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RUSVM Small Animal Surgery 1 > GDV > Flashcards

GDV Flashcards

1
Q

T/F: dilation of the stomach is requires medical treatment, but if volvulus is present it is surgical

A

True

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2
Q

What component of diet predisposes animals to GDV?

A

Increased vol of food fed once daily

Dry kibble

Fat/oils in 1st four ingredients

Raised food bowl

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3
Q

T/F: fish or egg supplements in feed increase risk of GDV?

A

False

Decrease risk

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4
Q

T/F: exercise pre or post prandial is a risk factor for GDV

A

False

No evidence that it has an impact

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5
Q

What breeds are highest risk for GDV?

A

Deep chested breeds

Great Dane 
St Bernard 
Weimaraner 
Irish setter 
Gordon setter
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6
Q

Does temperament affect risk for GDV?

A

Yes

Increased risk seen in dogs with anxiety, aggression to people

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7
Q

What procedure can put dogs at a higher risk of developing GDV?

A

Splenectomy

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8
Q

What is reperfusion injury?

A

Period when blood flow to tissue is absent followed by return of blood flow

Anaerobic metabolism by products

Accumulation of cellular waste products, toxins, and toxic oxygen radicals

Once perfusion is restored, toxins are released into general circulation

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9
Q

What is the most common direction of gastric rotation?

A

Clockwise

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10
Q

What is the difference between a torsion and volvulus?

A

Torsion <180

Volvulus >180

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11
Q

How does GDV appear with clockwise displacement?

A

Pylorus moves along ventral abdomen to left side

Stomach covered by omentum

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12
Q

How does GDV appear with counterclockwise displacement?

A

Pylorus moves dorsally to lie adjacent to esophagus

Greater curvature is along midline

Stomach is NOT covered by omentum

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13
Q

Clinical signs of GDV?

A 
Acute abdomen 
Restlessness
Hypersalivation 
“Praying” posture 
Vomiting 
Weakness 
Collapse
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14
Q

A dog comes in with a GDV.. what will you do first?

A

Stabilize !!

Aggressive fluid therapy — large bore cephalic or jugular catheter
Initially - crystalloid or hypertonic saline
Maintenance - crystalloid or colloid

BP and EKG monitoring

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15
Q

How do lactate levels relate to survival rate in GDV?

A

Absolute value is not as value and change in lactate in response to fluid resuscitation

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16
Q

T/F: you always do a gastric decompression before GDV surgery

A

True

  • improves CV and respiratory fxn
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17
Q

What is the 1st choice method for gastric decompression?

A

Stomach tube (orogastric)

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18
Q

How will you preform gastric decompression ?

A

Sedation +/- General anesthesia

Bite block
Measure tube length (mouth to xyphoid)

Advance tube slowly
Empty contents
Check effluent
Gastric lavage with 5-10ml/kg warm water

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19
Q

What will you do if you are unable to pass a orogastric tube in a GDV patient?

A

Trocharization

  • large bore needle/catheter
  • most typmapic site
20
Q

Complications of trocharization?

A

Hit spleen — hemorrhage

Leakage

21
Q

What will you see in radon a dog with GDV?

A

C shaped stomach
“Double bubble”

Pyloris is dorsal
Esophagus is distended

22
Q

How can you manage reperfusion injury?

A

Free radical scavengers.

Acetylcystine
Vit C, vit E, selenium
Desferoxamine (iron chelator)
Lidocaine

23
Q

What pain control can you use with GDV?

A

Oxymorphone, fentanyl, Buprenorphine

— drugs with minimal CV effects

24
Q

What are the benefits of early surgery for GDV?

A

Gastric repositioning improves blood flow

Surgery may be completed before onset of arrhythmia (better prognosis)

25
Q

How will you reposition the stomach ?

A

Decompress if still distended

Push down on fundus with right hand

Grasp pyloric antrum with left hand and treated stomach counterclockwise

  • confirm proper reduction by examining gastroesophageal junction
26
Q

How do you assess gastric viability?

