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6th MELEAH Surgery test 2 (gonna make it my bitch) > 3. GDV > Flashcards

3. GDV Flashcards

1
Q

What is the definition of Dilatation? What type of treatment can often treat it?

A

Distension of the stomach with fluid, food, and or gas often treated medically

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2
Q

Compare and contrast Dilatation and Dilatation-Volvulus

A
  • Dilatation (Dilation):
    • Distension of the stomach with fluid, food, and or gas (treated medically)
  • Dilatation-Volvulus
    • Enlargement of the stomach associated with rotation on its mesenteric axis (malposition/twisting) (treated SURGICALLY)
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3
Q

What comes first in terms of etiology (GDV versus Volvulus)?

A
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4
Q

Patients often has gas accumulation with leads to these 2 things which then leads to gastric dilatation? ****

A
  • Abnormal Gastroesophageal Function
  • Delayed Gastric empyting
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5
Q

What are 2 main factors that increase the risk of GDV?

A
  1. Dogs with first degree relative with history of GDV
  2. Increasing age
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6
Q

What type of risk factors do Diet contribute to potentially cause GDV? (4) Adding what can decrease the risk (1)?

A
  • Increase volume of food fed once daily (deep chested breeds should be fed 2-3 x day)
  • Dry kibble
  • Fats/oils in 1st four ingredients
  • Raised food bowl (up higher so they will eat quicker and take in air)

Decrease risk when you add fish or egg supplements

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7
Q

Does exercise cause GDV?

A

Get with the timesssssss thats so old news and was proved not true!!

It has no impact and doesnt contributes to decreased risk either

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8
Q

What breed is our posterchild for GDV?

A

Great danes

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9
Q

How does conformation increase the risk of GDV?

A

Increased thoracic depth to width ratio (Deep chested dogs)

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10
Q

When you see pita smiling what do you think of terms of risk of GDV?

A

“Happy” dogs with decreased risk

BUT INTERESTINGLY there is a Increasing anxiety level, aggression to people, spending 5 hours a day with owner- increased risk (SO QUIT SMOTHERING PITA JENNN)

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11
Q
  • Case reports state dogs unergoing splenectomy can potentially develop GDV, It’s especially high if this pathology happens to the spleen?
  • Dogs undergoing splenectomy vs control dogs had same low risk of developing GDV 6-8% so should we do a gastropexY?
A
  • especially high risk with splenic torsion
  • Does not support need for gastropexy at time of splenectomy
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12
Q

When what vessels and structures are compressed does GDV espepially become an absolute emergency?

A
  • Caudal vena cava Portal vein
    • leading to decreased Venous return, decreased CO and BP, and tissue perfusion leading to hypoperfusion (reperfusion)
  • Pushing on the diaphragm
    • causing a decrease tidal volume and leads to ventilation perfusion mismatch
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13
Q

What is a reperfusion injury?

A

Period when blood flow to tissue is absent followed by return of blood flow

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14
Q

Reperfusion injuries leads to an accumulation of this and what happens once perfusion is restored? What do you need todo to help with this

A
  • Accumulation of cellular waste products, toxins, and toxic oxygen radicals
  • Once perfusion is restored, toxins are release into general circulation
  • Important to stabilize prior to untwisting of the stomach or else you could have systemic response
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15
Q

Reperfusion Injury

  • Increase capillary permeability
  • Changes in vascular tone
  • ______ aggregation
  • _______ ______
  • Microvascular occlusions
  • ______
  • ______ cardiac contractility
  • No reflow phenomenum
A
  • Neutriphil
  • Platelet activation
  • Fever
  • Decreased cardiac contractility
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16
Q

What is the most common displacement with GDV and its 2 presentations in terms of degree rotated?

A

Clockwise rotation Most common

  • Torsion: < 180 degrees rotation
  • Volvulus: > 180 degrees rotation
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17
Q

Is counterclockwise pretty common with GDV, how many degrees is it often displaced when counterclockwise?

A

Rare <5% (<90 degrees)

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18
Q

How does the pylorus move with clockwise displacement? What is covered by the stomach?

A
  • Pylorus moves along ventral abdominal wall to left side
  • Stomach covered by omentum
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19
Q

When you are doing a exploratory laparotomy and you see the omentum covering the stomach what does this indicate?

