GDV Flashcards

1
Q

Describe acute gastric dilatation

A
  • stomach is in the normal position but very distended

- usually associated with over-eating

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2
Q

Describe chronic gastric volvulus

A
  • partial turn or misplacement of pylorus
  • causes decreased ability of eructation or increased gastric retention
  • gastropexy to fix
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3
Q

Describe the pathophysiology of GDV

A
  • 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
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4
Q

What are the cardiovascular effects of GDV?

A
  • compression of veins (decreased BP)
  • secretion of catecholamines (vasoconstriction)
  • arrhythmias
  • reperfusion injury
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5
Q

What are the respiratory effects of GDV?

A
  • distension puts pressure on diaphragm

- decreased excursions results in accumulation of CO2 (acidosis)

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6
Q

What are the GIT effects of GDV?

A
  • reduced blood supply to mucosa of stomach results in sloughing off and necrosis
  • bacterial translocation and septicemia
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7
Q

What are the metabolic effects of GDV?

A
  • poor tissue perfusion
  • cellular hypoxia
  • anaerobic metabolism
  • increased lactate
  • metabolic acidosis
  • liver/kidney buffer
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8
Q

What are the immune effects of GDV?

A
  • hypoxemia causing mucosal ischemia
  • loss of protective barrier
  • bacterial translocation
  • damage to lymphatics
  • portal hypertension
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9
Q

What are the renal effects of GDV?

A
  • vasoconstriction results in decreased GFR
  • decreased urine (oliguria)
  • acute renal failure
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10
Q

What is the typical history associated with GDV?

A
  • looking/biting at abdomen
  • “praying” position
  • non-productive retching
  • distended abdomen
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11
Q

What are the physical findings of GDV?

A
  • distended, painful, tympanic abdomen
  • active retching
  • hypersalivation
  • tachypnea, tachycardia
  • collapse
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12
Q

What are the laboratory findings associated with GDV?

A
  • increased WBC
  • increased ALT, bilirubin, BUN/Cr
  • hypokalemia
  • hypoglycemia
  • increased lactate
  • DIC
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13
Q

Which radiographic view is diagnostic for GDV?

A

right lateral

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14
Q

What are the treatment options for GDV?

A
  • fluids (shock doses)
  • decompression
  • pain management
  • antimicrobials and radical scavengers
  • surgery
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15
Q

What are the methods of gastric decompression?

A
  • orogastric tube
  • trocharization
  • emergency gastrostomy
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16
Q

What are the disadvantages of trocharization?

A
  • will not decompress stomach as well as tube
  • risk of lacerating stomach
  • can push needle into another organ
17
Q

Which type of drug is contraindicated in GDV patients?

A

glucocorticosteroids

18
Q

Describe gastric de-rotation

A
  • check position and palpate esophagus
  • push stomach dorsal and to the left
  • pull pylorus to the right
  • pass stomach tube
19
Q

How do you check for gastric wall viability?

A
  • presence of peristalsis
  • pink/red serosal color
  • palpate for thinning or friability
  • pulsation of vessels
  • bleeding of cut surfaces
20
Q

What does gastric necrosis normally occur in GDV?

A

along greater curvature of the stomach

21
Q

What are the techniques for a partial gastrectomy?

A
  • cut and sew
  • stapling
  • partial invagination
22
Q

Describe gastric invagination

A
  • necrotic section sloughs off and is digested
  • risk of gastric ulceration
  • can obstruct gastric outflow
23
Q

How is splenic viability evaluation?

A
  • venous congestion
  • vessel thrombosis
  • splenic torsion
24
Q

Describe incisional gastropexy

A
  • 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
25
Q

Describe belt loop gastropexy

A
  • 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
26
Q

Describe circumcostal gastropexy

A
  • make tunnel around last rib
  • create belt/flap off pyloric antrum
  • feed flap around the rib
27
Q

Describe tube gastropexy/gastrostomy

A
  • 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
28
Q

Describe incorporating gastropexy

A
  • stomach wall is incorporated in linea alba incision

- not recommended

29
Q

Describe laparoscopic-assisted gastropexy

A
  • dorsal recumbency
  • pull stomach up to abdominal wall
  • make incision into abdominal cavity and exteriorize that section of the stomach
  • do an incisional gastropexy
30
Q

Describe endoscopic-assisted gastropexy

A
  • 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
31
Q

What are the causes for post-op death?

A
  • shock
  • gastric necrosis
  • reperfusion injury
  • arrhythmias
32
Q

What is done for post-op care?

A
  • NPO for 24 hours
  • continue fluid for 24 hours
  • correct hypoK, hypoCl and metabolic acidosis
  • H2 blockers
  • coating agents
  • analgesics
33
Q

When is treatment of VPCs indicated?

A
  • associated with weakness or syncope
  • persistent tachycardia
  • pulse deficits or poor pulse quality
  • multifocal VPCs
34
Q

Which drug can be used to help reverse VPCs?

A

Lidocaine

35
Q

What is the prognosis for GDV?

A
  • 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