Acute gastric dilatation in dogs symptoms. Acute gastric dilatation and volvulus in dogs. Clinical signs and diagnosis of the disease

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Volvulus of the stomach(ZG) is a rare disease. It proceeds quite hard. There is ZZh around its transverse and longitudinal axis at 180-360 °. HR rarely exceeds 180 °. The twist of its parts can even reach 360 °. There are two main types of gastrointestinal tract: 1) transverse or mesenteric-axial, the most common, and 2) longitudinal or organoaxial (OP Kurguzov, 1998).

Gastric volvulus:
a, b - mesenteric-axial; c - organoaxial type

Etiology. Predisposing factors of gastric drainage are congenital anomalies, changes in the longitudinal axis of the stomach, relaxation or absence of the ligamentous apparatus, excessive mobility of the duodenum and spleen, pubescence of the stomach, hernias of the POD and sudden weight loss.

Autonomic and neuropsychiatric disorders are among the direct contributing factors of healthy life. The latter, causing regular and strong contractions of the gastric wall, can even cause it to rupture. This is also facilitated by the intake of large amounts of dense food, increased intra-abdominal pressure and closed abdominal injuries. ZZh can arise on the basis of its cicatricial deformities ("hourglass"), stomach tumors, defects in the diaphragm. Stubborn antiperistalsis, disruption of the normal act of evacuation of gastric contents in case of overflow of the stomach, and bloating of the stomach and intestines contribute to the emergence of gastric fluid.

Longitudinal volvulus occurs in the direction of the longitudinal axis of the stomach. Starting from the cardiac section, it continues in the direction of its output section. Longitudinal ZZh comes in two versions. In one case, the lesser curvature, including the large omentum and the transverse OK, turns to the greater curvature, and in the other case, the volvulus starts from the posterior part of the greater curvature and spreads towards the distal part. This process usually also includes a transverse OC and a large oil seal.

Transverse or mesenteric-axial inversion is more common than longitudinal. This occurs as a result of the twist of the stomach around its horizontal base. It passes through the lesser curvature and continues towards the inner edge of the greater curvature. Horizontal ZZH also occurs in two directions - both clockwise and counterclockwise.

Clinical presentation and diagnosis. ZZh begins suddenly, with sharp sharp pains in the epigastric region. The pain radiates to the back and left hypochondrium and is accompanied by nausea, vomiting, and then unsuccessful urge to vomit and bloating. Vomit, as a rule, does not contain any admixture of bile. Vomiting occurs after every attempt to swallow a sip of water or food.

The general condition of the patient progressively worsens up to collapse and the development of shock phenomena. Acute pain radiates to the back and left shoulder girdle. At the same time, there is a feeling of heaviness and bloating in the epigastric and hypochondrium regions. Immediately after this, vomiting appears, which at first happens with food, and then acquires a slimy character.

The epigastric region appears to bulge, while the lower abdomen is pulled in and sunk in. In the first hours after the gastrointestinal tract, increased peristalsis can be observed in the epigastric region, and peristaltic waves, in contrast to those with pyloric stenosis, are traced not only in the iso-, but also in the antiperistaltic direction. When the inlet and outlet sections of the stomach are completely closed, vomiting stops, but excruciating nausea and belching appear. The general condition of patients is progressively worsening.

Phenomena characteristic of the clinical picture of high NK develop, dehydration of the body develops rapidly, which is manifested by insatiable thirst, dry mouth, etc. In addition, there are also pains in the chest area, shortness of breath, breathing and cardiac activity are impaired. The pulse becomes frequent, weak filling and tension, blood pressure falls, collapse develops.

Of the local symptoms, bloating, tension of the muscles of the abdominal wall are more pronounced. On palpation, the abdomen is painful. Percussion gives high tympanitis, there is a swelling symptom in the stomach. It is not possible to insert the tube into the stomach. Borchard's triad is characteristic: the impossibility of introducing a probe into the stomach cavity, increasing abdominal distension and pain in the epigastric and hypochondrium regions.

RI contributes to the correct diagnosis of ZH. This reveals a high position of the diaphragm, a pronounced expansion of the stomach and the presence of a horizontal level of liquid in the stomach and a large gas bubble above it. With a complete volvulus, the RI fails due to the impossibility of introducing a barium suspension into the stomach. In case of incomplete gastric drainage, one or another deformation of the stomach and a delay in the evacuation of gastric contents can be detected.

