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Surgery > E2- GDV > Flashcards

E2- GDV Flashcards

1
Q

Definition of dilation/dilatation

A

“bloat”

distension of the stomach with fluid, food, and or gas (pressure on caudal vena cava if distension is huge)

MEDICAL- induce vomiting, antonausea meds

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2
Q

Definition of dilatation-volvulus

A

enlargement of the stomach associated with rotation on its mesenteric axis (maalposition/Twisting)

SURGICAL

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3
Q

Risk factors for GDV

A

***Dogs with first degree relative w/ hx of GDV***

increasing age

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4
Q

Dietary things that increase chances of GDV?

A

increase volume of food fed once daily

dry kibble

fats/oils in 1st four ingredients

raised food bowl

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5
Q

What dietary thing decreases the risk of GDV?

A

fish or egg supplements

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6
Q

What is the relationship b/t exercise and GDV?

A

used to think it was a risk factor, BUT now it is seen that it has no impact

no definitive conclusion

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7
Q

GDV breed dispositions

A

Great Danes

GSD, Irish setter, Doberman

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8
Q

GDV body conformation risks?

A

increased thoracic depth to width ratio

deep chested dogs!

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9
Q

Temperment association with GDV

A

“happy” dogs- decreased risk

increasing anxiety, aggression to ppl, spending 5 hrs a day with O = increased risk bc of stress

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10
Q

Should dogs undergoing a splenectomy get a gastropexy as well due to increased risk?

A

no supporting evidence

only 6-8% chance of developing GDV

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11
Q

Describe the event causes a reperfusion injury

A

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

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12
Q

What type of by-product accumulates during a reperfusion injury?

A

anaerobic metabolism by-products

accumlation of cellular waste products, toxins and toxic oxygen radicals

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13
Q

What happens once reprofusion is restored?

A

toxins are released into general circulation

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14
Q

Factors of reprofusion injury

A
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15
Q

Gastric displacement most common direction?

A

CLOCKWISE rotation

torsion is <180º rotation

volvulus is >180 rotation

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16
Q

Less common directoinal rotation?

A

counterclockwise rotation

rare <5% of cases

displacement <90º

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17
Q

Clockwise displacement- pylorus moves along the ______

A

ventral abdominal wall to the left side

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18
Q

Clockwise displacement- what is the stomach covered by?

A

omentum

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19
Q

Counterclockwise displacement- the plyorus moves where?

A

pylorus moves dorsally to lie adjacent to esophagus

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20
Q

Counterclockwise displacement- the greater curvature lies where?

A

along the midline

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21
Q

Counterclockwise displacement- is the stomach covered by omentum?

A

NO

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22
Q

Many Counterclockwise displacement GDVs are presented with history of ____

A

chronic GI signs

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23
Q

Clinical signs of GDV

A

acute

restlessness

hypersalivation

“praying” posture- taking pain away from abdomen

vomiting- nonproductive retching

weakness

collapse

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24
Q

GDV physical exam findings

A

distended, painful, tympanic abdomen (acute abdomen)

active retching

collapse

varying degrees of shock- compensatory & decompensatory

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25
Q

What do we do for initial stabilization GDV?

A

Aggressive fluid therapy- large bore cephalic or jugular catheters (avoid hindlegs)

initial fluids: crystalloids, hypertonic saline- colloid

maintenance: crystalloids, colloids

Blood pressure and EKG monitoring- shock 90mls/kg dog (25% right away)

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26
Q

How do we Dx GDV with lab findings?

A

CBC, Biochem, Lactate levels

lactate levels <6.0 increased survival

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27
Q

The goal of treatment for GDV is to…..

followed by?

A

stabilize cardiovascular, respiratory and renal systems initially

-fluids, decompression, pain management

then surgery and post surgical treatment

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28
Q

What is the first choice for GDV decompression?

A

stomach tube decompression is 1st choice!

trocharization, then tube, sedation, gastric lavage

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29
Q

Why is gastric decompression important?

A

improves CV and respiratory function

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30
Q

When do we perform gastric decompression?

A

after/during fluid/volume support

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31
Q

What is important to remember with orogastric intubation?

A

bite block

measure and mark tube length -xiphoid is good landmark

advance tube slowly

DO NOT force tube

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32
Q

T/F: gastric decompression can be performed with either sedation or general anesthesia

A

true

33
Q

during gastric decomprssion, what do we do once the stomach tube is in stomach?

A

empty contents

check effluent

gastric lavage- 5-10mls/kg warm water, gavage pump

(if they are not intubated, dont heavily sedate bc they can aspirate)

34
Q

If we are initially unable to pass an orogastric tube what should we do?

A

trocharization- only releases so much, not all

use large bore needle/catheter

most tympanic site- stomach is on LEFT SIDE

complications: spleen, leakage

then repeat orogastric intubation

35
Q

Assessment of orogastric tubing Vs trocharization

A

Tubing successsful 75.5%

Trocharization successful 86%

no evidence of gastric perforation

one splenic laceration w/ trocharization

NO DIFFERENCE b/t both methods and survival!

36
Q

What does the radiograph show?

A

GDV- after stabilization

37
Q

Why dont we put GDV dogs on their backs?

A

VD can predispose to reflux or aspiration

38
Q

What types of pain control?

A

drugs with minimal CV effects

Oxymorphone, fentanyl, buprenorphine

39
Q

What can be used for free radical scavengers for the reperfusion injury?

A

Acetylcysteine

Vitamin C, E & selenium

Desferozamine -iron chelator

Lidocaine- scavenger of reactive oxygen species (ROS), arrhythmias, CRI for pain control

40
Q

When do we want to do surgery?

