GDV Flashcards
Describe acute gastric dilatation
- stomach is in the normal position but very distended
- usually associated with over-eating
Describe chronic gastric volvulus
- partial turn or misplacement of pylorus
- causes decreased ability of eructation or increased gastric retention
- gastropexy to fix
Describe the pathophysiology of GDV
- stomach fills with gas or fluid, which alters sphincter position
- pylorus moves to the left as the rest of the stomach moves to the right
What are the cardiovascular effects of GDV?
- compression of veins (decreased BP)
- secretion of catecholamines (vasoconstriction)
- arrhythmias
- reperfusion injury
What are the respiratory effects of GDV?
- distension puts pressure on diaphragm
- decreased excursions results in accumulation of CO2 (acidosis)
What are the GIT effects of GDV?
- reduced blood supply to mucosa of stomach results in sloughing off and necrosis
- bacterial translocation and septicemia
What are the metabolic effects of GDV?
- poor tissue perfusion
- cellular hypoxia
- anaerobic metabolism
- increased lactate
- metabolic acidosis
- liver/kidney buffer
What are the immune effects of GDV?
- hypoxemia causing mucosal ischemia
- loss of protective barrier
- bacterial translocation
- damage to lymphatics
- portal hypertension
What are the renal effects of GDV?
- vasoconstriction results in decreased GFR
- decreased urine (oliguria)
- acute renal failure
What is the typical history associated with GDV?
- looking/biting at abdomen
- “praying” position
- non-productive retching
- distended abdomen
What are the physical findings of GDV?
- distended, painful, tympanic abdomen
- active retching
- hypersalivation
- tachypnea, tachycardia
- collapse
What are the laboratory findings associated with GDV?
- increased WBC
- increased ALT, bilirubin, BUN/Cr
- hypokalemia
- hypoglycemia
- increased lactate
- DIC
Which radiographic view is diagnostic for GDV?
right lateral
What are the treatment options for GDV?
- fluids (shock doses)
- decompression
- pain management
- antimicrobials and radical scavengers
- surgery
What are the methods of gastric decompression?
- orogastric tube
- trocharization
- emergency gastrostomy
What are the disadvantages of trocharization?
- will not decompress stomach as well as tube
- risk of lacerating stomach
- can push needle into another organ
Which type of drug is contraindicated in GDV patients?
glucocorticosteroids
Describe gastric de-rotation
- check position and palpate esophagus
- push stomach dorsal and to the left
- pull pylorus to the right
- pass stomach tube
How do you check for gastric wall viability?
- presence of peristalsis
- pink/red serosal color
- palpate for thinning or friability
- pulsation of vessels
- bleeding of cut surfaces
What does gastric necrosis normally occur in GDV?
along greater curvature of the stomach
What are the techniques for a partial gastrectomy?
- cut and sew
- stapling
- partial invagination
Describe gastric invagination
- necrotic section sloughs off and is digested
- risk of gastric ulceration
- can obstruct gastric outflow
How is splenic viability evaluation?
- venous congestion
- vessel thrombosis
- splenic torsion
Describe incisional gastropexy
- incision on right ventro-lateral wall
- roll the wall over and make incision through peritoneal and muscular layers
- lay pyloric antrum against this area and suture incisions together
Describe belt loop gastropexy
- parallel incisions through peritoneal and muscular layer to create tunnel
- create belt/flap off pyloric antrum
- tie suture to end of flap and feed through the loop, then reattach to stomach
Describe circumcostal gastropexy
- make tunnel around last rib
- create belt/flap off pyloric antrum
- feed flap around the rib
Describe tube gastropexy/gastrostomy
- stab incision into stomach and pass catheter
- tighten purse string around catheter
- other end comes out abdomen
- place multiple mattress sutures
- secure tube with finger trap
Describe incorporating gastropexy
- stomach wall is incorporated in linea alba incision
- not recommended
Describe laparoscopic-assisted gastropexy
- dorsal recumbency
- pull stomach up to abdominal wall
- make incision into abdominal cavity and exteriorize that section of the stomach
- do an incisional gastropexy
Describe endoscopic-assisted gastropexy
- place scope in esophagus and stomach
- use tip of scope to push antrum into right abdominal wall
- drive large suture through skin to hold stomach
- make incision into stomach adjacent to suture
What are the causes for post-op death?
- shock
- gastric necrosis
- reperfusion injury
- arrhythmias
What is done for post-op care?
- NPO for 24 hours
- continue fluid for 24 hours
- correct hypoK, hypoCl and metabolic acidosis
- H2 blockers
- coating agents
- analgesics
When is treatment of VPCs indicated?
- associated with weakness or syncope
- persistent tachycardia
- pulse deficits or poor pulse quality
- multifocal VPCs
Which drug can be used to help reverse VPCs?
Lidocaine
What is the prognosis for GDV?
- a leading cause of death in large breeds
- 10-33% mortality rate
- recumbent patients have higher mortality
- lacate levels > 6 mm/L indicate higher incidence of gastric necrosis
