GDV Flashcards
What is GDV?
Syndrome characterized by accumulation of gas in stomach &
subsequent rotation of stomach causing obstruction of eructation and pyloric outflow
What are the 3 presentations of GDV?
- Gastric Dilation w/o rotation
- Gastric Dilation Volvulus
- Chronic
Which presentation is the worst in the long run for the animal?
- 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
GDV is a medical emergency!!
What is the mortality rate?
15-28%
Where should you place a catheter in a GVD patient?
Jugular→ best
cephalic and IO→ okay
Never saphenous!
What is the eitiology of GDV?
Unclear but maybe due to delayed gastric emptying, laxity of ligaments, or commercial diets
What are the risk factors for GDV?
- Breed predilection:
- (Large/Giant) Danes, GSD, Dobie, St.Bernard
- Deep, narrow chest (dachshund, cat)
- Single meal
- Rapid ingestion (airophagia)
- Exercise after meal
What are the C/S of GDV?
- Cranial Abdominal Distention
- Tachypnea
- Tympanic Abdomen
- Pale MM
- Splenomegaly
- Altered Cardiac and RR parameters
What happens to the stomach in gastric dilation?
- Stomach distension by air→ fluid & frothy mucoid substance
- Frothy mucoid seals opening
- Dilated stomach pushes against diaphram → imparing respiration & decreased blood return
What happens to the stomach with gastric torsion?
- Stomache abruptly twists along long axis
- Rotation is < 180 degrees so no complete obstruction
- can be overlooked
- Can lead rapidly to volvulus
What happens to the stomach in gastric volvulus?
- Twisting of stomach along LONG axis
- Rotation of gastro-esophgeal junction is > 180 degrees →COMPLETE esophageal and pyloric obstruction
2 requirements of GDV?
- Failure of normal eructation
- Acute pyloric outflow obstruction
In GDV w/ clockwise rotation, to what degree is the stomach rotated
and what confirms diagnosis?
- Rotation: Between 180°-270°
- Confirmation: Omentum seen wrapped around stomach
In GDV w/ counter clockwise rotation, to what degree is the stomach rotated?
90 degrees
Which is more common in GDV clockwise or counterclockwise rotation?
Clockwise
(99% of the time)
Time of day for GDV presentation most common to least?
- Night → 68.7%
- Afternoon → 22%
- Morning →9.3%
What are the most common decompression methods used on GDV patients?
- Orogastric intubation (sedate to avoid stressing p)
- Gastrocetesis (use a long catheter)
- Gastrostomy (rarely done, requires LA)
Why is a Gastrostomy a bad choice for a GDV p?
Prolongs SX b/c have to decompress stomach, suture the stomach, close the abdomen,
THEN perform GDV sx (endangers the patient)
C/S of a GDV Patient at risk of Shock?
- Dyspnea + abdominal component
- Debilitated (unresponsive)
- Decreased HR & Conscience
- Increased RR, followed by decreased RR
- Back hair coat erect → p is trying to die
Should you be overly concerned with X-rays in an unstable GDV patient?
NO - Rads AREN’T therapeutic
When should you take rads of a GDV patient?
What are you looking for?
- Once the patient is stable and more relaxed
- Popeye flex or Smurf head
- Compartmentalization → “Double Bubble” → ensures torsion has occurred
Why are Rads used in a GDV patient?
To distinguish a gastric dilation(GD) from GDV
What are the 3 main objectives of GDV SX Management?
- Reposition the stomach
- Assess severity of Ischemic injury
- Perform a gastropexy to prevent recurrence
How do you know if the stomach has be repositioned properly in a GDV patient?
Why are we concerned?
- Pylorus is back on the R & the gastroesophageal jxn is NOT twisted
- Stomach doesn’t always return to proper position after decompression
What standard criteria are used to assess the severity of ischemic injury in a GDV case?
Check color of gastric wall, for presence of pulsating vessels, peristalsis
& bleeding from cut surface
How is a “pinch test” helpful when assessing the integrity of the stomach of a GDV patient?
Devitalized areas will feel THINNER than adjacent viable tissue
(helps assess ischemia)
How much of the stomach can be removed & the stomach still be viable?
50-60%
What must you ALWAYS do when performing a GDV SX?
EXPLORATORY CELIOTOMY!!!!!!!!!!!
What are we often worried about in GDV patient suffering from ischemia?
Reperfusion injuries
What type of Gastropexy reduces GDV recurrence by 92%?
RIGHT sided Gastropexy
What should you do after performing a Right sided Gastropexy in a GDV patient?
Document it in patient’s medical record!!!!!!!
(has implications for future SXs)
List the 4 different Gastropexy Techniques used for GDV correction.
- Circumcostal Gastropexy
- Belt Loop Gastropexy
- Incisional Gastropexy
- Grid Approach Gastropexy
How is a Circumcostal Gastropexy performed?
- Flap is created from the pyloric antrum & passed through the rib musculature
- Flap is sutured back to the stomach
What are the dimensions of the flap created in a Circumcostal Gastropexy?
Height of flap should be 1 1/2 times the width of the flap
How is the flap created in a Circumcostal Gastropexy?
from LESSER curvature of the stomach → lift up seromuscularis of pyloric antrum →
bring antrum as close as possible to the last rib
What happens if you hear a “hissing” sound while performing a Circumcostal Gastropexy?
Need a Thoracostomy tube!!!!
Where does the flap come from in a Belt Loop Gastropexy?
@ the level of the antrum from the the GREATER curvature of the stomach
Why is a Belt Loop Gastropexy preferred to a Circumcostal one?
- Easier to do & safer
- Can save time using skin staples
Describe a Belt Loop Gastropexy
- 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
Describe an Incisional Gastropexy
- 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
When can you perform a Gastropexy via Grid Approach?
- As a LAST RESORT, only if decompression was successful and owner can’t do SX
- prophylatic gastropexy
How do you perform a Gastropexy via Grid Approach?
- Bypass the esophagus and place a peg tube
- Go all the way through to mucosa & submucosa
- Attach peg tube to abdominal wall
Advantages of Gastrostomy Tube?
- Easy access for food & medications
- decompresses the stomach
How do you pace a Gastrostomy Tube?
What should you avoid?
- 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
What technique is performed to remove dark tissue (dead) from the stomach?
Gastrectomy
What percentage of patients requiring a partial Gastrectomy die?
35% or 1/3
What should you avoid when performing a Gastrectomy?
Why?
Leaving unhealthy tissue behind → Increases risks of rupture & subsequent peritonitis
At what level should you scrape the surface of the stomach to check for stomach health?
Boundary between live & dead tissue
What technique can be used for prophylactic gastropexy during on OHE?
Laparoscopy
How do you perform an Invagination (Gastrorrhaphy)?
- Determine amt of tissue that must be removed
- **INVERT tissue & suture it **
- Avoid harming the Greater Curvature vessels
- Tissue will slough off & be digested
Post-Op care for GDV SX?
*Intensive monitoring *Fasting/Enteral nutrition/Bland diet/low residue *ABX *SX control *Cardiac control *Pain control
What should be monitored during Post-Op GDV recovery?
- SX site →E-collar
- Urinary catheter → 1-2 mL/Kg/hr of urine
- Continually check BUN & Creatinine (TQ)
What is the ABX regime for GDV SX?
- ABX post op
- Repeat ABX if SX is > 90 min.
What should you always watch out for in Post-Op GDV patients?
(think <3)
Premature Ventricular Contractions→ can kill!
(always have an ECG on them)
What are some important points when educating clients about GDV?
- 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
List factors that increase the risk of bloat (GDV) in large breed dogs.
- 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%
When is the risk of post-op mortality the most high for GDV patients?
First 4 d. post-op
What often is the PRIMARY cause of post-op mortality in GDV patients?
(3)
- Gastric necrosis
- Gastric rupture
- Peritonitis
What is often the SECONDARY cause of post-op mortality in GDV patients?
Cardiac arrhythmias (50.6%)