A

Displacement! (clockwise)

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20
Q

How does the pylorus move with counterclockwise displacement? Is the stomach covered by omentum in this displacement too?

A
  • Pylorus moves dorsally to lie adjacent to esophagus
  • Stomach NOT covered by omentum
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21
Q

When GDV suspected animals present with a hosotry of chronic GI signs this is indicative of an _______ displacement often?

A

Counterclockwise

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22
Q

With counterclockwise displacement the _____ _______ lies along midline

A

greater curvature

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23
Q

What types of CS are often see with GDV? (7) Which one is classic GDV signs

A
  • Acute
  • Restlessness
  • Hypersalivation
  • “Praying” posture
  • Vomiting
    • Nonproductive retching (CLASSIC)***
  • Weakness
  • Collapse
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24
Q

when dogs are exhibiting the “Praying” posture what are they doing?

A

Trying to take the weight off the peritoneum

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25
Q

What does abdomen often feel like?

A

Distended, painful, tympanic abdomen

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26
Q

Upon physical exam dogs can often exhibit active retching, ____, and varying degrees of _____ (compensatory and decompensatory_

A
  • Collapse
  • Shock
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27
Q

What do you need todo to initially stabilize our GDV case?

A

Aggressive fluid therapy- Large bore cephalic or jugular catheters

(shock dose is 90 ml/kg bc that us replensihing blood volume, give 1/4 of a bolus at a time and monitor)

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28
Q

When offering aggressive fluid therapy to stabilize our GDV cases using Large bore cephalic or jugular catheters, why do we not use Intravenous catheters in the legs?

A

Bc the stomach is compressing the caudal vena cava and the blood isnt going to be getting back to the heart as well as we need it to in that location

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29
Q

For initial stabiliation along with fluids we should be monitoring ______ and ______

A
  • BP
  • EKG
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30
Q

CBC and chiochem can often be vague indicators fo GDV but what is prettygood for indicating prognsis compared to what it indicated in 1999 comapred to 2011?

A
  • 1999: Lactate levels < 6.0 shows an increased survival
  • 2011
    • Absolute values NOT AS VALUABLE
    • CHANGES IN LACTATE LEVELS in response to fluid resuscitation is a better indicator
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31
Q

What is the goal for treatment initially with GDV?

A
  • Goal is to stabilize cardiovascular, respiratory and renal systems initially
    • Fluids
    • Decompression
    • Pain management (can potentiate shock)
  • Then use of antimicrobial, free radical scavengers which occurs after decompression
  • THEN SURGERY and post op tx
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32
Q

What does gastric decompression improve?

A

Improves CV and respiratory function

33
Q

What is the first gastric decompression instrument of choice?

A

Stomach tube (can be difficult ot get past esophageal sphinctor so you may need to trocharize 1st)

34
Q

When performing an orogastric intubation its important to use a roll of vet wrap to prevent this?

A

Bite block (could swallow bitten off tube)

35
Q

What should we do in terms of sedation for orogastic intubation?

A

It is better for them to be awake with milkd sedation so can protect their airway with gag reflex or you can fully anesthezie and intubate if you have to

36
Q

Before choosing a tube for orogastirc intubation where should I measure on my patient?

A

Measure and mark the tube lenth and use the xiphoid as a good landmark located near the last rib

37
Q

With Orogastric intubation why do we advacne the tube slowly and not force the tube?

A

Can cause Perforation!!!

38
Q

What do you do for gastric decompression once we advance the tube into the stomach? (3)

A
  • Empty contents
  • Check effluent
  • Gastric lavage
    • 5-10 mL/kg warm water
    • Gavage pump
39
Q

So if you can’t pass the tube to decompress the stomach what is your next step and on what side is it often performed on, also state the potential complications?

A

Trocharization

  • Large bore needle/catheter
  • Most tympanic site (LEFT SIDE, can hear the “ping” but if sounds really dull the spleen could be over the stomach so don’t stick the needle in that
  • Complications
    • Spleen
    • Leakage
40
Q

What are the differences in survival for orogastric tubing versus trocharization?

A

NO DIFFERENCE (shit get that through yo head!)

