GDV

Question 1

What does the initial stabilization of a GDV patient entail?

Answer 1

aggressive fluid therapy
(use large bore cephalic or jugular catheters - 16 or 18G)
-initial: crystalloid solutions, hypertonic saline
- maintenance: crystalloids, colloids

blood pressure and EKG monitoring

Question 2

Why do we look at lactate levels in GDV diagnostics?

Answer 2

predictor as to how well animal is perfusing and responding to our management of their perfusion

should be less than 1,
but the goal is more to evaluate trends

Question 3

What are the two methods of Gastric Decompression?

Answer 3

1. Orogastric tube
2. Trocharization

Question 4

When we auscult the stomach prior to trocharization, we can “ping” the GDV patient similarly to the large animal. In the absence of a tympanic ping, and instead there’s a dull sound, should we just proceed?

Answer 4

NO.
it could be the spleen in front of there!
(Spleen can twist with the stomach)
don’t go sticking a large bore needle in an already enlarged spleen
…DUH

Question 5

How do we treat GDV?

Answer 5

Oxygen therapy,
pain control (oxymorphone, fentanyl, buprenorphine),
correct electrolyte-A/B-imbalance

Question 6

What are the free radical scavengers involved in reperfusion injury?

Answer 6

acetylcysteine
Vit C, E, and Selenium
desferoxamine (iron chelation)
lidocaine (from ROS)

Question 7

What are the 5 big goals of surgical management?

Answer 7

1. Gastric repositioning
2. Assess gastric viability
3. Evaluate pylorus
4. Evaluate spleen
5. Gastropexy (prevent from happening again)

Question 8

Explain how to reposition the stomach…

Answer 8

First, make sure you decompress the stomach if it’s still distended…

(for a clockwise rotation - the most common type - by R-handed surgeons)
push down on fundus with right hand
(Pylorus moves from right to left in GDV; do this first so you can do the next thing…)

grasp pyloric antrum with left hand,
and rotate stomach counterclockwise, and allow things to fall back to how they should, evaluate/assess…

Question 9

Dr. Karnik prefers the Incisional Gastropexy technique. How is this done?

Answer 9

Easy…
make 2 incisions and suture back together…

Incise the seromuscular layer
of the gastric antrum (near the area of the pylorus)…

and we’re suturing it to the right abdominal wall (so we need a corresponding incision in our transversus muscle in the right abdominal wall)
use simple continuous pattern

*photo shows 2 longitudinal incisions in the transversus m.*

Question 10

50% of GDV patients will develop cardiac arrhythmia. What type are they typically?

Answer 10

ventricular

*12-36 hours after onset of GDV*

Question 11

GDV patient presents with the following…

HR: 170bpm, uniform ventricular rhythms, strong pulses, normal BP
do you treat for cardiac arrhythmia?

Answer 11

Not yet.

if they breach 180, pulse deficits,
and multi-focal VPCs are present…
need to be treated (can turn into Vfib)

give lidocaine bolus

Question 12

In gastric displacement, clockwise rotation of <180^o is referred to as a _______,
whereas clockwise rotation of >180^o is a ________.

Answer 12

Torsion;
volvulus

Question 13

Why is GDV a systemic condition and not JUST affecting the stomach?

Answer 13

GDV is putting pressure on the caudal vena cava,
which is key…

This leads to decreased venous return
and decreased CO so insufficient perfusion…