A

Colour
Pulsation of blood vessels
Bleeding from cut surface
Peristalsis ** good indicator of healthy GI**

Palpate wall thickness “slip”
Surface oximetry

27
Q

T/F: is there is gastric necrosis it is usually along the greater curvature

A

True

  • partial gastrectomy required
28
Q

When reducing a GDV, you must always evaluate the spleen.. when is a splenectomy indicated with GDV?

A

Vessel thrombosis

Splenic torsion

29
Q

T/F: you should always do a gastropexy following reduction of GDV

A

True

Decreases recurrence from 50% to 4%

30
Q

What are the techniques that can be used for gastropexy?

A 
Incisional 
Belt loop 
Circumcostal 
Laparoscopic 
Endoscopic

All seem to perform similarly with 95% success rate

31
Q

What gastropexy technique involves incising the seromuscular layer in gastric antrum and the right abdominal wall and suturing these two edges together?

A

Incisional gastropexy

— use simple continuous pattern

32
Q

What is the minimum length that your incision should be for incisional gastropexy?

A

3cm

33
Q

What is the strongest gastropexy technique with a seromusuclar flap placed round the 13th rib?

A

Circumcostal

Risk
- rib fracture and pneumothorax

34
Q

What are the advantages to endoscopic assisted gastropexy?

A

Pyloric antrum is accurately visualized

Gastropexy can be performed with standard surgical instruments

35
Q

When would you do a prophylactic gastropexy?

A

Breed risk (eg Great Danes have 30x reduction in mortality)

Identified risk factors

Owner request

36
Q

What are the methods used for prophylactic gastropexy?

A

Open - during an elective OVH, castration

Laparoscopic

Endoscopic-assisted

37
Q

T/F: gastropexy prevents gastric dilation

A

False

38
Q

What post op care do you do in GDV reduction cases?

A

NPO for 12-24hrs
Fluid and electrolyte replacement

Monitor arrhythmia for 24hrs

Pain control

Blood pressure monitoring - hypotension at any time is a risk factor for death

Limit exercise

Anti-emetic - maropitant
H2 antagonist
Sucralfate
+/- metoclopramide

39
Q

Deaths following GDV occur in the 1st four days post op due to???

A

Shock - hypovolemic or shock

Gastric necrosis —> peritonitis

  • unrecognized area of necrosis
  • perforating ulcer
  • reperfusion injury

Cardiac arrhythmia

40
Q

Common electrolyte disturbances with GDV?

A

Hypokalemia. - potentiate arrhythmias, muscular weakness, and lethargy

Hypochloremia - gastric sequestration

41
Q

How common are arrhythmias with GDV and when do they begin?

A

50% will develop

12-36 hours after onset of GDV

42
Q

What are causes of cardiac arrhythmia?

A 
Myocardial ischemia 
Electrolyte abnormalities 
Acid-base alterations 
Vasoactive substances 
Imbalance of autonomic nervous system
43
Q

What are the most common types of ventricular arrhythmias?

A 
Premature ventricular contractions 
Paroxysmal ventricular arrhythmia (runs) 
Idioventricular rhythm (slow V-tach) 
Ventricular tachycardia 
Multifocal PVCs
44
Q

When do you treat cardiac arrhythmia?

A

V-tach with high rate (>180-190bpm)

  • pulse deficits
  • poor pulse quality
  • weakness

Multifocal PVC

45
Q

How do you treat cardiac arrhythmia associated with GDV?

A

Lidocaine

  • bolus or CRI
46
Q

What do you do for a refractory arrhythmia ?

A

Check electrolytes- K, Mg, and Ca

Pain management

47
Q

What is the prognosis for GDV?

A

80-90% survival in uncomplicated cases

30-40ish % mortality for cases with gastric necrosis/ partial gastrectomy/ splenectomy

55% mortality for cases with partial gastrectomy AND splenectomy

RUSVM Small Animal Surgery 1 (39 decks)

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