41
Q
  • Tubing is successful ____% of the time
  • Trocharization is sucessful ____% of the time
  • Is there evidence of gastric perfortion with either
A
  • Tubing is successful 75.5 % of the time
  • Trocharization is sucessful 86 % of the time
  • No evidence of gastric perforation
42
Q

What is wrong with this radiograph

A

Pylorus shouldn’t be up there!

43
Q

When performing rads what view should be avoided and why? Which is ok?

A
  • Right lateral and DV OKAY
  • VD can predispose to reflux or aspiration :-(
44
Q

What does oxygen therapy do to help aid with GDV

A

Helps offset poor ventilation

45
Q

When choosing paincontrol which should we consider and whY?

A
  • Drugs with minimal CV effects
  • Oxymorphone, fentanyl, buprenorphine
46
Q

What are some free radical scavanegers for reperfusion injury?

A
  • Acetylcysteine
  • Vitamin C, vitamin E, Selenium
  • Desferoxamine
    • Iron chelator
  • Lidocaine
    • Scavenger of reactive oxygen species (ROS)
47
Q

Surgery should be performed as soon as our patients are stabilized, what are the 2 main benefits of doing surgery early?

A
  • Gastric repositioning improves bloodflow
  • Surgery may be completed before onset of arrhythmias
48
Q

What things do we need to look at with surgical management (5)?

A
  • Gastric repositioning
  • Assessment of gastric viability
  • Evaluate pylorus
  • Evaluate spleen
  • Gastropexy
49
Q

We do gastric repositioning to decompress the stomach if still distended, what are the steps and how do you perform it?

A
  • Push down on fundus with right hand
  • Grasp pyloric antrum with left hand and rotate stomach counterclockwise
  • Confirm proper reduction by examining gastroesophageal junction
50
Q

HOW DO WE ASSESS GASTRIC VIABILITY?

A
  • “Standard” Criteria
    • Color
    • Pulsation of blood vessels
    • Bleeding from cut surface
    • Peristalsis
  • Palpation of wall thickness
  • Surface oximetry
51
Q

Where does gastric necrosis often take place?

A

Greater curvature near short gastric arteries

52
Q

Do hand sutures or stapling devices have a higher association with mortality?

A

Hand sutures assoc. with higher mortality

53
Q

Evalution of the spleen?

  • Venous congestion
    • resolution?
  • Vessel thrombosis
    • resolution?
  • Splenic torsion
    • resolution?
A
  • Venous congestion
    • resolution? Self limiting
  • Vessel thrombosis
    • resolution? Splenectomy
  • Splenic torsion
    • resolution? Splenectomy
54
Q

True or False:

Gastropext does prevent dilatation and volvulus?

A

False!!!!

Does NOT prevent dilatation

55
Q

Gastropexy recurrance ____% without pexy, and there’s a recurrence of _____% with pexy

A

Gastropexy recurrance 50 % without pexy, and there’s a recurrence of 4% with pexy

56
Q

Most gastropexy techniques perform similarly and the success rate is _____%

A

95

57
Q

An incisional gastropexy is you incise the ________ layer in the gastric antrum and ______ abdominal wall. You suture the edge of abdominal wall to the gastric incision with a ______ ______ pattern

A
  • Seromuscular
  • right abdominal wall
  • simple continuous
58
Q

What is the minimum length for a long incision in the transversus abdominus for an incisional gastropexy?

A

3 cm

59
Q

What are you trying to prevent when creating incisions for an incisional gastropexy?

A

Make incisions so that pyloric outflow tract and proximal duodenum are not twisted or kinked

60
Q

What is the strongest gastropexy technique? and what type of flap and where is it placed? What are the 2 risks

A

Circumcostal Gastropexy

  • Seromuscular flap placed around 13th rib
  • Risks:
    • Rib fractures
    • Pneomothorax
61
Q

What are the 3 advantages of doing endoscopic asssited GDV surgery?

A
  • Equipment more widely available
  • Pyloric antrum accurately visualized
  • Gastropexy performed with standard surgical instruments
62
Q

What are the 2 limitations to endoscopic assited GDV surgery?

A
  • Expertise in gastroscopy required
  • Potential organ trauma
63
Q

What is the likelyhood of recurrence of GDV of GD after gastropexy?