The study of peripheral blood gives a high leukocytosis with a shift to the left of the leukoformula. A decrease in the volume of circulating blood (BCC) (hypovolemia), a shift of the CBS towards alkalosis is characteristic of HG. Dehydration, hypochloremia, hypoproteinemia develop rapidly, which leads to a sharp deterioration in the condition of patients.

With HZ, necrosis of its wall can also develop, often leading to its perforation and the development of diffuse peritonitis. If this complication is not recognized and timely surgical intervention is not organized, the disease, as a rule, ends in an unfavorable outcome.

In chronic ZZh, its inlet and outlet openings do not completely close. In this case, paroxysmal pain occurs in the epigastric region, which spread towards the left hypochondrium. The pain is worse, especially after eating. There is also bloating, a feeling of tension and heaviness in the epigastric region. In a number of patients, there is a violation of the act of swallowing (dysphagia).

Chronic ZZh proceed more favorably. In some cases, they can be acute and become very severe.

In chronic ZZh, a high position of the dome of the diaphragm is also noted, and the gas bubble detected in the stomach is relatively large. With transverse volvulus, the stomach is, as it were, shortened, it acquires a saucer-like shape.

Differential diagnosis of gastric drainage is carried out between high NK, strangulated diaphragmatic hernia, acute expansion of the stomach, OP and other diseases of the abdominal cavity.

In some severe cases, it is necessary to resort to an urgent diagnostic laparotomy, which will make it possible to finally clarify the nature of the disease. Preoperative diagnosis is extremely rare. Patients are usually operated on with a diagnosis of high NK, perforated ulcer (PU) of the stomach, etc.

Treatment SJ surgical. Some surgeons are of the opinion that at the early stage of acute gastric drainage it is necessary to perform relatively easy surgery. During the operation, it is possible to eliminate (straighten) the HZ only after the elimination of adhesions, adhesions and emptying of its contents using a trocar. To reduce the pressure created in the stomach cavity and prevent re-volvulus, gastrostomy or GEA is performed, as well as gastropexy (suturing the anterior wall of the stomach to the anterior abdominal wall).

When the stomach wall is necrotic, perforation and its rupture, the opening is sutured, and if indicated, also its partial or total resection, if the patient's condition allows. If a diaphragmatic hernia is detected, plastic surgery is performed and the stomach is fixed to the anterior abdominal wall (gastropexy).

The postoperative period is usually difficult. Therapeutic measures here are directed against shock, peritonitis, a drop in stomach tone, etc. Measures are also being taken to correct VEB and KOS. For this purpose, a permanent gastric tube is used, transfusion of plasma, albumin, protein, the introduction of 5-10% glucose solution, isotonic sodium chloride solution. Antibiotic therapy, heart medications, vitamins, etc. are also prescribed.

In chronic ZZh, if the evacuation of stomach contents is not disturbed, conservative treatment is mainly carried out. In severe ZZh, the outcome of the disease is often unfavorable. However, despite the measures taken, mortality remains high and reaches 41% (P.N. Napalkov et al., 1976).

Grigoryan R.A.

Volvulus of the stomach is a rather rare disease, moreover, and little known to doctors. The main clinical manifestations of gastric volvulus resemble, in principle, the symptoms of high gastrointestinal obstruction. In the absence of diagnosis and treatment, the disease is dangerous to human life and ends in death.

Conditions for abnormal rotation of the stomach along the transverse or longitudinal axis are created as a result of the convergence of the pylorus and cardia, lengthening of the ligamentous apparatus, gastric overflow, increased peristalsis and vomiting.

Patients need urgent hospitalization in an inpatient surgical department for immediate surgery, namely, to straighten the volvulus and use a probe to empty the stomach cavity.

The disease occurs, according to statistics, at any age, but 40-50-year-olds are most susceptible to it. About 20% of pathological diseases occur in infants.

There is information that directly indicates the possibility of gastric volvulus in persons with gastroptosis, gastric ulcer, perigastritis, cicatricial deformity, stomach atony, stomach tumor, in which adhesions are observed in the abdominal cavity, aerophagia.

