The emergency occurs when gas can not escape the stomach, and it becomes overly distended. The normal contractions in the stomach wall cease, and the entire organ rotates in the abdomen. Since each end of the stomach is stationary, the blood supply is cut off by the twisting or torsing effect. The tissue quickly loses viability as it is starved for oxygen. As the stomach enlarges, it puts pressure on the diaphragm causing respiratory distress. Cardiac output may also be reduced by restriction of the abdominal arteries. Shock quickly ensues, followed by death if not immediately managed.

Factors that may contribute to the onset of GDV include over-eating or ravenous eating, once a day feeding, and exuberant activity after a meal. Older males are more likely to develop GDV than other dogs.

Dogs with GDV will have a distended painful abdomen and may be retching, hyper-salivating, gasping for breath, or comatose. An x-ray can help to visualize the gas that is trapped in the stomach, but symptoms and predilection are usually diagnostic. Shock should be treated with rapid IV fluid replacement and oxygen supplementation. Comatose dogs will be intubated to provide artificial respirations if necessary. A stomach tube will be passed in an attempt to deflate the stomach and restore blood circulation. Medical treatment of heart rhythm abnormalities, electrolyte imbalance, and sepsis is performed as required. Surgical repair of damaged stomach tissue and gastropexy, tacking the stomach to the abdominal wall, is performed as soon as the patient is stable enough for anesthesia.

Complications after surgery include relapse of all symptoms, cardiac arrhythmias, necrosis (death of tissue) and perforation of damaged organs, and peritonitis (sepsis of the abdominal cavity). The prognosis of any GDV patient depends on how soon the animal receives treatment and the extent of damage to the tissues involved. Follow up therapy will include antibiotics to prevent infection, IV fluids until the dog can eat normally, and pain control.

GDV is a serious emergency that requires immediate medical attention. If you suspect your dog is experiencing gastric bloat, it is always better to err on the side of caution and seek veterinary advice.

Dogs too are susceptible to foreign body obstruction. A dog may chew up and swallow parts of toys or tennis balls which may then require surgery to remove. Diseases that cause vomiting in dogs are numerous, including pancreatitis, parvovirus, inner-ear infections, liver disease, and kidney failure. Persistent vomiting should always be considered a symptom of disease.

Vomiting causes rapid water and electrolyte loss, and it upsets the acid-base balance in the body by expelling large amounts of hydrochloric acid produced in the stomach. Repeated vomiting is very traumatic to the stomach and esophagus and can lead to gastric ulceration and bleeding. If possible, take the vomitus – the material vomited – to the vet with your pet. The contents of the vomitus can give the doctor a clue as to the cause.

Diagnostic tests that may be performed on a vomiting pet include a complete blood count, blood chemistry profile, and electrolytes. An abdominal x-ray or ultrasound can reveal gastric and intestinal obstructions and tumors. Inflammatory bowel and pancreatic specific enzymes may be measured as well.

Treatment for vomiting is first of all symptomatic, but the underlying cause must be addressed and treated to prevent further episodes. A simple diet change may be in order in the case of food allergy, or the vomiting may be a sign of serious organ dysfunction.

Situations where an ultrasound machine might be used are numerous. Imaging can be made of the entire urinary tract to diagnose bladder and kidney stones, defects in the bladder wall and ureters, and prostate disease. The machine may have Doppler capabilities that measure blood flow to the liver and kidneys. Ultrasound is used to diagnose tumors and abscesses of the liver, spleen, and pancreas. A procedure called an echocardiogram employs an ultrasound to measure the heart chambers and valves, assessing cardiomyopathy or heart disease. A specialist usually performs advanced ultrasound techniques.

Unlike an X-ray that takes a still image of the body, the ultrasound gives real-time visualization of the organs. Blood flow through arteries and urine production from the kidneys can be seen as it occurs. X-rays produce radiation that carries certain risks with long term exposure. Ultrasound is not associated with the ionizing effects of radiation.

An ultrasound is a powerful tool available to veterinarians that can assist in diagnosing diseases, abscesses, and cancers that would go undetected without exploratory surgery. It is a wonderful advancement in medical technology that allows non-invasive assessment of the internal workings of the body.

Factors that exacerbate symptoms of a collapsed trachea are heat and humidity, obesity, heart failure (which can be secondary to collapsed trachea), inhalant allergens like cigarette smoke, respiratory infection, and anxiety. These can increase the coughing and tracheal deformation to the point of suffocation. The dog may pass out from anoxia – lack of oxygen to the brain. In fact, dogs with collapsed trachea may have elevated liver enzyme tests from chronic oxygen deprivation.

