Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SA DX & TX II > Exam 1 - GDV > Flashcards

Exam 1 - GDV Flashcards

1
Q

what is simple gastric dilatation?

A

enlargement of the stomach beyond its normal limits (with air/froth) WITHOUT malpositioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is gastric dilatation & volvulus?

A

enlargement of the stomach associated with rotation of the stomach on its mesenteric axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the general at risk population for GDV?

A

middle aged to older ‘deep chested’ large/giant breed dogs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what dog breeds are associated with having the highest risk of developing GDV?

A

great dane - 42% lifetime risk

gordon setter, irish setter, weimaraner, saint bernard, standard poodle, bassett hound, & GSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are some extrinsic risk factors associated with GDV?

A

eating rapidly, raised food bowls, small food particles, single food type, large volume of food per feeding, & history of kenneling/travel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are some intrinsic risk factors associated with GDV?

A

increased age, first degree relative with history of GDV, males, increased thoracic depth:width, fearful/anxious animal, gastric foreign bodies, & potentially prior splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the steps in which a GDV occurs?

A

stomach dilates - either from esophageal obstruction (animal can’t eructate or vomit) or pyloric obstruction (cannot pass ingesta to small intestine)

stomach rotates in a clockwise direction (~180-270)

pylorus & duodenum move VENTRALLY & to the LEFT of midline (clockwise)

spleen is displaced to the RIGHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the pathophysiology of GDV?

A

massive increase in intra-gastric pressure & volume - 20 mmHg will cause caval compression, with GDV, upwards of 60 mmHg

pressure on the diaphragm causes decreased tidal volume & impaired ventilation

caudal vena cava & portal system are compressed leading to obstructive shock, decreased CO, SV, MAP, & portal hypertension

distributive shock occurs with splanchnic pooling of blood

myocardial ischemia causes decreased venous return to the heart leading to circulatory shock

arrhythmias in 40-70% of cases (due to myocardial ischemia, splenic disease, & pancreatic ischemia - myocardial depression factor)

capillaries collapse causing mucosal necrosis - breakdown of gi mucosa & impaired portal system leading to bacterial translocation & endotoxemia

mixed acid base derangements

coagulopathy - multifactorial & DIC is possible

reperfusion injury from reactive oxygen species & pro-inflammatory mediators released systemically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why can a GDV dog present as anemic?

A

the tearing of the short gastric vessels during the volvulus leads to blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

why do we see mucosal necrosis in the stomach in an animal with GDV?

A

the mucosa is very metabolically active & receives >50% of blood flow & is >50% of the weight of the stomach - massive injury

full thickness ischemia & necrosis +/- perforation is possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the most common region of the stomach to necrosis with GDV?

A

greater curvature/fundus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what clinical signs does a GDV patient typically present with?

A

gastric distension, non-productive retching, hypersalivation, restlessness, pain/praying position

progression to depression & lateral recumbency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why is a saphenous catheter for iv fluids useless in a patient with GDV?

A

the venous return from the abdomen is impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the first step that should be taken for treating a GDV patient?

A

stabilize - large bore catheters in both cephalics or jugular with shock doses of crystalloids +/- colloids

also consider - analgesia, anti-emetics, flow-by oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

while fluids are going for a GDV patient, what other tests/information should you pursue?

A

PE, TPR, BP

continuous ecg & treat as indicated

blood gas

PCV, lactate, BUN/crea, electrolytes, & coagulation panel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

why should you do an ecg on a GDV patient?

A

many of them have arrhythmias - typically ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what arrhythmia is seen here? how do you know? how do you treat it?

A

v-tach

sustained VPCs, rate >160 bpm, R on T waves, multiform VPCs

lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why take a right lateral of a GDV patient?

A

pylorus is seen cranial to the body of the stomach - double bubble or reverse C shape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what could cause a pneumoperitoneum in a GDV dog?

A

gastric rupture - very unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is seen on rads that is supportive of a GDV?

A

pylorus is seen cranial to the body of the stomach - double bubble or reverse C shape

may see decreased serosal detail - rule out blood vs. gastric rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

T/F: if you confirm a GDV on a right lateral view, you still need a left lateral & VD view

A

false - stop after confirmed!!! avoid VD - can do DV if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

where is the pylorus seen on a DV view of a GDV dog?