A

40 dogs with 2yr follow up

  • No dog had recurrence of GDV
  • 2 dogs (5%) had GD
64
Q

What indications should we consider for prophylactic gastropexy?

A
  • Breed risk
  • Identified risk factors
  • Owner request

 Risk/cost benefit ratio

 Rotties 2.2 fold reduction in mortality

 Great Danes 30 fold reduction in mortality

 When lifetime risk =/> 34%, procedure cost effective

65
Q

You could perform a prophylactic gastropexy during a spay or open castration, the unfortunate thing is that regardless of performing the gastropexy there is one thing that it can’t prevent it from which is??

A

Does not prevent dilatation!!!

66
Q

What are 6 post operative care indications after gastropexy?

A
  • NPO for ≈ 12-24 hours
  • Fluid and electrolyte replacement
  • Monitor for arrhythmias for 24 hours
  • Pain control
  • Blood pressure monitoring
  • Encourage limited exercise
67
Q

Why is it so important to monitor blood pressure after a gastropexy?

A

Hypotension at any time is risk factor for death

68
Q

What kinds of drugs should we give post after gastropexy or GDV?

A

Anti-emetic: Maropitant (Cerenia)

H2-Receptor antagonists

  • Ranitidine
  • Famotidine

Sucralfate

  • 0.5 - 1 gm PO BID or TID

+/-Metoclopramide

69
Q

Post op deaths following a GDV are at their highest risk within how many days post op?

A

within the first 4 days!

70
Q

Post op deaths following a GDV are at their highest risk within 1st 4 days post op, what kinds of things cause death?

A

Shock

  • hypovolemic
  • septic - endotoxic

Gastric necrosis i.e peritonitis

  • unrecognized areas of necrosis
  • perforating ulcers
  • reperfusion injury

Cardiac arrhythmias

71
Q

What kinds of electrolyte disturbances do we see with GDV? (2 main what do they cause?)

A

Hypokalemia

  • can induce or potentiate arrhythmias, muscular weakness, lethargy

Hypochloremia

  • gastric sequestration
72
Q
A
73
Q

____% of GDV patients will develop arrythmias ____-____ hours after onset of GDV. They are typically _______(atria or ventricular?) and usually abate ____-____ hours

A

50% of GDV patients will develop arrythmias 12-36 hours after onset of GDV. They are typically ventricular (atria or ventricular?) and usually subsides 24-72 hours

74
Q

What are 5 main causes of cardiac arrythmias in GDV patients? Which is most common cause

A
  • Myocardial ischemia (MOST COMMON)
  • Electrolyte abnormalities
  • Acid-base alterations
  • Vasoactive substances
  • Imbalance of autonomic nervous system
75
Q

What are some causes of ventricular arrythmias (5)?

A
  • Premature ventricular contractions
  • Paroxysmal ventricular arrhythmias (runs)
  • ldioventricular rhythm (Slow V-tach)
  • Ventricular tachycardia
  • Multifocal PVCs
76
Q

When do we need to step in and treat the arrythmia?

A
  • V-tach with high rate (>180-190bpm)
    • Pulse deficits
    • Poor pulse quality
    • Weakness
  • Multifocal PVCs
77
Q

What drug can we give as a bolus or constant rate infusion for ventricular arrythmias?

A

Lidocaine

78
Q

When we see refractory arrythmias what should we check for in GDV patients?

A
  • Check electrolytes
    • Potassium
    • Magnesium
    • Calcium
  • Pain management
79
Q

Prognosis

  • ___-___% Survival rate for uncomplicated cases
  • Preoperative arrhythmias – _____% mortality
  • Gastric necrosis - ____% mortality
  • Partial gastrectomy – ____% mortality
  • Splenectomy – ____% mortality
  • Partial gastrectomy + splenectomy – ____% mortality
  • Overall mortality _____ in recent years
A
  • 80-90% Survival rate for uncomplicated cases
  • Preoperative arrhythmias – 38% mortality
  • Gastric necrosis - 46% mortality
  • Partial gastrectomy – 35% mortality
  • Splenectomy – 32% mortality
  • Partial gastrectomy + splenectomy – 55% mortality
  • Overall mortality decreased in recent years

6th MELEAH Surgery test 2 (gonna make it my bitch) (8 decks)

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