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Module 16 > Approach to and Management of Gastric Dilation and Volvulus > Flashcards

Approach to and Management of Gastric Dilation and Volvulus Flashcards

1
Q

what are risk factors for GDV (11)

A
  1. Large and giant breeds
  2. Dogs with a close relative (parent or sibling) who has had GDV
  3. Large thoracic depth to width ratio (deep narrow chest)
  4. Underweight for breed
  5. Increasing age
  6. Previous splenomegaly or splenectomy
  7. Aerophagia or ‘gulping’ food
  8. Eating from a raised bowl
  9. Stress (being kennelled, car journey or dog show)
  10. Feeding once a day, particularly dry food
  11. Small food particle size (<30mm in diameter)
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2
Q

how does the pylorus typically move during GDV

A

from the right side of the abdomen ventrally under the fundus to the left

90 to 360

pylorus moves ventrally + to the left

fundus moves to right

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3
Q

what is the best method to confirm diagnosis

A

abdominal radiography

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4
Q

what should be stabilized before surgery

A

fluid therapy and orogastric intubation

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5
Q

what is the shock fluid bolus

A

90 ml/kg/hr for 15 mins then re evaluate

repeat up to 4 times

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6
Q

what is the length of the orogastric tube to use

A

premeasured to the last rib

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7
Q

what two structures need to be sutured together to prevent reccurence

A

the pylorus to the right body wall

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8
Q

what is a gastronomy

A

incising

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9
Q

what is a gastrectomy

A

excising a portion

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10
Q

what is a gastropexy

A

fixing stomach to body wall

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11
Q

what occurs to the spleen in all cases

A

dragged by gastrosplenic ligament

displace dorsally and to the right

congested: stretching/twisting of vessels

resolves as repositioned

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12
Q

what occurs to the gastric wall

A

intra-gastric pressure rises

vessels in wall become compressed and hypoxia and necrosis of the wall can occur

gastric necrosis and perforation quickly

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13
Q

what are the cardiovascular effects (3)

A
  1. reduced venous return to heart: pressure on caudal vena cava
  2. hypovolemic shock: fluid extravasation into stomach
  3. septic shock: compromised gastric wall –> bacteremia, gastric wall necrosis –> septic peritonitis
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14
Q

what type of arrhthymias can develop

A

25% of cases develop ventricular arrhythmias within 48 hours

toxins released from compromised stomach and other factors

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15
Q

what is the commonest age

A

>7 years

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16
Q

how does GDV present (4)

A
  1. large breed dog
  2. rapid onset persistent vomiting fluid
  3. tympanic abdomen
  4. collapse
17
Q

what does GDV look like on rads

A
  1. gas filled distended stomach
  2. compartmentalization lines
  3. cannot see fluid filled pylorus on right lateral view
18
Q

how should you stabilize a GDV patient (6)

A
  1. fluid resuscitation
  2. gastric decompression
  3. IV antibiotics
  4. oxygen therapy
  5. therapy for arrhythmias
  6. analgesia
19
Q

what are the key goals of surgery (3)

A
  1. reposition stomach
  2. assess stomach for necrosis
  3. prevent recurrence: perform gastropexy
20
Q

how do you reposition the stomach (6)

A

180 degrees clockwise rotation is commonest

  1. ensure establish direction before derotating
  2. decompress stomach first (tube)
  3. find duodenum and follow it to pylorus
  4. pull pylorus back into normal position
  5. at same time push fundus over to other side
  6. check cardia to ensure untwisted
21
Q

what is a normal gastric wall viability

A

pink, blanches and rapidly recolours

peristalsis

active hemorrhage from cut surface

22
Q

what is a compromised gastric wall look like

A

erythematous

23
Q

what does a necrotic gastric wall look like (3)

A
  1. green, blue, purple, black
  2. no pulsation, no peristalsis, no bleeding from incision
  3. palpable thinning of wall
24
Q

what should you do with necrotic areas

A

partial gastrectomy

25
Q

what should you do with severely compromised areas of the gastric wall

A

partial gastrectomy or gastric invagination

26
Q

how is a right sided incisional gastropexy

A
  1. pylorus to right body wall behind ribs
  2. incise seromuscular layer of pylorus and transverse abdominus muscle
  3. anchor dorsal incisions together
  4. continuous suture cranial edges
  5. repeat on caudal edges
  6. suture incision edges together using polydioxanone 2/0
27
Q

what should you do prior to closing (2)

A
  1. assess spleen for necrosis
  2. check remainder of abdomen
28
Q

when should a splenectomy be considered (3)

A
  1. persistent congestion after 10 mins of repositioning
  2. avulsion or infarction of vessels
  3. gross necrosis
29
Q

what are early complications of surgery (3)

A
  1. cardiac arrhythmias
  2. gastric wall necrosis
  3. peritonitis
30
Q

what are long term complications of surgery

A
  1. gastric hypomotility
  2. recurrence 5-10%

Module 16 (26 decks)

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