Canine GDV Flashcards
gastric dilation and volvulus
bloat w/ clockwise rotation of the stomach
ALWAYS AN EMERGENCY
gastric dilation
bloat without rotation
NOT emergent
intrinsic risk factors for GDV
- deep chested
- older
- underweight
- if first degree relatives are affected
extrinsic risk factors for GDV
- once daily feeding
- feeding from raised bowl
- aerophagia
- stress
signalment for GDV
large and giant breeds
wide age range
no sex predilection
clinical signs of GDV
- retching
- non-productive vomiting
- hypersalivation
- restlessness
- abdominal distention
- weakness
- collapse
PE of GDV patients
- distended, tympanic cranial abdomen
- splenomegaly
- hypovolemic shock
is hyperlactatemia a sufficient reason to take to surgery
NO - helps guide prognosis because lactate > 6 mmol/L is associated with a greater risk of gastric necrosis and complications
diagnosis of GDV
- clinical signs
- radiographs
radiographs of GDV
ALWAYS do right lateral and VD views
gas dilated stomach WITH gastric shelf sign
treatment for GDV
surgical emergency
- stabilize patient prior to surgery
steps of GDV surgery
- gastric decompression
- gastric derotation
- prophylactic gastropexy
gastric decompression
orogastric tube vs trocarization
orogastric tube: placing a tube from the mouth into the stomach to release the gas
trocarization: place catheter into stomach in paracostal space
gastric derotation
- grab pylorus on patient’s L side and the stomach on the R side
- push the stomach down on the R side and pull the pylorus up from the L side
- gently untwist the stomach in counterclockwise rotation by pulling pylorus ventrally and to the right
- assess for gastric wall viability
- resect necrosed gastric wall
parameters for assessing gastric wall viability
seromuscular layer MUST be viable - mucosa does not
- color
- consistency
- blood flow
- motility
prophylactic gastropexy
most often an incisional gastropexy
- incise partial thickness into the antrum of the stomach
- incise into the transverse abdominal muscle BEHIND LAST RIB on the RIGHT SIDE of the body
- suture the cranial end of the antrum incision to the cranial end of the abdominal wall incision
- suture the caudal end of the antrum incision to the caudal end of the abdominal wall incision
- place 2 simple continuous suture lines to close either side of the incision, bringing the abdominal wall and antrum together
goal of the incisional gastropexy
create a permanent attachment between the antrum and the R side of the body wall
how do you know if it is a true GDV when you open the abdomen
omentum will be overing the stomach
if no omentum covering – dilation only, no volvulus
postoperative management
- fluids
- analgesia
- gastric wall protection (PPIs, H2 blockers, sucralfate)
- antibiotics
- prokinetics
what are common complications of GDV
- arrhythmias - can give lidocaine for Vtach
- aspiration pneumonia
- DIC - poor prognosis
prognosis of GDV
if NO gastric necrosis - excellent, only 2% mortality
if gastric necrosis - 34-46% mortality
overall mortality: 15-30%
overall surgical approach to GDV
- decompression and derotation of stomach
- exploratory laparotomy - check for hemoabdomen, spleen, pancreas, gastric outflow
- assess gastric wall integrity
- incisional gastropexy
- +/- biopsies + cultures
- closure