Breed predilection and x-rays confirm a diagnosis of a collapsed trachea, and treatment begins with cough suppressants and bronchodilators. Secondary heart failure will be treated with specific drugs, although the health of the heart may improve by controlling the airway disease. A weight loss program should be started for obese dogs. Avoidance of irritants like smoke is very important. As the disease progresses, surgery may be an option. Not all collapsed tracheas can be repaired however. If the weakness in the cartilaginous rings is in the throat, synthetic rings can be sutured in place. If the defect is in the chest, surgery may not be corrective or even possible. Many dogs with a collapsed trachea have a weakness in the walls of the bronchi, the main branches of airway into the lungs. For these pets, symptomatic treatment is the only option.
Because a collapsed trachea is heritable, affected dogs should not be bred.

Arthritis is very common in older dogs as an aging process. It can be very painful, cause limping and lameness, and lead to muscle atrophy (wasting) from reduced exercise. This condition is called degenerative joint disease and is a consequence of wear and tear on the cartilage that pads the bones from rubbing together. Inflammatory joint disease is an arthritic process that is not related to aging. Instead, infection or immune-mediated disease is the cause of joint stiffness and pain. Tick-borne diseases such as Lyme and Ehrlichia are common causes of this painful joint condition. Treatment for pain is indicated, but the underlying illness must be treated as well.

Hip dysplasia is a common cause of limping in dogs. It is not a disease, but a mal-formation or a poor confirmation of the hip joint. The femur bone in the rear leg is topped with a ball that fits into the acetabulum (socket) of the pelvis. In this heritable condition, the ball can slip around or completely out of the socket causing discomfort. Over time, arthritic changes occur as abnormal wear occurs. An x-ray can confirm hip dysplasia, but it may not predict the severity of symptoms that may arise as a result. Hip replacement and a “salvage” surgery called a femoral head ostectomy are recommended when pain is not controlled with joint health supplements and medications.

It is important to have any persistent limping checked by the veterinarian to determine the cause and provide pain relief.

It seems obvious to control pain after surgery, an injury, or during a painful illness like pancreatitis. But in fact, the practice of pain management has not always been widespread in veterinary medicine. The acknowledgement that our pets do indeed experience emotions like pain was not always a popular belief. Even in human medicine, pain is often under-treated. It is proven that untreated pain suppresses the immune system, delays healing, and prolongs recovery from surgery. It is our greatest responsibility as the caretakers of our pets to alleviate suffering, and there are fortunately many options available to ensure that we are successful.

Pain can be articulated by people. However in pets, it must be observed and measured. There are several pain scales that veterinarians can use to anticipate and measure pain. Dogs and cats exhibit pain differently than people except in the case of acute, excruciating pain where vocalizing occurs. Being pack animals, dogs tend to keep a low profile, staying away from others including human family members. They may refuse food and be defensive, cowering and growling or snapping in anticipation of discomfort. Cats will also hide and guard their wounds, and both dogs and cats may over-groom a tender area. Pain is also measured by empirical methods, assuming that an animal would feel the equivalent of a human after experiencing surgery, trauma, or an illness. Increased blood pressure, heart rate, and respiratory rate may also be used as indicators of pain.

Treatment for pain depends completely on the source and severity of discomfort. Medications, physical therapy, alternative therapies such as acupuncture, and other palliative measures can all be used alone or in combination. Multi-modal approaches to pain control tend to be the most effective.

For minor pain, heat and compression can give relief. Cold increases the perception of pain. Range of motion exercises can keep an arthritic animal limber and strong. There are specialists in physical therapy that utilize tools like water treadmills to increase flexibility and avoid muscle wasting caused by chronic pain.

Medications that alleviate pain are called analgesics. There are different categories of analgesics which have different mechanisms of action. Drugs are used for moderate to severe forms of pain. Non-steroidal anti-inflammatory drugs (NSAIDs) are useful for conditions like arthritis where pain relief is best achieved when inflammation in the joints is controlled. Opiates are reserved for severe pain, like after major surgery. They are usually not given long term because of the potential for side effects on the GI tract like constipation. Opiate drugs come in oral, injectable, and transdermal forms. Local anesthetics can be injected into the tissues around a surgical incision to completely numb the site. Just as in humans, epidurals can be given by injecting an opiate directly into the spinal canal, completely blocking the nerve pathways for entire regions of the body.

Pain should be assumed, predicted, and preemptively controlled in our pets. Because we can not tell an animal “this is going to hurt a bit”, even minor pain can affect their health and wellbeing significantly.

One way to ensure your pet’s safety is to evaluate a blood chemistry profile before the surgery. This can detect compromised organ function, anemia, electrolyte imbalance, and bleeding disorders. Although it is impossible to screen for every possible disease process with one blood sample, the most likely problems that would preclude or complicate surgery can be ruled out.