A

pylorus seen on the left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

when may you do thoracic rads in a GDV patient?

A

if the patient is stable enough & an older - some may have aspiration pneumonia

older patients - need to rule out neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

before doing gastric compression, what should you do?

A

give the patient an opioid - hydromorphone/methadone/fentanyl - for pain relief & mild sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what are the 2 methods used for gastric decompression?
orogastric tube trocharization/percutaneous decompression
26
how do you use an orogastric tube for gastric decompression?
choose a large, stiff tube with a smooth tip & measure from the tip of the nose to the last rib & mark the tube consider elevating the front half of the body to decrease pressure at the cardia place a roll of tape in the dog's mouth to prevent them from biting the tube or use a tape muzzle pass the tube through the center of the roll of tape & pass down esophagus - if you feel resistance near the cardia, DO NOT FORCE THE TUBE once the tube is in the stomach - material should flow (have bucket ready) can lavage after with 5-10ml/kg of warm water
27
how is percutaneous gastric decompression performed in a GDV patient?
determine the area of greatest tympany - often on the left side just behind the last rib - can use ultrasound to confirm the spleen is not between the body wall & stomach clip/aseptic prep/lidocaine block of the region use a 14 or 16 G over the needle catheter & insert into stomach - remove the stylet & consider attaching to extension set apply gentle pressure on the abdomen to decompress
28
what are the benefits of using an orogastric tube for gastric decompression?
can achieve more rapid & complete decompression can lavage the stomach
29
what are the benefits of using trocharization for gastric decompression?
typically no sedation required may be better tolerated rapid
30
what are the disadvantages of using an orogastric tube for gastric decompression?
some patients may not tolerate the tube without further sedation may not be able to pass tube beyond the volvulus/cardia may perforate the stomach if overly aggressive
31
what are the disadvantages of using trocharization for gastric decompression?
less complete decompression especially if large amounts of food or thick froth is present may lacerate the spleen - usual minimal consequence
32
what are the goals of surgery in a GDV patient?
decompression, derotation, damage control, & permenant gastropexy
33
what are the anesthetic considerations for surgery for a GDV patient?
continue to stabilize the patient & close monitoring minimize time in dorsal recumbency - clip & initial prep in lateral minimize anesthetic time MAC sparing anesthesia protocol
34
what is the first step in GDV surgery?
decompression of the stomach - make a LARGE ventral midline incision from xiphoid to pubis must decompress the stomach before derotating (may be able to palpate cardia & guide OG tube in or can use a catheter/needle & attach to suction)
35
how is derotation done in GDV surgery?
standing on the dog's RIGHT side use your right hand to pull the pylorus TOWARDS you (ventrally/up - from left to right) use your left hand to push the body of the stomach dorsally & to the left (away from you/down) confirm the return to the normal anatomic position with the pylorus & duodenum on RIGHT - should be able to easily pass OG tube
36
after decompression & derotation is complete, what is done next in a GDV surgery?
damage control - complete abdominal explore concurrent gi obstruction is possible (fb, neoplasia, intussusception) confirm hemostasis
37
why may you see a hemoperitoneum in a GDV surgery?
short gastric arteries may tear causing a hemoperitoneum - confirm no continued hemorrhage & ligate as needed
38
what happens if during your abdominal explore in a GDV surgery, you see that the spleen has necrosed?
splenectomy - while rare, it can happen look for lack of pulses & black in color
39
during your abdominal explore of a GDV surgery, you see that the spleen is dark purple - what do you do?
nothing - spleen will appear congested & will improve with time
40
what are some signs of gastric necrosis?
serosa of the stomach is gray/green/black thin with lack of normal 'slip' lack of bleeding when incised lack of peristalsis?
41
if in doubt about the viability of the stomach after decompression/derotation, what can you do?
complete abdominal explore & go back & re-evaluate
42
T/F: if necrosis or perforation is present in the stomach, resection is indicated
true - 60% of the stomach can be removed greater curvature or fundus resected easily
43
what happens if there is necrosis on the cardia of the stomach?
resection isn't always possible - may be grounds for humane euthanasia if resection is possible - animal may have reflux esophagitis
44
