GDV Flashcards by jared Jensen

rotation of viscera around its mesenteric attachments

volvulus

ex: gastric dilation-volvulus, mesenteric volvulus, colonic volvulus

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rotation of viscera around its long axis

torsion

ex: splenic torsion, lung lob torsion, liver lobe torsion, mesenteric torsion, colonic torsion

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torsion is rotation of viscera around its

long axis

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volvulus is rotation of viscera arounds its

mesenteric attachment

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the point where the esophagus attaches to the stomach

cardia

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the point of the stomach where it starts to funnel towards the pylorus

antrum

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what part of the stomach likes to move during GDV

the pylorus - moves clockwise

ventral and over to the left side (normally on the right side)

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what side the pylorus normally on

right side (deep)

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How does the pylorus move in GDV

clockwise, ventral and over to the left side

commonly 180 degrees

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Mesenteric torsion typically occurs in what kind of dogs

German shepherd dogs
Flat-coated retriever’s

mortality approaches 100% in GSD

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What should you not do with splenic torsion

do not untwist

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What causes splenic torsion

unknown

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What kind of dogs typically get splenic torsions

large breed dogs

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What radiographic view should you do for GDV diagnosis

right lateral

see double bubble and the esophagus coming down to a point

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What breeds are risk factor for GDV

Great Dane
GSD
St Bernard
Irish wolfhound
Standard Poodle
Irish Setter
Akita
Mastiff
Bassett Hound
guinea pigs

*Narrow-deep chested dogs

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T/F: counterclockwise GDVs can occur

True - about 5%

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What are the historical risk factors for GDV

one meal a day
first-degree relative
rapid eating
thin / underweight
fearful / anxious
Male > Female
older dogs
gastric foreign body
previous splenectomy?
meterorological / lunar influence

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With GDV surgery, what is pexied

antrum (just oral to the pylorus) pexied to the right side

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What are the prognostic risk factors of dogs with GDV

1) Mentation of animal- ambulatory vs recumbent vs comatose

2) Preoperative arrhthmias

3) Serum lactate concentration

4) Evidence of gastric necrosis- gastric lavage

5) Evidence of sepsis, DIC

6) Time to recognition and surgery

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How does GDV typically present

-Nonproductive retching
-Hypersalivation
-+/- Abdominal distension “BLOAT”
-Signs of Shock

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Are pre or postoperative arrhythmias a prognostic risk factor for GDV

Preoperative arrhythmias

What serum lactate for dogs with GDV is suggestive of gastric necrosis

> 6 mmol/L and persistent hyperlactemia

<4mmol/L is good

What serum lactate for dogs with GDV is a good prognosis

<4 mmol/L and a drop of >40% after fluid resuscitation is good

What stabilization should you give for dogs with GDV

Circulatory support

Gastric decompression- oral intubation, trocharization

How is gastric decompression achieved

Oral intubation Trocharization

Why should you give circulatory support to dogs with GDV

multifactorial shock - obstructive, distributive, cardiogenic pt will have tachycardia and weak pulses +/- arrhythmias

How should you provide circulatory support to patients with GDV

1) Cephalic catheters 2) Monitor PCV, TS, lactate 3) Crystalloids- 90 ml/kg, start with 1/4 dose, hang a liter 4) Colloids- are controversial

For rapid decompression should you use oral intubation or trocharization

Trochar

What are the pros of oral intubation for gastric decompression

evacuate stomach lavage

What are the cons of oral intubation for gastric decompression

Gastric rupture Stressful to the dog- need sedation? which is risky because they arent stabilized yet

What are the cons of trochar for gastric decompression

Iatrogenic trauma can not lavage can not access or assess contents

How is tube decompression achieved

1) Measure to the last rib 2) Pass large bore tube slowly 3) Change position if resistance 4) Drop the end of the tube in water 5) Lavage

Usually, trochar decompression is on which side

Right side (where stomach body is) spleen position is unpredictable ultrasound to make sure

What is used for trochar decompression

large hypodermic needle or large intravenous catheter

What is a crystalloid shock dose

about 90ml/kg start with 1/4

What is the success of tubing vs trochar for gastric decompression

75% tubing 86% trochar

What does GDV look like on radiographs

Right lateral view will see the double bubble/reverse C esophageal dilation, small vena cava, microcardia vs cardiomegaly

What is the surgical plan for GDV

1) Derotate the stomach 2) Abdominal exploratory 3) Assess splenic viability 4) +/- splenectomy 5) Assess gastric viability 6) +/- Gastrectomy 7) Gastropexy

Way to tie off the spleen

Hand suturing Stapling equipment Ligasure- a vessel sealing system that is combination of pressure and energy, upper limit of 7mm, 2 to 4 second seal cycle, feedback controlled response system

How do you tell gastric viability

Color Thickness Peristalsis Arterial pulsation Cut-surface bleeding

What is mucosal slip

in a healthy stomach, the mucosa and submucosa will slip away as a distinct layer. if not viable, there wont be a slip and just have a thin layer

What part of the stomach dies off first when blood supply is obstructed

Mucosa- 75% of the blood supply fundus, body, and greater curvature get the initial loss, but this is good because you can cut these if the pylorus is dead then the entire stomach is dead only isolation that can occur is the cardia

When doing a gastrectomy, you can resect up to ________& of the body of the stomach

70%

How do you close the stomach after doing a gastrectomy

Double-layer inverting pattern Thoracoabdominal stapler (TA 90) Invagination?- DONT DO IT

When doing a gastropexy for GDV you need to attach the ________ to the _______

pyloric antrum to the right side of the body wall pyrlous is the most mobile and the most viable part of the stomach

What is the most viable part of the stomach for GDV

pylorus

What is the most mobile part of the stomach

pylorus

T/F: invagination is an acceptable way to close a gastrectomy

False- very bad

What are acceptable ways to Gastropexy

1) Circumcostal 2) Belt-loop 3) Incisional 4) Smeak-o-pexy Incisional is most common- matching incisions in the antrum and body wall and suturing them together

What should you do for postoperative care after GDV surgery

-Continuous ECG monitoring -IV fluids -Fentanyl CRI -Lidocaine CRI -Gastrointestinal motility modifiers -Gastrointestinal protectants -Multiple small frequent meals

What is the prognosis of GDV

10-18% mortality Increased if splenectomy or gastrectomy Recurrence is <5%

Gastric malposition can cause

partial pyloric outflow obstruction