Monitoring equipment used during surgery has greatly improved the safety and outcome of general anesthesia. In the past, the level of anesthesia could only be measured subjectively. Heart rate and respirations were observed to indicate the depth of anesthesia. Modern monitoring of blood pressure, blood oxygen saturation (pulse oximetry), and electrocardiogram (EKG) are much more accurate at assessing the patient’s wellbeing. The depth of anesthesia can be “fine tuned” using these parameters to improve safety and speed recovery.

The drugs used to induce and maintain anesthesia have become far safer as well. Induction agents and gas anesthetics are minimally metabolized by the body and are eliminated very quickly compared to older protocols. A rapid recovery reduces the chance of anesthetic injury to the kidneys and other organs. The pet is able to return to eating and drinking shortly after the procedure which prevents dehydration and boosts the immune system during healing.

A side effect of general anesthesia is lowered blood pressure. Intravenous fluids can be administered to normalize blood pressure and ensure adequate tissue oxygen perfusion. Life-saving drugs can be administered through an IV catheter in the case of an emergency.

Analgesia (pain control) is better achieved through the drug choices that veterinarians can utilize. It is a proven fact that pain suppresses the immune response, slows healing, and increases recovery times. Your pet will receive pre- and post-operative pain medications that will ensure their comfort and improve the outcome of surgery.

The veterinary staff will give you specific instructions to follow before and after surgery. The pet will need to fast for a period of time to reduce nausea during anesthesia. Vomiting while unconscious is very dangerous, and an empty stomach will avoid this problem. Be sure that you understand the fasting instructions. Withholding water for too long before surgery can lead to dehydration which may cause problems with recovery.

After surgery, you will be given aftercare instructions. Restricted activity, physical therapy, antibiotics, pain medications, rechecks, and scheduling suture removal are common follow up procedures to a surgery. You will want to monitor your pet’s appetite and attitude afterward and call the vet if there are any problems. An Elizabethan collar may be sent home to prevent the animal from chewing and scratching at the incision.

You should understand what will be done during surgery and the expected results. Discuss the procedure with the veterinarian and the nursing staff so that you are comfortable with your part in the follow up care of your pet.

Biopsy by endoscopy3 or exploratory laparotomy is the only definitive way to confirm the presence of inflammatory cells within the stomach and intestinal wall. A general anesthetic is administered to facilitate tissue collection. An endoscope3 is a narrow tube with a camera and forceps attached at the end that is passed through the esophagus to obtain upper GI tissue biopsies, or through the colon to harvest lower GI tissue samples. It is not always possible to collect diagnostic samples using an endoscope. So exploratory laparotomy, though obviously more invasive, is sometimes necessary. After surgery, the tissue samples are sent to a pathologist for examination.
Some patients will improve during a food trial with a prescription hypoallergenic diet. There are two basic types of food available by prescription for IBD: novel protein, novel carbohydrate formulas and hydrolyzed protein formulas. Whichever type of food is used, the most important factor in realizing their effectiveness is to eliminate all other sources of calories. This includes treats, table scraps, rawhides, even flavor-infused chew toys as they all may contain ingredients to which the pet is allergic.
Oral medications are used to treat patients who do not respond to food trials. These include antibiotics, antiemetics, and corticosteroids, often prescribed in combination with each other. Because there is no cure for Inflammatory Bowel Disease, long-term use of these drugs is used to control symptoms. There are possible side effects from chronic steroid use, so your veterinarian will usually prescribe a tapering dose regimen to determine the minimum dose required to alleviate symptoms. Prednisone (prednisolone) is the steroid of choice, although a safer drug called budesonide, which is less systemically bioavailable, may control some IBD patients. Prednisone should not be used in patients suspected of having intestinal lymphoma, as diagnosis and remission can be difficult or impossible to achieve. Antibiotics used include metronidazole, sulfasalazine, and tylosin. These drugs are used for their anti-inflammatory effect on the colon as well as to normalize the bacterial flora in the gut. It is important to use a therapeutic dose of antibiotic so that bacterial resistance is less likely. Sulfasalazine is used on a short term basis because of a risk of KCS (reduced tear production)4, and it may be toxic to cats because of its aspirin content. Antiemetics are medications that control vomiting. Metoclopramide is an antiemetic that also increases peristaltic contractions, making it a good choice for IBD treatment.
While not considered a drug, probiotic may be useful to reduce the dose of steroid necessary and improve symptoms of Inflammatory Bowel Disease. Probiotic is a dormant form of beneficial bacteria that normally resides in the healthy intestine. In-vitro studies show that it may have anti-inflammatory effects by blocking the enzymes produced by white blood cells in the gut wall. The most common probiotic is called Lactobacillus Acidophillus. It is available over the counter as well as in pet products specifically made for the treatment of diarrhea.
It should also be noted that Omega 3 fatty acid supplements may be of benefit in the IBD patient.
1. 4. Food Allergies
2. 26. Understanding Giardia Infections
3. 25. Endoscopic Procedures
4. 39. Dry Eye (KCS)