Acute abdomen/GDV

Question 1

What are the common causes of an acute abdomen disorder?

Answer 1

Foreign body 
Gas 
gastroenteritis 
pancreatitis 
Gastric Dilation Vovulus 
haemoabdomen 
urinary tract obstruction
pyometra

Question 2

Rare causes of acute abdomen

Answer 2

Septic peitonitis
Mesenteric Volvulus
hepatic abscess
pyelonephrits

Question 3

What major body sytems are affected by GDV?

Answer 3

shock hypovolameia 
respiratory depression
decreased venous return 
distended abdomen 
weak pulses and weak pulse quality
retching/unproductive of vomit 
pain on abdomen palpation

Question 4

What tests should be considered in the GDV patient?

Answer 4

PCV/TS
haemotology
Biochem (renal values)
Clotting times

Question 5

What analgesia should be considered for the GDV patient?

Answer 5

Opioids
morphine 
methadone 
fentanyl 
do not give NSAIDS

Question 6

What are the risk factors of GDV?

Answer 6

Breed 
body shape 
anxious temperament
die-composition and number of meals 
speed of eating

Question 7

What are the local effects of a GDV?

Answer 7

Gastric wall

spleen

Question 8

What are the systemic effects of a GDV?

Answer 8

reduced venous return 
reduced cardiac output
hypotension 
acidosis 
hyperlactaemia 
inflammatory mediators
ischeamia re-perfusion injury 
SIRS 
Sepsis 
DIC

Question 9

What is the initial approach to a GDV?

Answer 9

Stabilise 
fluids! 
oxygen 
decompress stomach 
establish GDV or GD
Rapid surgical correction of vovulus 
prophylaxis 
(surgical/environmental)

Question 10

How is the stomach decompressed in GDV?

Answer 10

Stomach tube
measure tube, pass the tube through vet wrap within the mouth, lavage with warm saline
percutaneous decompression
14-16g catheter placed at point of maximal distension
removes gas but not fluid
exlap soon after

Question 11

Surgical management of a GDV

Answer 11

Gastric decompression and repositoning
gastropexy
Assessment of the viability of abdominal organs and resection of devitalised tissue
short period of aggressive stabilisation then surgery

Question 12

Anaesthetic considerations GDV

Answer 12

limit the effects on the cardiorespiratory system
opiates and diazepam 
propofol/alfaxalone 
isofulrane 
avoid nitrous 
IVFT 
antibiotics

Question 13

What is increased lactate concentration associated with?

Answer 13

Tissue necrosis

Question 14

How is gastric resection achieved?

Answer 14

Hand sewn
stapler
avoid invagination

Question 15

What other condition may be seen in the GDV patient?

Answer 15

Splenic torsion

21%

Question 16

How is gastropexy preformed?

Answer 16

incisional 
belt loop 
tube 
Avoid
gastrocolonpexy 
laproscopic

Question 17

How should you carry out post-operative care for GDV patient?

Answer 17

IVFT 
observe pulses, weak deficits 
Monitor temperature 
Gradually re-introduce to food 
Analgesia 
PCV/TS 
Urine output 
ECG/blood pressure

Question 18

What are the complications associated with GDV?

Answer 18

cardiac arrythmias (VPCs, treat lidocaine) 
hypotension/hypoperfusion 
haemorrhage, inadequate IVFT, low COP) 
aspiration pneumonia 
monitor respiration and temp
abnormal gastric motility 
Vomitting regurg 
metaclopromide infusion 
gastric protectants
Gastric necrosis/ performation 
SIRS/sepsis/DIC

Question 19

What is the outcome of a GDV?

Answer 19

Mortality 15% 
gastric necrosis and partial resection 30% 
Recurrence 
70-80%
Gastropexy 4-10%

Question 20

Prophylactic gastropexy

Answer 20

risk/benefit
breeds disposed
laproscopic gastropexy
endoscopy