how is resection performed on necrosed areas of the stomach in a GDV surgery?
partial gastrectomy - pack off the abdomen & place several stay sutures cut out necrotic tissues close in 2 layers (mucosa/submucosa SC & muscularis/serosa inverting with 2-0 PDS)
45
what is invagination in terms of techniques used in GDV surgery?
area of necrosis on the stomach is folded inward (invaginated) with a cushing/lembert pattern placed through the healthy tissue around it may be faster than resection
46
what are some possible complications of invagination of necrotic tissues of the stomach?
ulceration - common hemorrhage gi obstruction from tissue
47
which is preferred for addressing necrotic tissue on the stomach in a GDV surgery, resection or invagination?
resection
48
why is a gastropexy necessary for a GDV surgery?
80% recurrence rate without a pexy - need to do a right sided gastropexy to prevent the same problem from happening incisional gastropexy preferred
49
T/F: after a GDV surgery, the patient can be considered out of the woods
false
50
what is included in post-operative management of GDV surgery patients?
continuous ECG for at least 24 hours, blood pressure, PCV/TS, lactate, +/- periodic brief abdominal ultrasound +/- cbc/chem every few days
51
if the arrow is pointing out the caudal most extent of the diaphragm, what does the line next to it represent?
location of where you should do the gastropexy
52
what are some common post-operative complications of GDV?
arrhythmias, hypotension, ileus (vomiting/regurgitation), anorexia, & aspiration pneumonia less common - DIC & sepsis/peritonitis (gastric necrosis not identified & treated intra-op or dehiscence)
53
what is the ball structure seen in the center? what is to the right of it?
omentum spleen
54
when should you use antibiotics post-op in a GDV patient?
indicated if there was perforation/septic peritonitis or evidence of septicemia
55
T/F: you should avoid NSAIDs in post-op GDV patient
true opioids instead - methadone has less gi effects
56
what kind of gi support should be offered to post-op GDV patients?
antiemetics, prokinetics as needed, & antacid meds may need an ng tube to periodically empty the stomach if there is severe ileus
57
how is nutrition handled post op in a GDV patient?
begin feeding within 12-24 hours if anorexic for >24 hours - consider NG tube
58
what are some poor prognostic indicators in GDV patients?
lactate that doesn't improve, pre-op arrhythmias, >6hr of clinical signs, hypotension at any time, need for splenectomy/partial gastrectomy, peritonitis/sepsis, & DIC
59
T/F: there is 10-28% mortality reported in GDV patients
true
60
T/F: lactate increases in GDV patients due to hypoxia secondary to anaerobic metabolism
true
61
T/F: there is a general shift towards response to resuscitation rather than a cut off value in predicting prognosis when it comes to watching lactate values
true - there are many papers evaluating the prognostic value of lactate & they all have conflicting results
62
T/F: you should recommend a prophylactic gastropexy to at risk breeds & any dog that develops dilatation as it will prevent volvulus, bloat, & dilatation
false - while you should recommend the surgery, it only prevents volvulus not bloat/dilation
63
what are some ways owners can prevent the risk of their pet developing GDV?
avoid raised bowls minimize stress/anxiety especially during feedings feed multiple smaller meals rather than one large meal a day
64
______ ________ is a possible sequela to GDV & can require resection of the stomach
gastric necrosis
65
T/F: stabilization in a GDV patient before surgery is extremely important
true - fluids & gastric decompression
66
how is an incisional gastropexy performed?
4-6cm incision is made through the peritoneum & transversus abdominis on the right body wall 1cm behind the last rib & parallel to the linea make a similar 4-6cm incision through the seromuscular layer of the pyloric antrum use 0 or 2-0 PDS in a simple continuous pattern, suture the dorsal aspect of each incision together followed by the ventral aspect
67
how is a belt loop gastropexy performed?
seromuscular flap created around a vessel along the greater curvature of the pyloric antrum make 2 5 cm incisions along the right body wall through the peritoneum/transversus abdominis m. for flap to be passed through
68
how is a circumcostal gastropexy performed?
make a double or single-hinged flap of the seromuscular layer over the pyloric antrum passed cranial to caudal around the 11th or 12th rib rare complications include - pneumothorax (particularly if using the mid to proximal portion of rib) & rib fractures
69
what are some common post-operative complications of GDV?
arrhythmias, hypotension, ileus (vomiting/regurgitation), anorexia, & aspiration pneumonia less common - DIC & sepsis/peritonitis (gastric necrosis not identified & treated intra-op or dehiscence)

SA DX & TX II (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions