Gastric Dilation and Volvulus GDV Flashcards
What does GDV stand for
Gastric Dilation and Volvulus
What is GDV
is where the stomach becomes dilated with gas and then twists along its axis.
What happens to the body when a GDV happens
When the stomach twists the pyloric and oesophageal sphincter twists/rotates preventing the gastric gas from escaping through normal physiological means (Tear, 2017). The dilatation continues causing compression of the vessels, decreasing venous return to the heart. The torsion compromises the blood supply to organs which can lead to tissue necrosis.
Clinical Signs of GDV
- Unproductive retching
- Hyper salivation
- Collapse
- Restless
- Depressed
- Distended abdomen
- Belching
- Grunting with effort to breath
- Tachycardia
- Pale MM and prolonged CRT
- Hypovolemic shock
What are the predisposing factors of GDV
- Middle age
- Feeing only once a day
- Deep chested
- Rapid eating
- Exercise after eating
- Drinking lots of water after eating a large amount of food
Pre op
- Bloods tests to access potassium levels
- Large bore intravenous catheters should be placed into the left and right cephalic veins. Fluid therapy should be administered at shock rates.
- An orogastric tube should be passed into the oesophagus through a roll of bandage/tape to decompress the stomach. If this is passed successfully the stomach is lavaged with warm saline to reduce the acidic contents.
- Radiographs should be taken with the patient in right lateral recumbency; this positioning will show the pyloric sphincter.
- Antibiotics and pain relief is administered under the direction of the veterinarian.
- Once the patient is stable enough, a gastropexy should be performed- this permanently affixes the stomach to the abdominal wall preventing the reoccurrence of a GDV but not a GD
Patient Prep
A large area around the ventral midline is clipped, usually from the xiphoid to the pubis is sufficient, and with a wide area clipped on either side of the proposed incision site. The site is then prepared aseptically.
Patient Positioning
The patient is placed in dorsal recumbency with the head and chest raised with the aid of a towel or support bag. This will help reduce the pressure of the stomach on the diaphragm (Burbidge, n.d.). The forelimbs and hind limbs are secured with the use of positioning aids.
Instruments / Materials
A general surgical kit will be required as well as: abdominal retractors, suction apparatus, orogastric tube, laparotomy sponges, non-crushing clamps (Doyens Bowel Clamps), sterile saline. Four quarter draping is required so that the surgeons can make the window the appropriate size for the patient, and these patients have distended abdomens, so a larger window is often required.
Surgical procedure
An incision is made into the abdomen and if the stomach contents have twisted, the veterinarian will correct the stomach malposition. If more than 1/3 of the stomach’s blood supply has been compromised, euthanasia is recommended, as survival is poor. If there are small amounts of necrotic tissue, this can be removed, and then the stomach is sutured to the abdominal wall; this is to prevent reoccurrence. If the spleen was also twisted a splenectomy may need to be performed.
Post op
In the first 24 hours the patient should be carefully monitored. The patient should be handled minimally and if the patient requires moving care should be taken. Two major complications in a GDV post-operatively are Disseminated Intravascular Coagulation and Cardiac Arrhythmias. Intravenous fluid therapy is required at maintenance rates. It was thought previously that patients should be starved post-operatively for 8-12 hours, however, this is no longer recommended as this can cause gut stasis. It is important to get the gut motile. A diet that is complete and balanced and easily digestible is the diet of choice. This is feed to the patients at resting energy requirements.
