND CLINICAL RELEVANCE: Presence of the identified risk factors should warrant aggressive treatment. Lidocaine treatment was not associated with mortality rate or postoperative complications, but was associated with prolonged hospitalization time.

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.

Postoperative death in sows as a result of gastric mucosal de-gloving at the pars oesophagea.

It is well documented that pigs frequently die from postoperative acute gastric dilatation, and proximal gastric 'stress' ulceration. Three cases of gastric mucosal 'de-gloving' are reported. This was secondary to acute gastric dilatation and resulted in death from acute haemorrhage. All animals had undergone major abdominal surgery. Histology confirmed that the proximal gastric mucosa had been 'de-gloved', or torn from the gastro-oesophageal junction, leaving exposed muscle fibres. This syndrome has not been reported previously. The postmortem appearances of this mechanical injury could easily be mistaken for extensive oesophago-gastric peptic ulceration. This has major implications for prevention.

[Gastric necrosis from acute dilatation without underlying psychiatric disorder]. / Nécrose gastrique sur distension aiguë sans contexte psychiatrique.

Acute gastric dilatation with necrosis is a rare and severe complication associated with anorexia nervosa, bulimia, and psychogenic polyphagia. The Authors report an unusual case without underlying psychiatric context. Gastric necrosis was suspected based on imaging findings (plain radiograph and computed tomography). The detection of these imaging signs in an appropriate clinical setting, even without underlying psychiatric context, is important to avoid any delay in diagnosis and reduce mortality.

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 > or = 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.

Plasma lactate concentration as a predictor of gastric necrosis and survival among dogs with gastric dilatation-volvulus: 102 cases (1995-1998).

OBJECTIVE: To determine relationships between plasma lactate concentration and gastric necrosis and between plasma lactate concentration and outcome for dogs with gastric dilatation-volvulus. DESIGN: Retrospective study. ANIMALS: 102 dogs. PROCEDURE: Information on signalment, history, plasma lactate concentration, medical and surgical treatment, cost of hospitalization, and outcome was retrieved from medical records. RESULTS: 69 of 70 (99%) dogs with plasma lactate concentration < 6.0 mmol/L survived, compared with 18 of 31 (58%) dogs with plasma lactate concentration > 6.0 mmol/L (1 dog euthanatized for economic reasons was not included). Gastric necrosis was identified in 38 (37%) dogs. Median plasma lactate concentration in dogs with gastric necrosis (6.6 mmol/L) was significantly higher than concentration in dogs without gastric necrosis (3.3 mmol/L). Specificity and sensitivity of using plasma lactate concentration (with a cutoff of 6.0 mmol/L) to predict which dogs had gastric necrosis were 88 and 61%, respectively. Sixty-two of 63 (98%) dogs without gastric necrosis survived, compared with 25 of 38 (66%) dogs with gastric necrosis. CONCLUSIONS AND CLINICAL RELEVANCE: Preoperative plasma lactate concentration was a good predictor of gastric necrosis and outcome for dogs with GDV. Preoperative measurement of plasma lactate concentration may assist in determining prognosis of dogs with GDV.

A prospective study of survival and recurrence following the acute gastric dilatation-volvulus syndrome in 136 dogs.

Dogs (n = 136) with gastric dilatation-volvulus (GDV) syndrome were followed over time to measure recurrence and mortality rates and to identify prognostic factors. Thirty-three (24.3%) died or were euthanized during the first seven days. Of 85 cases that were followed for up to three years, nine (10.6%) cases each had a recurrence of GDV and seven (8.2%) cases died or were euthanized. The median survival times for cases that had gastropexies and those that did not were 547 and 188 days, respectively. Depressed or comatose cases on admission were three and 36 times, respectively, more likely to die than alert cases, while cases with gastric necrosis were 11 times more likely to die.

Factors associated with perioperative mortality in dogs with surgically managed gastric dilatation-volvulus: 137 cases (1988-1993).

OBJECTIVE: To evaluate factors associated with perioperative mortality in dogs with gastric dilatation-volvulus and to determine the influence of treatment differences between university and private specialty practices on outcome. DESIGN: Retrospective analysis of medical records. ANIMALS: 137 dogs with gastric dilatation-volvulus. PROCEDURE: Signalment; frequency of preoperative and postoperative treatments and complications; intraoperative findings; surgical technique; and hematologic, serum biochemical, and electrocardiographic results were recorded, evaluated for association with mortality, and compared between institutions. RESULTS: Mortality did not differ between institutions, and overall mortality was 18% (24/137). Surgical techniques differed between institutions, but were not associated with mortality. Gastric necrosis was associated with significantly higher mortality (46%; 13/28). When partial gastrectomy or splenectomy was performed, mortality (35 and 32% or 8/23 and 10/31, respectively) was significantly increased. Splenectomy was performed in 11 of 23 dogs requiring partial gastrectomy, and when both procedures were performed, mortality (55%; 6/11) was significantly increased. Preoperative cardiac arrhythmias were associated with significantly higher mortality (38%; 6/16). Mortality in dogs > 10 years old was not significantly greater than that in younger dogs. CLINICAL IMPLICATIONS: Patient management differences between practices did not seem to influence survival in dogs with surgically managed gastric dilatation-volvulus. Signalment, including age, did not influence mortality. Gastric necrosis, gastric resection, splenectomy, and preoperative cardiac arrhythmias were associated with mortality > 30%.

Canine gastric dilatation/volvulus syndrome in a veterinary critical care unit: 295 cases (1986-1992).

Two hundred ninety-five case records were included in an analysis of dogs treated by a standardized protocol for gastric dilatation/volvulus syndrome between 1986 and 1992. A breed predisposition was demonstrated for Great Danes, German Shepherd Dogs, large mixed-breed dogs, and Standard Poodles. One hundred and ninety-three dogs had gastric dilatation and volvulus (GDV) confirmed at surgery, 66 had simple gastric dilatation (GD), and 36 others had gastric dilatation but volvulus could not be proved or disproved (GD +/- V). Among dogs with GDV, the fatality rate was 15% (29/193). Twenty-six (13.5%) dogs with GDV underwent partial gastrectomy, and 8 (31%) died or were subsequently euthanatized. In comparing the group of dogs with GDV that survived to those that died, there were no statistical differences in the age of dog, time between onset of clinical signs and admission, time from admission to surgery, or duration of anesthesia. Cardiac arrhythmias were detected in 40% (78/193) of the dogs with GDV. There also was no statistical correlation between development of a cardiac arrhythmia and outcome in dogs with GDV. The causes of death in dogs with GDV were multiple and varied; presumed gastric necrosis was a common reason for intraoperative euthanasia (11 dogs). Among dogs with GD or GD +/- V, the fatality rate was 0.9% (1/102).

Analysis of risk factors for gastric dilatation and dilatation-volvulus in dogs.

The Veterinary Medical Data Base was usd to conduct an epidemiologic study of gastric dilatation and dilatation-volvulus (GDV) to describe changes over time in frequency of canine hospital admissions, to identify risk factors, and to estimate their relative importance. Cases in this case-control study included 1,934 dogs with GDV that were admitted to 12 participating veterinary hospitals from 1980 to 1989. The controls were 3,868 dogs with other diagnoses that were randomly selected from the same hospitals. Frequency of GDV per 1,000 canine hospital admissions ranged from 2.9 to 6.8. The case fatality rate was 28.6 and 33.3% for gastric dilatation alone and for gastric dilatation with volvulus, respectively. Using logistic regression analysis, the odds ratio (OR) and its 95% confidence limits (95% CL) for GDV associated with purebred vs mixed-breed dogs were 2.5 and 2.1, 3.0, respectively. The risk of GDV was associated with increasing age (chi 2 = 305.6, P < 0.0001) and increasing weight (chi 2 = 627.8, P < 0.0001). Significant association of GDV risk with sex or neuter status was not found. The 5 breeds having at least 10 cases and 8 controls and with the highest risk of GDV were Great Dane (OR, 10.0; 95% CL, 6.4, 15.6), Weimaraner (OR, 4.6; 95% CL, 2.3, 9.2), Saint Bernard (OR, 4.2; 95% CL, 2.3, 7.4), Gordon Setter (OR, 4.1; 95% CL, 1.8, 9.3), and Irish Setter (OR, 3.5; 95% CL, 2.4, 5.0). The effect of increasing body weight on GDV risk was less than that of increasing ideal adult breed weight, determined by published breed standards.(ABSTRACT TRUNCATED AT 250 WORDS)