GDV Flashcards
T/F: dilation of the stomach is requires medical treatment, but if volvulus is present it is surgical
True
What component of diet predisposes animals to GDV?
Increased vol of food fed once daily
Dry kibble
Fat/oils in 1st four ingredients
Raised food bowl
T/F: fish or egg supplements in feed increase risk of GDV?
False
Decrease risk
T/F: exercise pre or post prandial is a risk factor for GDV
False
No evidence that it has an impact
What breeds are highest risk for GDV?
Deep chested breeds
Great Dane St Bernard Weimaraner Irish setter Gordon setter
Does temperament affect risk for GDV?
Yes
Increased risk seen in dogs with anxiety, aggression to people
What procedure can put dogs at a higher risk of developing GDV?
Splenectomy
What is reperfusion injury?
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
What is the most common direction of gastric rotation?
Clockwise
What is the difference between a torsion and volvulus?
Torsion <180
Volvulus >180
How does GDV appear with clockwise displacement?
Pylorus moves along ventral abdomen to left side
Stomach covered by omentum
How does GDV appear with counterclockwise displacement?
Pylorus moves dorsally to lie adjacent to esophagus
Greater curvature is along midline
Stomach is NOT covered by omentum
Clinical signs of GDV?
Acute abdomen Restlessness Hypersalivation “Praying” posture Vomiting Weakness Collapse
A dog comes in with a GDV.. what will you do first?
Stabilize !!
Aggressive fluid therapy — large bore cephalic or jugular catheter
Initially - crystalloid or hypertonic saline
Maintenance - crystalloid or colloid
BP and EKG monitoring
How do lactate levels relate to survival rate in GDV?
Absolute value is not as value and change in lactate in response to fluid resuscitation
T/F: you always do a gastric decompression before GDV surgery
True
- improves CV and respiratory fxn
What is the 1st choice method for gastric decompression?
Stomach tube (orogastric)
How will you preform gastric decompression ?
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
What will you do if you are unable to pass a orogastric tube in a GDV patient?
Trocharization
- large bore needle/catheter
- most typmapic site
Complications of trocharization?
Hit spleen — hemorrhage
Leakage
What will you see in radon a dog with GDV?
C shaped stomach
“Double bubble”
Pyloris is dorsal
Esophagus is distended
How can you manage reperfusion injury?
Free radical scavengers.
Acetylcystine
Vit C, vit E, selenium
Desferoxamine (iron chelator)
Lidocaine
What pain control can you use with GDV?
Oxymorphone, fentanyl, Buprenorphine
— drugs with minimal CV effects
What are the benefits of early surgery for GDV?
Gastric repositioning improves blood flow
Surgery may be completed before onset of arrhythmia (better prognosis)
How will you reposition the stomach ?
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
How do you assess gastric viability?
Colour
Pulsation of blood vessels
Bleeding from cut surface
Peristalsis ** good indicator of healthy GI**
Palpate wall thickness “slip”
Surface oximetry
T/F: is there is gastric necrosis it is usually along the greater curvature
True
- partial gastrectomy required
When reducing a GDV, you must always evaluate the spleen.. when is a splenectomy indicated with GDV?
Vessel thrombosis
Splenic torsion
T/F: you should always do a gastropexy following reduction of GDV
True
Decreases recurrence from 50% to 4%
What are the techniques that can be used for gastropexy?
Incisional Belt loop Circumcostal Laparoscopic Endoscopic
All seem to perform similarly with 95% success rate
What gastropexy technique involves incising the seromuscular layer in gastric antrum and the right abdominal wall and suturing these two edges together?
Incisional gastropexy
— use simple continuous pattern
What is the minimum length that your incision should be for incisional gastropexy?
3cm
What is the strongest gastropexy technique with a seromusuclar flap placed round the 13th rib?
Circumcostal
Risk
- rib fracture and pneumothorax
What are the advantages to endoscopic assisted gastropexy?
Pyloric antrum is accurately visualized
Gastropexy can be performed with standard surgical instruments
When would you do a prophylactic gastropexy?
Breed risk (eg Great Danes have 30x reduction in mortality)
Identified risk factors
Owner request
What are the methods used for prophylactic gastropexy?
Open - during an elective OVH, castration
Laparoscopic
Endoscopic-assisted
T/F: gastropexy prevents gastric dilation
False
What post op care do you do in GDV reduction cases?
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
Deaths following GDV occur in the 1st four days post op due to???
Shock - hypovolemic or shock
Gastric necrosis —> peritonitis
- unrecognized area of necrosis
- perforating ulcer
- reperfusion injury
Cardiac arrhythmia
Common electrolyte disturbances with GDV?
Hypokalemia. - potentiate arrhythmias, muscular weakness, and lethargy
Hypochloremia - gastric sequestration
How common are arrhythmias with GDV and when do they begin?
50% will develop
12-36 hours after onset of GDV
What are causes of cardiac arrhythmia?
Myocardial ischemia Electrolyte abnormalities Acid-base alterations Vasoactive substances Imbalance of autonomic nervous system
What are the most common types of ventricular arrhythmias?
Premature ventricular contractions Paroxysmal ventricular arrhythmia (runs) Idioventricular rhythm (slow V-tach) Ventricular tachycardia Multifocal PVCs
When do you treat cardiac arrhythmia?
V-tach with high rate (>180-190bpm)
- pulse deficits
- poor pulse quality
- weakness
Multifocal PVC
How do you treat cardiac arrhythmia associated with GDV?
Lidocaine
- bolus or CRI
What do you do for a refractory arrhythmia ?
Check electrolytes- K, Mg, and Ca
Pain management
What is the prognosis for GDV?
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
