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Small Animal Surgery > GDV > Flashcards

GDV Flashcards

1
Q

What is GDV?

A

Syndrome characterized by accumulation of gas in stomach &

subsequent rotation of stomach causing obstruction of eructation and pyloric outflow

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2
Q

What are the 3 presentations of GDV?

A
  • Gastric Dilation w/o rotation
  • Gastric Dilation Volvulus
  • Chronic
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3
Q

Which presentation is the worst in the long run for the animal?

A
  • Chronic is the most dangerous presentation
  • pt tries to vomit after eating a lot, exercising and drinking a lot of water.
  • The twisted stomach returns to normal position but is debilitated and doesn’t regain full strength
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4
Q

GDV is a medical emergency!!

What is the mortality rate?

A

15-28%

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5
Q

Where should you place a catheter in a GVD patient?

A

Jugular→ best

cephalic and IO→ okay

Never saphenous!

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6
Q

What is the eitiology of GDV?

A

Unclear but maybe due to delayed gastric emptying, laxity of ligaments, or commercial diets

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7
Q

What are the risk factors for GDV?

A
  • Breed predilection:
    • (Large/Giant) Danes, GSD, Dobie, St.Bernard
    • Deep, narrow chest (dachshund, cat)
  • Single meal
  • Rapid ingestion (airophagia)
  • Exercise after meal
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8
Q

What are the C/S of GDV?

A
  • Cranial Abdominal Distention
  • Tachypnea
  • Tympanic Abdomen
  • Pale MM
  • Splenomegaly
  • Altered Cardiac and RR parameters
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9
Q

What happens to the stomach in gastric dilation?

A
  • Stomach distension by air→ fluid & frothy mucoid substance
  • Frothy mucoid seals opening
  • Dilated stomach pushes against diaphram → imparing respiration & decreased blood return
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10
Q

What happens to the stomach with gastric torsion?

A
  • Stomache abruptly twists along long axis
  • Rotation is < 180 degrees so no complete obstruction
    • can be overlooked
  • Can lead rapidly to volvulus
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11
Q

What happens to the stomach in gastric volvulus?

A
  • Twisting of stomach along LONG axis
  • Rotation of gastro-esophgeal junction is > 180 degrees →COMPLETE esophageal and pyloric obstruction
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12
Q

2 requirements of GDV?

A
  • Failure of normal eructation
  • Acute pyloric outflow obstruction
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13
Q

In GDV w/ clockwise rotation, to what degree is the stomach rotated

and what confirms diagnosis?

A
  • Rotation: Between 180°-270°
  • Confirmation: Omentum seen wrapped around stomach
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14
Q

In GDV w/ counter clockwise rotation, to what degree is the stomach rotated?

A

90 degrees

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15
Q

Which is more common in GDV clockwise or counterclockwise rotation?

A

Clockwise

(99% of the time)

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16
Q

Time of day for GDV presentation most common to least?

A
  • Night → 68.7%
  • Afternoon → 22%
  • Morning →9.3%
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17
Q

What are the most common decompression methods used on GDV patients?

A
  • Orogastric intubation (sedate to avoid stressing p)
  • Gastrocetesis (use a long catheter)
  • Gastrostomy (rarely done, requires LA)
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18
Q

Why is a Gastrostomy a bad choice for a GDV p?

A

Prolongs SX b/c have to decompress stomach, suture the stomach, close the abdomen,

THEN perform GDV sx (endangers the patient)

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19
Q

C/S of a GDV Patient at risk of Shock?

A
  • Dyspnea + abdominal component
  • Debilitated (unresponsive)
  • Decreased HR & Conscience
  • Increased RR, followed by decreased RR
  • Back hair coat erect → p is trying to die
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20
Q

Should you be overly concerned with X-rays in an unstable GDV patient?

A

NO - Rads AREN’T therapeutic

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21
Q

When should you take rads of a GDV patient?

What are you looking for?

A
  • Once the patient is stable and more relaxed
  • Popeye flex or Smurf head
  • Compartmentalization → “Double Bubble” → ensures torsion has occurred
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22
Q

Why are Rads used in a GDV patient?

A

To distinguish a gastric dilation(GD) from GDV

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23
Q

What are the 3 main objectives of GDV SX Management?

A
  1. Reposition the stomach
  2. Assess severity of Ischemic injury
  3. Perform a gastropexy to prevent recurrence
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24
Q

How do you know if the stomach has be repositioned properly in a GDV patient?

Why are we concerned?

A
  • Pylorus is back on the R & the gastroesophageal jxn is NOT twisted
  • Stomach doesn’t always return to proper position after decompression
25
Q

What standard criteria are used to assess the severity of ischemic injury in a GDV case?

A

Check color of gastric wall, for presence of pulsating vessels, peristalsis

& bleeding from cut surface

26
Q

How is a “pinch test” helpful when assessing the integrity of the stomach of a GDV patient?

A

Devitalized areas will feel THINNER than adjacent viable tissue

(helps assess ischemia)

27
Q

How much of the stomach can be removed & the stomach still be viable?

A

50-60%

28
Q

What must you ALWAYS do when performing a GDV SX?

A

EXPLORATORY CELIOTOMY!!!!!!!!!!!

29
Q

What are we often worried about in GDV patient suffering from ischemia?

A

Reperfusion injuries

30
Q

What type of Gastropexy reduces GDV recurrence by 92%?

