GDV

Question 1

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what are the risk factors of GDV?

Answer 1

• Aerophagia
  ◦ exercise after food
  ◦ drinking too quickly
  ◦ eating quickly/scavenging
  ◦ stress/anxiety - hospitalisation
  ◦ dry diet
• deep chested dog - GDS, great dane, flat coat, doberman, ST Bernards, Dachshund

Question 2

what occurs with GDV and what problems does this cause?

Answer 2

Gas distendsion and twisted stomach
- usually clockwise 90%
- caudal vena cava compression –> obstructive shock
- gastric vessle occlusion - necrosis
- splenic engorgement +/- splenic twist
- Bloasted abdomen and non-productive reching

Question 3

how do you diagnose GDV?

Answer 3

Radiography - unstable patient so single view
Right lateral abdo

Question 4

what is the treatment for GDV?

Answer 4

Treatment of obstructive shock:
IVFT - Bolus; cephalic veins
Diaphragmatic compression - oxygen therapy
Cardiac arrythmias - ECG; VTACH is common -> Lidocaine
Pain relief - Methadone
Lidocaine excellent for analgesia also, give regardless as a constant rate infusion

Stomach Decompression:
- Orogastric tube - quickest, diagnostic clue for 360 degree twist if can’t get in
- Nasogastric tube - easier to get in, but slower to decompress
Percutaneous decompression (slowest):
- Needle, may rip the stomach wall
- Catheter, kinks and drains even slower

Question 5

what needs to be thought about/monitored during analgesia of GDV patients?

Answer 5

maintain cardiac output:
- ECG
- BP
- Avoid alpha 2 or ACP

ASA grade 3 or 4:
- premed: methadone +/- midazolam
- could consider midazolam co-induction

monitor for reperfusion injury:
- acidosis (lactate)
- hyper kalaemia

Ventilation/perfusion mismatach (poor perfusion and diaphragmatic compression)
- monitor CO2 - if high, consider ventilation

Question 6

what is done during a GDV surgery?
what is the post-op care?

Answer 6

Incisional gastropexy - A 3–4 cm incision is made in the stomach, and then sutured to a similar incision in the right abdominal wall.
Top tip - to make it even easier, fully needle decompress the stomach to deflate it and make handling as easy as possible
Remember if the spleen is twisted - remove it BEFORE untwisting to avoid reperfusion injury

post-op:
- maintain cardiac output - fluid therapy
- analgesia - mehtadoen and lidocane
- cardioprotection - monitor with ECG for 24h and continue lidocane for 24h regardless
distrubutive shock (SIRS) and DIC can develop, so monitor for those

Disseminated intravascular coagulation