Presumptive diagnosis can be made based on signalment, history, and physical examination findings. Abdominal radiography can help confirm diagnosis and exclude gastric dilatation alone or food bloat.2,14,15 Right lateral, left lateral, and dorsoventral positions are suitable for diagnosis via radiographs. Dorsoventral positioning is preferred over ventrodorsal to minimize stress and decrease the risk for aspiration pneumonia from inversion.
The classic double bubble appearance of GDV in the right-lateral view represents a gas-distended gastric lumen with the pylorus located craniodorsal to the fundus. Pylorus and fundus are divided by a soft tissue opaque band that compartmentalizes the gas in the fundus and pylorus, making 2 bubble shapes (Figure 1). Focal gas opacities in the gastric walls may suggest necrosis, and free gas in the abdomen can indicate gastric perforation.15
Early in the course of disease, CBC results may only reveal a stress leukogram. Hemoconcentration, thrombocytopenia, and leukopenia can occur as GDV progresses, indicating onset of septicemia and disseminated intravascular coagulation.2,15,16 Prerenal azotemia, elevations in liver enzymes due to tissue hypoxia, and mild to moderate electrolyte disturbances may be noted. GDV causes mixed acid–base disturbances, and pH can be elevated, decreased, or normal.2,15,16
Several studies demonstrate a relationship between initial plasma lactate values and morbidity/mortality17-22; however, there is considerable variability and overlap between survivors and nonsurvivors, making initial lactate a poor prognostic indicator (Table). The response of lactate to stabilization efforts should instead be used to help guide resuscitation and prognostication. A decline in plasma lactate of >40% to 50% after fluid resuscitation suggests a significantly greater chance of survival, regardless of the initial value.4,17
Electrocardiography should be performed to evaluate for ventricular arrhythmias secondary to myocardial ischemia, electrolyte disturbances, and reperfusion injury.14