Diseases of the diaphragm are particularly predisposing factors for the progression of gastric volvulus. Especially - paraesophageal hernia. Much less often, the disease occurs in a hernia of the sliding esophageal opening of the diaphragm, hernias of Larrey-Morgagni, Bohdalek, with relaxation of the diaphragm and traumatic diaphragmatic hernia.

There is evidence of gastric volvulus in the case of surgical interventions: selective vagotomy, gastrostomy, Lewis operation, Nissen fundoplication.

The trigger factor for the onset of the disease may be an increase in intra-abdominal pressure due to abundant food, abdominal trauma, vomiting, and physical activity.

Volvulus of the stomach by its etiology is divided into two types - congenital or acquired and idiopathic.

Usually, the idiopathic type is observed in 2/3 of all patients and develops due to the weak state of the ligamentous apparatus of the stomach, which helps to bring the pylorus and cardia closer together with a full stomach.

The second type is observed in 1/3 of patients and directly depends on acquired or congenital abnormalities leading to excessive gastric mobility.

Gastric volvulus is acute and chronic. The first occurs, as a rule, less often than chronic and occurs equally often with respect to both axes of the stomach. As for the chronic type, the disease is the result of the rotation of the stomach about the transverse axis.

Symptoms

Symptoms usually depend on the age of the patient, the rate of development of the disease, and the degree of gastric torsion.

In the clinical course of the disease, two main phases are distinguished:

• 1st - volvulus has not reached 180 ° and there is no complete closure of the lumen of the pyloric and cardiac parts of the stomach;
• 2nd - the volvulus reaches 180 ° and there is a complete closure of certain parts of the stomach.

Acute gastric volvulus occurs suddenly and is mainly characterized by the occurrence of intense pain in the left hypochondrium and the epigastric region, sometimes radiating to the chest (its lower parts) and back.

There is repeated vomiting with a passable cardia. It does not bring relief to the sick. Abdominal asymmetry is observed due to swelling in the epigastric region, moderately painful on palpation.

In the first hours after the gastric volvulus, there may be stools and gas discharge, and peristaltic intensified noises are also heard. In the case when the gatekeeper and cardia are completely closed, the patient's condition worsens. Bloating occurs, pain intensifies.

Above the swollen area of ​​the abdomen, during physical examination, intestinal noises disappear and high tympanitis is detected, regurgitation occurs after just a few sips of water, swallowing is almost impossible, thirst increases.

With the volvulus of the stomach regarding the longitudinal axis, the following are observed: involuntary repeated vomiting, acute and severe pain in the epigastric region, the impossibility or difficulty of passing the probe into the stomach.

With acute volvulus of the stomach (with diseases and congenital anomalies of the diaphragm), the course of which is localized in the pleural cavity, there are sharp pains in the epigastric region and chest, radiating to the shoulder, scapula, shortness of breath is observed.

Diagnostics

The clinical picture of this abnormal disease resembles an infringement of a diaphragmatic hernia. A phenomenon such as bloating in the upper left quadrant of the abdomen is a hallmark of volvulus. Increased gastric motility is visually observed.

Relaxation of the left side of the diaphragm is one of the most common causes of gastric volvulus. Gastric volvulus is also possible if it ends up in a diaphragmatic hernia. Due to obstruction, all attempts to introduce a gastric tube are ineffective. The diagnosis is clarified with the help of an X-ray examination in a hospital, which is undertaken immediately.

The acute course of gastric volvulus, as a rule, is manifested by pronounced intoxication, in the parenchymal organs, dystrophic changes, metabolic severe disorders and hemodynamic disorders. The diagnosis is based mainly on the data of clinical examination and X-ray examination.

It is quite difficult to diagnose gastric volvulus in relation to the longitudinal axis, especially if there is no defect in the diaphragm.

It is possible to reveal on the roentgenograms the high position of the diaphragm and the existence of a large gas bubble with a horizontal liquid level.

In the stomach during volvulus relative to the transverse axis of the organ during an X-ray examination (the patient is in a standing position), two levels of fluid are revealed: the first is in the fundus of the stomach, the second is in the body of the stomach.

X-ray contrast study is also important in identifying diseases of the diaphragm, leading to the formation of chronic gastric volvulus.

Although alkaline phosphatase and amylase levels may be elevated, laboratory findings are nonspecific.

Prophylaxis

The disease is so rare that there are currently no special preventive measures.

