Approach to and Management of Gastric Dilation and Volvulus Flashcards
what are risk factors for GDV (11)
- Large and giant breeds
- Dogs with a close relative (parent or sibling) who has had GDV
- Large thoracic depth to width ratio (deep narrow chest)
- Underweight for breed
- Increasing age
- Previous splenomegaly or splenectomy
- Aerophagia or ‘gulping’ food
- Eating from a raised bowl
- Stress (being kennelled, car journey or dog show)
- Feeding once a day, particularly dry food
- Small food particle size (<30mm in diameter)
how does the pylorus typically move during GDV
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
what is the best method to confirm diagnosis
abdominal radiography
what should be stabilized before surgery
fluid therapy and orogastric intubation
what is the shock fluid bolus
90 ml/kg/hr for 15 mins then re evaluate
repeat up to 4 times
what is the length of the orogastric tube to use
premeasured to the last rib
what two structures need to be sutured together to prevent reccurence
the pylorus to the right body wall
what is a gastronomy
incising
what is a gastrectomy
excising a portion
what is a gastropexy
fixing stomach to body wall
what occurs to the spleen in all cases
dragged by gastrosplenic ligament
displace dorsally and to the right
congested: stretching/twisting of vessels
resolves as repositioned
what occurs to the gastric wall
intra-gastric pressure rises
vessels in wall become compressed and hypoxia and necrosis of the wall can occur
gastric necrosis and perforation quickly
what are the cardiovascular effects (3)
- reduced venous return to heart: pressure on caudal vena cava
- hypovolemic shock: fluid extravasation into stomach
- septic shock: compromised gastric wall –> bacteremia, gastric wall necrosis –> septic peritonitis
what type of arrhthymias can develop
25% of cases develop ventricular arrhythmias within 48 hours
toxins released from compromised stomach and other factors
what is the commonest age
>7 years
how does GDV present (4)
- large breed dog
- rapid onset persistent vomiting fluid
- tympanic abdomen
- collapse
what does GDV look like on rads
- gas filled distended stomach
- compartmentalization lines
- cannot see fluid filled pylorus on right lateral view
how should you stabilize a GDV patient (6)
- fluid resuscitation
- gastric decompression
- IV antibiotics
- oxygen therapy
- therapy for arrhythmias
- analgesia
what are the key goals of surgery (3)
- reposition stomach
- assess stomach for necrosis
- prevent recurrence: perform gastropexy
how do you reposition the stomach (6)
180 degrees clockwise rotation is commonest
- ensure establish direction before derotating
- decompress stomach first (tube)
- find duodenum and follow it to pylorus
- pull pylorus back into normal position
- at same time push fundus over to other side
- check cardia to ensure untwisted
what is a normal gastric wall viability
pink, blanches and rapidly recolours
peristalsis
active hemorrhage from cut surface
what is a compromised gastric wall look like
erythematous
what does a necrotic gastric wall look like (3)
- green, blue, purple, black
- no pulsation, no peristalsis, no bleeding from incision
- palpable thinning of wall
what should you do with necrotic areas
partial gastrectomy
what should you do with severely compromised areas of the gastric wall
partial gastrectomy or gastric invagination
how is a right sided incisional gastropexy
- pylorus to right body wall behind ribs
- incise seromuscular layer of pylorus and transverse abdominus muscle
- anchor dorsal incisions together
- continuous suture cranial edges
- repeat on caudal edges
- suture incision edges together using polydioxanone 2/0
what should you do prior to closing (2)
- assess spleen for necrosis
- check remainder of abdomen
when should a splenectomy be considered (3)
- persistent congestion after 10 mins of repositioning
- avulsion or infarction of vessels
- gross necrosis
what are early complications of surgery (3)
- cardiac arrhythmias
- gastric wall necrosis
- peritonitis
what are long term complications of surgery
- gastric hypomotility
- recurrence 5-10%