A

RIGHT sided Gastropexy

31
Q

What should you do after performing a Right sided Gastropexy in a GDV patient?

A

Document it in patient’s medical record!!!!!!!

(has implications for future SXs)

32
Q

List the 4 different Gastropexy Techniques used for GDV correction.

A
  • Circumcostal Gastropexy
  • Belt Loop Gastropexy
  • Incisional Gastropexy
  • Grid Approach Gastropexy
33
Q

How is a Circumcostal Gastropexy performed?

A
  • Flap is created from the pyloric antrum & passed through the rib musculature
  • Flap is sutured back to the stomach
34
Q

What are the dimensions of the flap created in a Circumcostal Gastropexy?

A

Height of flap should be 1 1/2 times the width of the flap

35
Q

How is the flap created in a Circumcostal Gastropexy?

A

from LESSER curvature of the stomach → lift up seromuscularis of pyloric antrum →

bring antrum as close as possible to the last rib

36
Q

What happens if you hear a “hissing” sound while performing a Circumcostal Gastropexy?

A

Need a Thoracostomy tube!!!!

37
Q

Where does the flap come from in a Belt Loop Gastropexy?

A

@ the level of the antrum from the the GREATER curvature of the stomach

38
Q

Why is a Belt Loop Gastropexy preferred to a Circumcostal one?

A
  • Easier to do & safer
  • Can save time using skin staples
39
Q

Describe a Belt Loop Gastropexy

A
  • Flap made from greater curvature
  • 2 PARALLEL incisions over Transversus abdominus mm CAUDAL to the last rib
  • Pass “belt” through the transversus mm & suture back to the antrum
40
Q

Describe an Incisional Gastropexy

A
  • Secures pyloric antrum to abdominal wall
  • 2 incisions
  • Suture the seromuscularis layer of the pyloric antrum to the muscle wall of the abdomen
  • Just as strong as the Circumcostal method
41
Q

When can you perform a Gastropexy via Grid Approach?

A
  • As a LAST RESORT, only if decompression was successful and owner can’t do SX
  • prophylatic gastropexy
42
Q

How do you perform a Gastropexy via Grid Approach?

A
  • Bypass the esophagus and place a peg tube
  • Go all the way through to mucosa & submucosa
  • Attach peg tube to abdominal wall
43
Q

Advantages of Gastrostomy Tube?

A
  • Easy access for food & medications
  • decompresses the stomach
44
Q

How do you pace a Gastrostomy Tube?

What should you avoid?

A
  • Wide incision lateral to the nipple line
  • Place tube @ level of pyloric antrum & inflate balloon @ the tube’s end w/ saline
  • Secure tube to stomach with Purse String suture pattern *Pull stomach against abdominal wall to secure
  • Use a Chinese Finger Trap to secure the tube externally *
  • Remove in 5-7 d.
  • Don’t obstruct the pylorus
45
Q

What technique is performed to remove dark tissue (dead) from the stomach?

A

Gastrectomy

46
Q

What percentage of patients requiring a partial Gastrectomy die?

A

35% or 1/3

47
Q

What should you avoid when performing a Gastrectomy?

Why?

A

Leaving unhealthy tissue behind → Increases risks of rupture & subsequent peritonitis

48
Q

At what level should you scrape the surface of the stomach to check for stomach health?

A

Boundary between live & dead tissue

49
Q

What technique can be used for prophylactic gastropexy during on OHE?

A

Laparoscopy

50
Q

How do you perform an Invagination (Gastrorrhaphy)?

A
  • Determine amt of tissue that must be removed
  • **INVERT tissue & suture it **
  • Avoid harming the Greater Curvature vessels
  • Tissue will slough off & be digested
51
Q

Post-Op care for GDV SX?

A

*Intensive monitoring *Fasting/Enteral nutrition/Bland diet/low residue *ABX *SX control *Cardiac control *Pain control

52
Q

What should be monitored during Post-Op GDV recovery?

A
  • SX site →E-collar
  • Urinary catheter → 1-2 mL/Kg/hr of urine
  • Continually check BUN & Creatinine (TQ)
53
Q

What is the ABX regime for GDV SX?

A
  • ABX post op
  • Repeat ABX if SX is > 90 min.
54
Q

What should you always watch out for in Post-Op GDV patients?

(think <3)

A

Premature Ventricular Contractions→ can kill!

(always have an ECG on them)

55
Q

What are some important points when educating clients about GDV?

A
  • Several meals a day (min of 2)
  • High protein (>30%, raw meat is good)
  • Low fat diets
  • Only feed small volumes each meal
  • Need adequate amt of fiber
  • No strong exercise after eating
  • Control water intake post meal
  • Don’t perform a gastropexy → 75.8% of dogs will develop GDV again
56
Q

List factors that increase the risk of bloat (GDV) in large breed dogs.

A
  • Raising the food dish→doubles the risk
  • Very fast eaters→ 38% increased risk
  • Age →risk increases 20% w/ each additional yr of age
  • Family HX →immediate relative w/ GDV increases patient’s risk by 63%
57
Q

When is the risk of post-op mortality the most high for GDV patients?

A

First 4 d. post-op

58
Q

What often is the PRIMARY cause of post-op mortality in GDV patients?

(3)

A
  • Gastric necrosis
  • Gastric rupture
  • Peritonitis
59
Q

What is often the SECONDARY cause of post-op mortality in GDV patients?

A

Cardiac arrhythmias (50.6%)

Small Animal Surgery (10 decks)

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