Treatment

Treatment of gastric volvulus is extremely rapid. Conservative measures can sometimes be successful, but they do not eliminate the causes leading to volvulus. In case of gastric volvulus, gastric decompression should be performed immediately. If it is not possible to install the probe, then attempts should be abandoned, since this may well contribute to perforation of the stomach wall, especially in children.

Untimely surgical treatment leads to the progression of severe complications and an increase in mortality.

Wall perforation with the development of peritonitis, as well as necrosis, are the most frequent complications of acute gastric volvulus. Necrosis of the stomach wall due to a strong blood supply to the stomach occurs in only 5-28% of all cases. The most common complications are acute pancreatitis, rupture of the spleen, rupture of the common bile duct, jaundice, gastric bleeding due to the formation of acute ulcers.

Mortality in acute gastric volvulus ranges from 30 to 50%, in case of complications by necrosis of its wall - reaches 60%.

The most common surgical intervention is median laparotomy. Volvulus of the stomach, which is complicated by necrosis of the wall directly in the hernia of the opening of the esophageal diaphragm, is an indication for thoracotomy.

Expanding the stomach is the main stage of the operation, but it is performed only after decompression of the organ. For this, a gastrostomy and a puncture of the stomach are performed.

Necrosis of the stomach wall is also an indication for gastric resection, and sometimes gastrectomy.

Often, after the expansion of the volvulus of the stomach, a relapse of the disease occurs and here surgeons disagree. Some believe that the operation should be completed with gastropexy, while others - with gastrostomy. Some surgeons generally use both of these interventions.

Today, there is evidence of the use of the laparoscopic method for chronic gastric volvulus.

The dog's stomach is a single-chambered, curved sac, located so that its widest part is directed forward. It tapers towards the rear. The entrance of the esophagus into the stomach is quite wide, funnel-shaped, so the dog regurgitates food so easily, the exit from the stomach is much narrower. Both the inlet and outlet of the stomach are equipped with a locking muscle (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 stomach capacity also varies - from 0.6 to 8 liters, averaging about 1 liter in a dog weighing 10 kg. The stomach cavity is lined with 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 is quickly removed from it - when examining the stomach with a normally working pylorus, the removal of the contrast agent is observed after 10 minutes and after about 2 hours the stomach should be emptied.

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

Mechanism of gastric volvulus

Acute expansion-inversion option ...

Acute enlargement is defined as a 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 gas. In many cases, the expansion 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 the walls stretched from puppyhood, or due to spasm of the pylorus (exit from the stomach into the intestines), which can be caused by painful shock, fright or nervous stress, food that is too cold or hot, not digested food is retained in the stomach. Microorganisms (cocci, lactic acid bacteria, etc.) that 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 volume of gases. The accumulation of fermentation gases contributes to the occurrence of tympania (methiorism). Due to the large bend, the pylorus is displaced to the left (= torsion). At this point, the stomach rotates clockwise around the esophagus (= 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 dog relaxed in a dream, the stomach can shift and wrap up. If twisting occurs, the contents of the stomach cannot pass into the intestines and the gases released will swell the stomach to incredible proportions.

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

Symptoms (clinical signs)

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

Diagnostics

First aid.

Timely and competent help can save your dog's life. Intensive therapy consists in lowering the pressure in the stomach to reduce its distension, in the elimination of cardiopulmonary insufficiency of the dog and the relief of painful shock.

-The first and most urgent measure is a puncture of the stomach. A special hollow needle is inserted through the dog's skin from the side, pierced the wall of the stomach with it, and gases are released through it.
Gently relieving the pressure in the stomach can prevent bloat and only enlargement will be presented in the dog.
- The dog is experiencing so much pain from the swelling that he will not notice the pain from the needle prick, while carrying out the manipulation, remember that this procedure can save your dog's life.
-Transport the animal to the veterinarian immediately / POSSIBLE CAUSES AND RISK FACTORS

Why is it so?

The etiology of gastric volvulus syndrome is not fully understood. Doctors never came to a consensus about the causes of this formidable disease. Many experts distinguish one of the components of the syndrome, the so-called acute enlargement of the stomach, into a separate disease. Others, and not without reason, consider the expansion of the stomach to be only the initial stage of its volvulus. We will try to understand the reasons.

