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My 2017 RUSVM SAS 1 > Exam 2 GDV > Flashcards

Exam 2 GDV Flashcards

1
Q

differenc b/w acute gastric dilatation, chronic gastric volvulus, & acute gastric dilatation with volvulus

A

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

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2
Q

risk factors for developing GDV

A

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

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3
Q

pathophysiology leading up to GDV

A

stomach distension (gas, fluid fermention)-> altered sphincters (limited eructation & emptying) -> further distension (clockwise stomach rotation, pylorus cranial & left, stomach moves right)

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4
Q

CV, resp, GI, metabolic, immune & renal events that occur during GDV

A

CV:

  • compression of low pressure veins
  • decr. preload, afterload, CO, BP
  • catecholamine release
  • arrhythmias
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5
Q

what is reprefusion injury & its role during GDV

A

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

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6
Q

typical CS associated w/ GDV

definitive dx GDV

A

looking/biting at abd

praying posture

non productive retching

distended abd

radiographs

RLat

double bubble sign

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7
Q

radiographic view of choice for dx GDV

why

A

RLat

malposition of pylorus gives “Double Bubble” sign

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8
Q

how does the stomach most commonly move w/ GDV

A

clockwise rotation

70-360 degree rotation

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9
Q

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

A
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10
Q

key components of preoperative stabilization of GDV pt and in what order do you want to perform

A
  1. Fluids
  2. decompression
  3. pain mgmt
  4. antimicrobials & free radical scavengers
  5. sx!
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11
Q

what are free radical scavengers & what is their potential benefit in tx GDV pts

A

acetylcysteine

Vit C, Vit E, selenium

deferoxamine

lidocaine

help bind (scavenge) toxic ROS

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12
Q

options for correcting hypovolemic shock often associated w/ GDV

A

Crystalloids @ 45-90 mL/kg IV

Crytalloids/colloids combo @ 40 mL/kg + 10-20 mL/kg IV

7% hypertonic saline

anything to help hypovolemia

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13
Q

what methods can be used to decompress the stomach

A

orogastric intubation

trocharization

emergency gastrostomy

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14
Q

what precautions should be taken when performing orogastric intubation

A

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

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15
Q

what is trocarization

what are the potential complications

A

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*
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16
Q

advantages of early surgical correction in management of GDV

A

avoids recurrent dilatation

rapid correction of circulatory compromise

minimize or prevent gastric wall necrosis

chance of avoiding development of arrhythmias

= better outcome

17
Q

what area of the stomach is most commonly affected by vascular compromise

A

greature curvature

18
Q

how is viability of the stomach typically assessed

how can palpation of the stomach wall be helpful in assessing viability

A

peristalsis

serosal color

palpate for thinning or friability

pulsation of vessels

bleeding cut surfaces

19
Q

what abn in the spleen may occur w/ GDV

How are they managed

A

Venous congestion - self limiting once back in normal postion

Vessel thrombosis - splenectomy

Splenic torsion - splenectomy

20
Q

what are the goals of a gastropexy

A

permanent adhesion of stomach to abd wall preventing volvulus

pyloric antrum/right lateral body wall

gastropexy DOES NOT prevent dilatation!

21
Q

techniques, advantages & disadvantages of the incisional, belt loop, circumcostal, tube, and incoporating gastropexies

A

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

22
Q

what part of the stomach must be immobilized

A

preferably the pyloric antrum in fairly normal anatomical position

23
Q

is any one technique of gastropexy superior to all others

is there a significant difference in recurrence rates b/w different techniques

A
24
Q

most critical time period for post-op GDV pts

A

first 4 days d/t:

shock - hypovolemia or septic

gastric necrosis - peritonitis a/o perforation

reperfusion injury

arrhythmias

25
Q

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

A

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

26
Q

Px for GDV pts

A

10-33 % mortality w/o necrosis

Lactate level prognostic

>6mmol/L higher chance of necrosis.

27
Q

Which vein would be least desirable to use for fluid administration in a GDV pt?

  1. Cephalic
  2. jugular
  3. saphenous
A

saphenous

My 2017 RUSVM SAS 1 (17 decks)

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