Gastric Dilatation Volvulus

Question 1

What are 3 steps to the pathophysiology of GDV?

Answer 1

1. rotation of the stomach counter-clockwise when viewing from cranial to caudal in dorsal recumbency
2. volvulus of the stomach results in venous compression, congestion, and local compromise of blood perfusion to the stomach, resulting in necrosis
3. this causes air to accumulate in the stomach, eventually impeding venous return to the heart via the vena cava, resulting in hypovolemic shock –> global tissue ischemia, systemic inflammatory response, arrhythmia due to inflammatory mediators and myocardial ischemia

Question 2

Once the stomach rotates, what additional damage can be caused?

Answer 2

tearing of the short gastric vessels connecting the stomach and spleen

Question 3

What dogs are predisposed to GDV? What are 3 other predisposing factors?

Answer 3

Great Danes > GSDs, Rottweilers, Irish Wolfhounds –> deep chested dogs!!

1. related to a dog that has GDV
2. anxious dogs
3. fast eaters

Question 4

What are the 2 most common clinical signs associated with GDV? What else is seen?

Answer 4

1. non-productive retching/vomiting
2. abdominal distension

• restless/nervous pacing
• pain
• increased respiratory signs
• shock/cardiovascular collapse - tachycardia, weak pulses, pale MM, prolonged CRT, depressed to comatose mentation

Question 5

What 3 diagnostics are recommended for cases of GDV?

Answer 5

1. ECG - VPCs
2. blood gas - metabolic acidosis +/- respiratory compensation, hypercapnea
3. right lateral abdominal radiograph - displaced gas fills pylorus –> double bubble, Popeye arm

Question 6

What is the first part to treating GDV? What are 5 important steps?

Answer 6

STABILIZE PATIENT

1. place 2 large-bore cephalic catheters (caudal venous return is poor!)
2. shock dose crystalloid fluid therapy
3. decompress stomach with an orogastric tube or trocarization
4. monitor BP and ECG
5. measure lactate levels for prognosis insight (>6 mmol/L = gastric necrosis)

Question 7

What are the major pros and cons to using an orogastric tube vs. trocar to decompress the stomach in cases of GDV?

Answer 7

OROGASTRIC TUBE:
- pros = more effective emptying
- cons = heavy sedation needed, tube may not pass, possible esophageal trauma/rupture

TROCAR:
- pros = rapid, no sedation needed
- cons = limited decompression, gastric wall laceration, splenic puncture

Question 8

What is the goal in GDV surgery? What is classically seen once the abdomen in entered?

Answer 8

fully decompress and reposition the stomach, evaluate viability of stomach + resect necrotic tissue, determine if a splenectomy is required

drape of omentum covers the stomach

Question 9

How can a GDV be prevented?

Answer 9

gastropexy of pyloric region

• incisional
• circumcostal
• belt-loop
• incorporating
• tube

Question 10

What are 4 negative prognostic indicators in cases of GDV?

Answer 10

1. lactate >6 mmol/L
2. need for gastric resection/splenectomy
3. long onset of signs to time of presentation (5-6 hrs)
4. recumbency at presentation