GDV Flashcards
Risk factors
- deep chested dogs (pointer, doberman, Great Dane, GSD, Bernese mt dog, boxer, lab, Dogue de Bordeaux, dachshunds
- eating and then exercise
- familial hx
- older dogs: symptomatic GDVs (coexisting issues)
- younger dogs: GDV primary problem (scavenging)
- wolfing down food -> aerophagia**
- pain & stress -> aerophagia**
Many causes of aerophagia - scavenging, familial hx, eating with exercise, pain in older dogs
Clinical signs
- retching, unproductive v+ efforts and hypersalivation
- rapid anterior abdominal distension
- circulatory collapse and dyspnoea
Concurrent pathophysiological changes include:
- hypovolaemic shock
- electrolyte and acid-base abnormalities
- gastric necrosis
- cardiac arrhythmias
- endotoxaemia
What is the problem with a GDV?
Gas distension and twisted stomach
- obstructive shock is the fundamental problem
- CS consistent with obstructive shock
- if the GDV was missed and now 4-5h down the line, the stomach may have ruptured and so now have distributive shock
- distension and twisted stomach can also affect the spleen -> engorged with blood, can also twist
Which direction do most go?
- 90% go clockwise (when looking cranially)
Diagnosis
Clinical signs
- obstructive/distributive shock
- bloating (most of the time is obvious -> giant abdomen)
- sometimes just a quiet dog but suspicious bc of breed
Radiography
- risk of death during x-ray due to stress or putting pressure on the caudal vena cava (if put on back)
- only do 1 x-ray
- RL
- usually 180 twist so pylorus and fundus have swapped position, pylorus now at top -> reverse C of stomach (or boxing glove appearance)
- 360 twist -> everything back to where it was so hard to diagnose, looks normalise but bloated pt
Next diagnostic step
- try and pass an orogastric tube
– 360 twist won’t be able to get through
– if do get it in, it is more likely to be bloated pt rather than a GDV
Stabilisation - dealing with bloat
Orogastric tube
Percutaneous decompression
- needle vs catheter
- needle very quick to get in
- solid needle won’t kink so persistent drainage, but can damage the stomach
Nasogastric intubation
Stabilisation - dealing with obstructive shock
IVFT
- bolus fast
- cephalic -> obstruction of the caudal vena cava so drains back end, so saphenous IV fluid would never get back to the heart
- ideally both cephalics
- mimic the volume it’s losing every time it beats that is not getting from the obstructive CVC, just to keep it alive whilst decompressing
Analgesia
- full opioids e.g. methadone
Oxygen
- may struggle to breathe due to diaphragmatic compression
Intermittent ventricular tachycardia
- need to fix this as under GA the pt will arrest
- check bp as well
- if the ventricular complexes aren’t associated with low bp then may be okay under GA
- to fix Vtach -> lidocaine
- ECG
- lots of these pts will develop Tach anyway so can argue give lidocaine CRI regardless, also good analgesic
Anaesthetic
ASA III-V
Premed
- already have methadone on board
- midazolam
- don’t touch ACP or alpha-2s
Monitoring
- standard
- multiparameter for ECG, BP, CO2
Rare complication
- as untwisting the stomach, lots of blood can come back
- spleen can necrotise
- if suddenly goes bradycardic can be acutely hyperkalaemic
- have epoc ready to test K levels
Surgery options
- incisional
- belt-loop
- circumcostal
- Peg
Incisional surgery
- incision into the pyloric wall (just get through the serosa so haven’t breached the stomach
- then incision into the abdo wall
- stitch them together
Post op
Vtach
- need to keep this pt on lidocaine for 24h
All post op care for 24h in practice
Danger period in 1st 24h -> SIRS & DIC
Prevention / prophylaxis?
Prophylactic sexy offered during routine procedures when ~1y/o
- evidence for risk level is low: risk from GA and general abdo surgery, generate dead space in abdomen from it so risk of mesenteric torsion
