Exam 2 GDV Flashcards
differenc b/w acute gastric dilatation, chronic gastric volvulus, & acute gastric dilatation with volvulus
AGD : normal postion, distended stomach
CGV: slight malposition, vomiting, eructation, gastropexy
AGDV: distension of stomach & rotation of the stomach on its mesenteric axis AKA gastric torsion
risk factors for developing GDV
lg giant breeds, deep chested dogs, first degree relative
fast eater, lg volume fed, raised food bowls, fats & oils
post prandial activity
restricting H2O before/after feeding
egg or fish decr risk!
Age – ligaments
Post splenectomy ?
Underweight dogs
Intact females
Males > females
Temperament
pathophysiology leading up to GDV
stomach distension (gas, fluid fermention)-> altered sphincters (limited eructation & emptying) -> further distension (clockwise stomach rotation, pylorus cranial & left, stomach moves right)
CV, resp, GI, metabolic, immune & renal events that occur during GDV
CV:
- compression of low pressure veins
- decr. preload, afterload, CO, BP
- catecholamine release
- arrhythmias
what is reprefusion injury & its role during GDV
tissue blood flow absent then returned when GDV corrected
toxins released into general circulation from accumulation of waste products & toxic O2 radicals
causes: capillary permeability
altered vascular tone
platelet activation
vascular occlusions
fever
negative inotrope
neutrophils
no reflow phenomenon
typical CS associated w/ GDV
definitive dx GDV
looking/biting at abd
praying posture
non productive retching
distended abd
radiographs
RLat
double bubble sign
radiographic view of choice for dx GDV
why
RLat
malposition of pylorus gives “Double Bubble” sign
how does the stomach most commonly move w/ GDV
clockwise rotation
70-360 degree rotation
which type of GDV most commonly associated w/ hx of chronic GI signs
why is severity of signs associated with this type of rotation usually less severe than those associated w/ more typical clockwise displacemet
key components of preoperative stabilization of GDV pt and in what order do you want to perform
- Fluids
- decompression
- pain mgmt
- antimicrobials & free radical scavengers
- sx!
what are free radical scavengers & what is their potential benefit in tx GDV pts
acetylcysteine
Vit C, Vit E, selenium
deferoxamine
lidocaine
help bind (scavenge) toxic ROS
options for correcting hypovolemic shock often associated w/ GDV
Crystalloids @ 45-90 mL/kg IV
Crytalloids/colloids combo @ 40 mL/kg + 10-20 mL/kg IV
7% hypertonic saline
anything to help hypovolemia
what methods can be used to decompress the stomach
orogastric intubation
trocharization
emergency gastrostomy
what precautions should be taken when performing orogastric intubation
sedation if necessary
bite block
large bore tube
measure nose to last rib
lube tube
do not force tube d/t chance of perforating esophagus
what is trocarization
what are the potential complications
large bore needle percutaneous into distended stomach
- puncture spleen if not over tympanic area*
- peritonitis d/t leakage if trochar needle lacerates stomach or intestines*
advantages of early surgical correction in management of GDV
avoids recurrent dilatation
rapid correction of circulatory compromise
minimize or prevent gastric wall necrosis
chance of avoiding development of arrhythmias
= better outcome
what area of the stomach is most commonly affected by vascular compromise
greature curvature
how is viability of the stomach typically assessed
how can palpation of the stomach wall be helpful in assessing viability
peristalsis
serosal color
palpate for thinning or friability
pulsation of vessels
bleeding cut surfaces
what abn in the spleen may occur w/ GDV
How are they managed
Venous congestion - self limiting once back in normal postion
Vessel thrombosis - splenectomy
Splenic torsion - splenectomy
what are the goals of a gastropexy
permanent adhesion of stomach to abd wall preventing volvulus
pyloric antrum/right lateral body wall
gastropexy DOES NOT prevent dilatation!
techniques, advantages & disadvantages of the incisional, belt loop, circumcostal, tube, and incoporating gastropexies
incisional: 3-6 cm incision R ventro-lateral wall through peritoneum & T. abd m., then incision pyloric antrum/stomach suture 2/0 or 3/0 absorb., quick, won’t hold if incisions not big enough
belt loop: parallel incisions 2 cm apart to create tunnel R abd wall peritoneum & m., then parallel 4 cm incision 3 cm apart through serosa/muscular near pyloric antrum, pull through/suture, can hold more securely, longer procedure
circumcostal: create tunnel around 11th-12 rib R side, create stomach flap w/ base near lesser curvature, suture w/ 2/0 or 3/0, strong holding pexy, longer technique
tube: incision through R abd wall caudal to last rib, purse string suture in stomach for 14-20 fr foley or mushroom tip catheter, suture stomach to abd wall, secure w/ finger trap, can use with severe stomach compromise that will need feeding tube also, not as strong a pexy (but will still hold)
incorporating: stomach wall is incorporated in linea alba incision, not recommended (imagine having to open belly again with the stomach in that position!), if required abrupt d/c of anesthesia
what part of the stomach must be immobilized
preferably the pyloric antrum in fairly normal anatomical position
is any one technique of gastropexy superior to all others
is there a significant difference in recurrence rates b/w different techniques
most critical time period for post-op GDV pts
first 4 days d/t:
shock - hypovolemia or septic
gastric necrosis - peritonitis a/o perforation
reperfusion injury
arrhythmias
what role do arrhythmias play in pathophysiology of GDV pts
what type(s) are most common
When do they typically occur
how do they affect px
what are potential cause of arrhythmias
when should they be treated
with what
contribute to mortality rate
Ventricular Premature Depolarizations (VPC’s)
12-36 hrs after presentation
should be tx when asociated w/ weakness or syncope, persistent tachycardia >150 bpm, pulse deficits or poor pulse quality, multifocal
Lidocaine
Px for GDV pts
10-33 % mortality w/o necrosis
Lactate level prognostic
>6mmol/L higher chance of necrosis.
Which vein would be least desirable to use for fluid administration in a GDV pt?
- Cephalic
- jugular
- saphenous
saphenous