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

2., the mass and physique of the dog. A dog's massiveness and physique are two important factors that increase the risk of volvulus. Massiveness and "looseness" predetermine weakness and sprain of the ligaments, which are unable to keep a full stomach in the correct position.
3, temperament and psyche, or all diseases from the nerves.
Acute gastric dilatation and volvulus are more common in dogs, which their owners call "fearful", "impressionable" 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 disorders of both phosphorus-calcium and potassium-sodium metabolism in the body.
5, puppy rearing bias, 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 in adulthood. Because of the desire of the breeder to save money or because of his ignorance, puppies, just weaned from their mother, abruptly switch to poorly nutritious and difficult to digest food. Due to lack of time, negligent breeders transfer puppies to 3 meals a day, instead of 4-5 meals a day. Everyday overflow of a puppy's stomach leads to stretching of its walls. The volume of the stomach increases and gradually its walls become flabby (atony), poorly contract. As a rule, dogs raised from such puppies eat much more than a normal stomach can accommodate, and constitute the main risk group for volvulus. In addition to the 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, violation of the diet. Feeding and walking, and even more so the working use of animals, should be "spaced" in time by at least one and a half to two hours. Too often, a patient with a volvulus is admitted to the clinic after physical exertion, which was preceded by an abundant feeding.

S.V. Pozyabin

candidate of veterinary sciences, Assistant of the Department of Veterinary Surgery, Moscow State Academy of Medical Sciences K. I. Skryabin,

Volvulus in dogs is a polyetiological disease, an acute surgical disease that develops as a result of mechanical obstruction or reflex spasm of the cardia and pylorus of the stomach, followed by the accumulation of gases in it, its displacement along the longitudinal or transverse axis, splenomegaly, impaired blood circulation in the systemic circulation and the development of shock the state of the body, leading to death.

If emergency surgical care is not provided to the animal, death can occur within 4-6 hours from the onset of the disease. Despite the wide popularity of this disease among practicing doctors, the number of complications and mortality in the postoperative period remain quite high: mortality in the postoperative period reaches 25%. Despite the favorable outcome of the disease in the postoperative period, the probability of recurrence of the disease is high: up to 30% of the total number of animals in the first 2-8 months after a favorable outcome of treatment.

One of the first mentions of this disease in the domestic literature is a textbook on private surgery, 1952, but the causes of the disease are not described there, although the course of the surgical intervention proposed by the author and the postoperative diet is described in some detail. Later, in the textbook on operative surgery Petrakova K.A. et al. (1991) mention only gastrectasia in dogs or acute expansion of the stomach without twisting it along its longitudinal or transverse axis. According to foreign literature, the incidence of dogs diagnosed with volvulus of carnivores gradually increased from 0.036% in 1964 of the total number of surgical patients in veterinary clinics to a peak of 0.57% in 1994, that is, the incidence of diseases increased by about 15 times. According to our data, in Moscow the percentage of patients with such a diagnosis does not exceed 0.4% of the total number of surgical patients, but even this seemingly small number requires special attention from practicing veterinary specialists. Surgical intervention in this pathology requires from the doctor not only knowledge of the anatomy of the dog and the skills of abdominal surgery, but also a complete understanding of the etiology and pathogenesis of this disease, without which it is impossible not only to successfully conduct a surgical intervention, but also to ensure adequate preoperative preparation of the patient and prescribe postoperative treatment ...

ETIOLOGY OF THE DISEASE.

Volvulus in dogs is a disease with a multifactorial etiology. It is impossible to single out one single cause that caused the onset of this disease, however, systematizing the data of many authors, it can be revealed that the risk factors for this disease are:

Dog size Is the most frequently cited risk factor for volvulus in dogs. The most predisposed dogs are large breeds weighing more than 25 kilograms. When considering the breed of animals that have recovered from this disease, it is possible to distribute breeds taking into account the reduction in the risk of gastric volvulus as follows: East European and German, Great Dane, Giant Schnauzer and Basset Hound, Doberman Pinscher, Black Terrier, Airedale Terrier, Labrador, Great Dane, Rottweiler , bullmastiff, Russian greyhound, other breeds. However, it should be borne in mind that this pathology can occur in all breeds of dogs without exception.

Dog constitution. Under the constitution should be understood the general physique of the body, due to the anatomical and physiological structure, hereditary factors and manifested in the nature of its response to the influence of environmental factors. The average value of the ratio of depth to width of the chest for different breeds can also be estimated as a risk factor for volvulus in carnivores. The depth of the chest is understood as the vertical distance from the highest point of the withers behind the shoulder blades to the lower surface of the chest. The width of the chest is the greatest distance between the arches of the ribs. If the reading is greater than or equal to 1.4, the dog is most prone to bloating.

Feeding and maintenance. Predisposing to this disease is feeding bulky feeds, such as oatmeal, pearl barley, millet porridge, poor quality products, in some cases overfeeding of dogs with industrial dry food occurs further hyperplasia of the walls of the stomach. Also, one of the reasons may be greed when giving food, aerophagia. A one-time abundant feeding before a walk provokes twisting of the stomach, which is overfilled with forage masses.

Anatomical reasons consider the failure of the ligamentous apparatus of the dog's stomach. It is known that due to its significant ability to displace, the stomach is not firmly fixed in the abdominal cavity, but it has certain points of attachment, due to which it remains relatively inactive. These points are the gastro-diaphragmatic, gastro-hepatic, and gastro-duodenal ligaments, the end of the esophagus and the initial duodenum. In dogs, the gastro-splenic ligament is very loose and the gastro-colonic ligament is absent. As a result, the cardiac, pyloric parts and the lesser omentum form a practically stationary axis around which the stomach rotates during filling.

For physiological reasons include impaired gastric motility associated with both chronic gastritis and hyperplasia of the stomach walls. The disease can also be provoked by chronic diseases of the liver, gallbladder, pancreas (hepatopathies of various etiologies, cholecystitis), helminthic lesions of the gastrointestinal tract, dysbacteriosis. Disruption of the vagus, which is responsible for both the production of gastric juice and gastric motility, may also be predisposing factors. Possible provocation of gastric volvulus by the occurrence of a stressful situation.

PATHOGENESIS OF THE DISEASE.

The pathogenesis of gastric volvulus in carnivores consists of several stages, which exert their influence on various organs and organ systems of the dog. These stages can be conditionally divided into:

- primary filling with gases of the stomach due to the onset of fermentation processes and spasms of the pyloric and cardiac parts of the stomach (gastrectasia)

- twisting of the stomach and spleen around the esophagus and the gastro-splenic ligament (actually the volvulus of the stomach);

- violation of hemodynamics in the aorta, portal vein of the liver and caudal vena cava, increased pressure in the abdominal and thoracic cavity;

- disorders of water and electrolyte metabolism, hypoxia, hypovolemia, increased toxicosis and death.

The main thing in the development of pathogenesis is the acute expansion of the dog's stomach, the accumulation of gases, disruption of the blood supply to the stomach wall and innervation - gastrectasia. The next stage is twisting it around the esophagus along with the spleen and gastro-splenic ligament. When the stomach is twisted, the vessels feeding it also turn out to be twisted, as a result of which the nutrition of the stomach walls is disrupted (venous outflow and arterial inflow stops or greatly decreases). Stagnation of blood occurs in the walls of the stomach, causing tissue ischemia, hemorrhagic inflammation after a certain period of time and, as a result, necrosis. The greater curvature and the fundus of the stomach are the first to be affected. Approximately 4 hours after the onset of the disease, necrosis of these parts of the stomach can be detected, which will require a partial gastrectomy.

The next stage is the development of splenomegaly. The enlargement of the spleen can be up to 200-400%. In the enlarged spleen, the processes of venous stagnation of blood, blood hemolysis and the accumulation of under-oxidized products in the blood begin, which in the postoperative period leads to acute inflammation of the organ. The next effect on the body of a bloated stomach is pressure on the organs of the abdominal and thoracic cavity, as a result of which the outflow along the caudal vena cava and hepatic veins is reduced, which leads to a decrease in blood flow to the heart and a decrease in blood volume in the pulmonary circulation. The pressure on the diaphragm is exerted by a decrease in the volume of exchange air and, as a consequence, a decrease in the oxygen enrichment of the blood coming from the pulmonary artery. A decrease in the flow of blood into the lungs and a depletion of oxygen in the blood leads to oxygen starvation of the body, a violation of metabolic processes due to the accumulation of under-oxidized metabolic products in the blood and tissues. The next stage is a drop in body temperature due to disturbances in the thermoregulation system due to a violation of the water-elitrolyte balance and disruption of the central nervous system, a drop in temperature leads to deeper changes in the body. Acute toxicosis of the body begins, disruption of the work of all systems and organs.

The next stage is the development of reactive pancreatitis. The pancreas excretes endotoxins and myocardial suppression factor, a polypeptide that is released during enzymatic activation that occurs during pancreatic ischemia. Malnutrition of the myocardium leads to disruption of the heart. All these irreversible changes ultimately lead to death.

From the foregoing, it can be concluded that the main pathogenetic effect of an enlarged stomach is primarily aimed at disrupting blood circulation, water-electrolyte balance, hypovolemia and hypoxia, causing toxicosis, which ultimately leads to shock, followed by cardiac arrest and death.

CLINICAL SIGNS AND DISEASE DIAGNOSTICS

In case of gastric volvulus in carnivores in the first 1-2 hours after the onset of the disease, the following clinical signs are present, as a rule, already revealed during anamnesis: a sharp deterioration in the dog's condition, most often after feeding and an active walk. The animal becomes restless, cannot find a painless position, constantly moves, or assumes a forced lying position. In an animal, we can observe unsuccessful attempts to vomit, an increase in the abdominal cavity in volume. Although gastric activity is present, the torsion of the esophagus occurs during gastric volvulus, which prevents the passage of vomit.

In the future, 2 hours after the onset of the disease, during a clinical examination, we register the following signs:

An increase in the volume of the abdominal wall, especially in the left hypochondrium due to the accumulation of gases in the stomach. With percussion, a tympanic sound is heard in almost all the anterior two-thirds of the abdominal cavity, and in the region of the xiphoid cartilage or slightly to the left, you can find a dull sound caused by an enlarged spleen displaced by an enlarged stomach;

During auscultation of the abdominal cavity, increased gas formation is heard, peristalsis is not audible, during auscultation of the heart, severe tachycardia, sometimes with symptoms of arrhythmia and extrasystole;

- the body temperature is lowered, the mucous membranes are anemic, dry, tachypnea, weakness first of the hind, and then of the front extremities, the filling of the veins is moderate.

Differential diagnosis Gastric volvulus in dogs should be carried out taking into account the similarity of the clinical picture of this disease with acute gastric dilatation - gastrectasia. Acute gastric dilatation in dogs is regarded as gastric distension without displacement from its anatomically correct position in the abdominal cavity (torsion), caused by spasm of gastric constrictors or mechanical obstruction of food into the duodenum. This must be taken into account, since these two seemingly identical pathologies require different treatment regimens. If, with an acute expansion of the stomach (gastroectasia), it is possible to carry out the procedure for setting a gastric tube, then with a true volvulus of the stomach, an urgent laparotomy is necessary to give the stomach anatomically correct position, probing and deflation of gases.

Generally, dogs with signs of acute enlargement and volvulus of the dog's stomach have the same symptoms listed above. For the differential diagnosis of these two pathologies, a gastric tube is used. For large breeds of dogs (weighing 20 kg and above), which most often suffer from volvulus of the stomach of carnivores, both soft rubber probes and more rigid rubberized plastic probes are suitable. The diameter of the probe can vary from 2.0 to 3.5 cm, depending on the size of the dog, the length should be one and a half distance from the incisors to the last rib with the head extended forward. To set the probe, a mouth dilator is used, after which the probe, lubricated with petroleum jelly or oily ointment, is carried out under the palatine curtain into the pharynx and esophagus. It must be remembered that the esophagus is ventral to the trachea, so the probe, when the animal is on its back, must move forward and upward above the palatine curtain. After the probe has moved 20-30 centimeters behind the palatine curtain, it is necessary to conduct a test using a filled vessel with water for the probe to enter the trachea (when you exhale from the end of the probe lowered into the water, bubbles appear). If the probe has entered the esophagus, but cannot enter the stomach, then this is a volvulus of the dog's stomach (when the stomach is twisted, the esophagus also twists, the probe cannot pass). If the probe passes into the stomach, and gastric gases come out of the probe, this is an acute expansion of the stomach, and then the stomach is washed from food masses and anti-fermenting substances are introduced into the stomach (hypertonic soda solution, alcohol, activated carbon, etc.).