A

as soon as stabilized- the longer the torsion, the increase risk of lack of blood supply

41
Q

Benefits of early surgery?

A

better prognosis

gastric repositioning improves bloodflow

surgery may be completes before onset of arrhythmias

42
Q

What are the 5 factors when doing surgical management for GDV?

A

gastric repositioning

assessment of gastric viability

evaluate pylorus

evaluate spleen

gastropexy

43
Q

Discribe surgical gastric repositioning

A

decompress the stomach if still distended

push down on fundus w/ right hand

grasp antrum w/ left hand and rotate stomach counterclockwise

confirm proper reduction by examinging gastroesophageal junction

(trying to bring pyloris from left side to the right side)

44
Q

Assessment of gastric viability

A

“standard” criteria- color pink/red (black=bad), pulsation of blood vessels, bleeding from cut surface, peristalsis (movement is indicator of health)

palpation of wall thickness

surface oximetry

45
Q

Gastric necrosis location

A

greater curvature near short gastric arteries

46
Q

Gastric necrosis- hand suturing vs staples?

A

hand sutures associated with higher mortality

staples are better?

47
Q

Areas of necrosis are present in ____% of GDV cases

A

10%

48
Q

Gastric perforation occurs when

A

the stomach wall is very thin

non-viable tissue, remove the necrosis

entire stomach necrotic? euthanize :(

49
Q

Evaluation of the spleen with GDV sx?

A

venous congestion- self limiting

vessel thrombosis- splenectomy

splenic torsion- splenectomy

50
Q

What are the chances of GDV reoccurring without a pexy surgery?

A

50% -it will happen again!!

51
Q

What is the chance of recurrence with the pexy surgery for GDV?

A

4% - VERY LOW

52
Q

T/F: gastropexy prevents dilation

A

FALSEE does NOTT

53
Q

Goal of gastropexy?

A

permanent adhesion on right lateral body wall (pexy pylorus)

54
Q

____% success rate for most gastropexy techniques

A

95%

55
Q

Incisional gastropexy procedure

A

incise the seromuscular layer in gastric antrum and right abdominal wall- dont penetrate mucosa

suture edge of abdominal wall to gastric incision w/ simple continuous pattern

3-4cm oral to pylorus in the transverse abdominus

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

56
Q

What type of gastropexy is this?

A

Belt loop gastropexy

make a loop of stomach tunnel through transversus muscle

57
Q

What is the strongest gastropexy technique?

A

circumcostal gastropexy

58
Q

Describe the circumcostal gastropexy procedure

A

seromuscular flap placed around 13th rib

technically demanding

Risks: rib fractures (bc you make a flap & go around rib), pneumothorax

59
Q

Laparoscopic-Assisted gastropexy

A

dorsal recumbancy

single port-SILS port

Two ports- camera port and instrument port (babcock forceps)

60
Q

Endoscopic assisted advantages

A

equipment more widely available

pyloric antrum accurately visualized

gastropexy performed w/ standard surgical instruments

61
Q

Endoscopic assisted limitations

A

expertise in gastroscopy required

potential organ trauma

62
Q

Reasons for doing propylactic gastropexy

A

breed risk- great danes esp if 1st relative had it

identified risk factors

owner requests it

63
Q

Postoperative care for GDV

A

NPO for 12-24hrs

Fluid and electrolyte replacement

Monitor for arrhythmias for 24hrs after sx

Pain control

Blood pressure monitoring -hypotension at any time is risk factor for death

encourage limited exercise- get them up and walking

64
Q

What is medical postop care for GDV?

A

anti-emetic: maropitant (cerenia)

H2-receptor antagonists (nausea) -ranitidine, famotidine

Sucralfate (coats stomach/esophagus)- 0.5-1gram PO BID or TID

+/- metoclopramide- promotility

65
Q

Deaths following GDV postop occur w/in_____

A

1st 4 days postop

66
Q

Postop death from shock

A

hypovolemic

septic- endotoxic

67
Q

Postop death from gastric necrosis

A

gastric necrosis leads to peritonitis

  • unrecognized areas of necrosis
  • perforating ulcers
  • reperfusion injury
68
Q

Electrolyte disturbances postop GDV

A

Hypokalemia- can induce or potentiate arrhythmias, muscular weakness, lethargy

Hypochloremia- gastric sequestration

69
Q

____% of P will develop arrhythmia

A

50%

70
Q

Cardiac arrhythmias occur _____ after onset of GDV

A

12-36hrs

(usually less intense in 24-72hrs)

71
Q

Cardiac arrhythmias are typically what type?

A

ventricular are most common

72
Q

Causes of cardiac arrhythmias

A

myocardial ischemia (decrease CO so myocardium gets irritated)

electrolyte abnormalities

acid-base alternatives

vasoactive substances

imbalance of autonomic nervous system

73
Q

Types of arrhythmias with GDV?

A

premature ventricular contractions

paroxysmal ventricular arrhythmias (runs)

idioventricular rhythm (slow v-tach)

ventricular tachycardia >180HR

multifocal PVCs → v fib

74
Q

When do we treat arrhythmias?

A

V-tach with high rate (>180-190bpm)

pulse deficits

poor pulse quality

weakness

multifocal PVCs

75
Q

Lidocaine use for arrhythmias

A

bolus 1-2mg/kg IV q 5 mins

constant rate infusion (maintenance) 25-80ug/kg/min

76
Q

What electrolytes should we check for refractory arrhythmias?

A

potassium, magnesium, calcium

77
Q

Pain relationship to refractory arrhythmias?

A

pain → arrhythmias

so we need pain management

78
Q

Survival rate for uncomplicated cases of GDV?

A

80-90% -very good

Surgery (15 decks)

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