Lifespan and Causes of Death in the Irish Wolfhound - Vetsuisse ...

3.5.1.3 Diagnosis
The history and clinical presentation of GDV cases is usually fairly characteristic of
the disease. If the state of the patient allows for an X-ray to be taken (right lateral
recumbency), torsion can be differentiated from simple dilation using this method.
The dilated and torsed stomach usually exhibits the classical "double bubble" pattern
(Waschak and Jergens 2004).
3.5.1.4 Therapy
Treatment only has a chance if action is taken promptly and purposefully. If the
practice is not equipped to perform an emergency operation, it is crucial to make a
rapid diagnosis and initiate emergency patient stabilisation before referring the
patient to an appropriately equipped clinic.
Emergency stabilisation consists of decompression and shock treatment. At first,
initial decompression is achieved through percutaneous punction with a 1.2 mm (18
Gauge) needle through the left flank. The needle is then attached to a suction pump,
and suction is continued until operation in order to relieve the pressure on the main
veins and diaphragm.
Alternatively, it is possible to try to achieve decompression through a thick
oesophageal probe in the standing, non-sedated or mildly sedated dog (Suter and
Niemand 2001 c; Waschak and Jergens 2004). This is reported to be rarely
successful, although failure to reach the stomach can be considered diagnostic for
complete torsion.
Second, shock treatment should be initiated by putting an i.v. catheter into the
cephalic vein (alternatively, into both cephalic veins to achieve faster administration)
and applying 7 ml/kg of a plasma expander, mixed with 20 ml/kg of Ringer lactate. 4
mg/kg each of gentamycin and dexamethasone can also be added. Using a caudal
vein (e.g. the V. saphena) for the infusion is contraindicated, since the caudal caval
vein is compressed by the dilated stomach (Suter and Niemand 2001 c).
It should be noted that there is some controversy about the order in which
decompression and fluid therapy should be initiated. For example, Waschak and
Jergens (2004) find it preferable to attempt decompression only after the initiation of
fluid therapy.
After stabilisation of the patient is achieved, surgical decompression, reposition and
gastropexy should be undertaken in an adequately equipped clinic. If the patient fails
to respond to stabilisation measures, surgery should be initiated as quickly as
possible (Waschak and Jergens 2004).
Several surgical techniques have been described in the literature. The following
technique is taken from Suter and Niemand (2001 c):
Standard surgical preparation (shaving, washing, initial disinfection etc.) is performed
on the standing animal under continuous infusion and decompression. Inhalation
anaesthesia (pure O 2 ) is combined with neuroleptanalgesia (cave: drugs that may
exacerbate hypovolaemia are counterindicated, e.g. acepromazine). The dog is
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