If the diagnosis is doubtful, when it is not possible to put a gastric tube, or the tube cannot pass into the esophagus, it is necessary to conduct X-ray studies for volvulus of the stomach of carnivores in the dorso-ventral and latero-medial projections. We recommend performing X-ray examinations in the dorso-ventral projection in the prone position, and in the latero-medial projection in the left lateral position, since they are the least stressful for the animal during volvulus. During the analysis of X-ray images, confirming and questioning the diagnosis of volvulus in dogs, we identified the main criteria, comparing which we can make the correct conclusion about the presence or absence of volvulus in a dog.

- displacement of the pylorus anteriorly or its location in the left hypochondrium: displacement of the cardia and pylorus from the anatomical locations will indicate a volvulus of the stomach on the roentgenogram, it is easy to detect in the latero-medial projection;

- deformation of the gas-filled stomach, manifested by the X-ray symptom of an hourglass in the dorsoventral projection (the presence of a constriction on the greater curvature of the stomach);

- displacement of the intestines and spleen to the right hypochondrium or ileal will indicate volvulus of the stomach, this is found in the latero-medial projection.

On the presented Rantgenogram No. 1, performed in the dorsoventral projection, a gas-filled stomach is visible, which occupies most of the abdominal cavity, the displacement of the intestines and spleen into the right ileal. In this case, a conclusion is made about the volvulus of the stomach in srbaki. On X-ray No. 2 there is a lateral projection of the same dog, it is impossible to make an unambiguous conclusion about the volvulus of the stomach.

Radiograph No. 1 - volvulus of the dog's stomach.

It is necessary to take into account the fact that not always performing radiography in only one projection allows an accurate diagnosis of this pathology. Only the analysis of X-ray studies in the dorso-vetral and lateral-medial projections at the same time makes it possible to reliably diagnose the disease and proceed to the surgical treatment of this pathology.

In the case when a uniform enlargement of the stomach is detected, without displacement of the spleen and intestines from the anatomical sites, a conclusion is made about the presence of an acute expansion of the stomach - gastrectasia (X-ray No. 3).

Ultrasonography may be used to confirm the diagnosis of volvulus in dogs. In this case, it is necessary to accurately determine the location of the spleen and the degree of its enlargement. With a significant increase in the size of the spleen (splenomegaly) or when it is located in the right hypochondrium or the region of the xiphoid cartilage, a conclusion is made about the volvulus of the stomach.

Radiograph No. 3 Gastrectasia in a dog, dorso-ventral projection, Uniform enlargement of the stomach, spleen in the left hypochondrium, intestines pushed into the pelvic region.

CONCLUSION

The etiological features of gastric volvulus in dogs are the predisposition of large breeds of dogs weighing more than 25 kilograms and over the age of 4 years with a bulky type of feeding. In the pathogenetic aspect, with gastric torsion due to compression of the portal vein of the liver and the caudal vena cava, an increase in pressure in the chest cavity in a sick animal, the phenomena of hypovolemia, hypoxia and acute toxicosis begin, which leads to a deep disruption of the work of all systems and organs. Differential diagnosis should be based on the similarity of gastric volvulus with gastrectasia in dogs with special research methods. Volvulus in dogs is an acute surgical pathology that requires a clear understanding of its etiology and pathogenesis and the performance of surgical intervention in the first hours from the onset of the disease.

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Torsion of the stomach is rare, since the 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. This relaxation can be innate and acquired.

When the ligamentous apparatus relaxes and the stomach overflows with contents, the pylorus approaches the cardiac part. Then there is a similarity with the conditions of volvulus 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 (weight lifting, falling, trauma) usually leads to the development of torsion of the stomach.

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

The volvulus can be complete when the cardiac 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, which is called an hourglass.

With volvulus around the transverse axis, the transverse colon remains downward from the stomach, and with volvulus around the longitudinal axis passing through the cardia to the gatekeeper, it is thrown upward from it.

Stomach torsion symptoms

In the clinical course of gastric torsion, two main phases should be distinguished: 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 said 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 excruciating hiccups sets in. The patient usually takes a semi-sitting position, the pain intensifies, anxiety appears, shortness of breath, pulse is small and fast, intense thirst and immediate vomiting after a few sips of water. An attempt to insert the probe is mostly unsuccessful, 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 felt like a tense ball. X-ray examination - high standing of the diaphragm and the presence of a large gas bubble with a horizontal liquid level.

For correct recognition of this disease, one must remember about the possibility of gastric volvulus, which greatly facilitates the diagnosis.