GDV Flashcards
What does GDV stand for?
Gastric Dilation-Volvulus
What changes occur to the stomach in a dog with GDV?
Gross gaseous distension
Rotation of the stomach around the long axis of the oesophagus
(Pelorus moves from the RHS along the ventral body wall to the left)
What can lead to gastric dilation?
Failure of eructation
Delayed/impaired gastric emptying
What are the four key immediate effects of GDV?
Obstruction of the caudal vena cava
Increased gastric pressure and avulsion of the short gastric vessels
Stretching and avulsion of splenic vessels and splenic torsion
Cranial pressure on the diaphragm
How can obstruction of the caudal vena cava affect the patient?
Decreased venous return to the heart
Decreased cardiac output
Hypovolaemic shock
What happens as a result of increased gastric pressure and avulsion of the short gastric vessels?
Mucosal haemorrhage and ischaemia
Gastric wall necrosis
What happens as a result of stretching and avulsion of the splenic vessels and splenic torsion?
Splenic necrosis
What happens as a result of increased cranial pressure on the diaphragm?
Poor ventilation
What are the downstream results of GDV which may present as clinical signs?
Metabolic derangements
Arrhythmia should
Inflammation, endotoxaemia, disseminated intravascular coagulation (DIC)
What are some key parts of the history which may indicate GDV?
Large breed
Exercise
Dog is deteriorating, progressive weakness
Evidence of potential respiratory collapse (e.g. respiratory collapse)
What is the normal resps for a large breed?
90-100
A dog presents with suspected GDV. What interventions do you perform.
Place IV catheter and give fluids
Take a radiograph of the abdomen
How would you administer fluids to this patient? Why?
Place large bore catheters in BOTH cephalic veins
If you put fluid in saphenous, it will get obstructed at the level of the caudal vena cava.
What radiographic signs are characteristic of GDV?
Division of the stomach into two compartments by a soft tissue band.
- Pylorus forms top small section.
This can help differentiate between GDV and GD.
(Stomach stretching beyond the costal arch indicates dilation)
How would you perform gastric decompression?
Orogastric tube
Measure from nose to costal arch then mark with tape
Give a small amount of sedation and use a roll of tape to stop dog chewing
Pass tube through mouth into stomach
If you are unable to pass a stomach tube in to the stomach on the first attempt, what should you do?
Why?
Decompress the stomach by passing a catheter through the skin and into the stomach
(Percutaneous gastric decompression)
Buys you time
What are the aims of surgical treatment of GDV?
- Derotation of the stomach
- Removal of necrotic tissue
- Gastropexy
How could you tell whether the stomach has twisted clockwise or anticlockwise?
If you can see OMENTUM over the top of the stomach, the stomach has twisted CLOCKWISE
What should you do once you have returned the stomach to its normal position?
Empty the stomach with a tube into a bucket on the floor.
Flush through with warm water
Which part of the stomach commonly dies in GDV cases?
Why?
Fundus
Rupture of short gastric vessels PLUS pressure necrosis of mucosa
When is there poor prognosis for patients with gastric necrosis?
When necrosis reaches the oesophageal junction
Why is gastropexy important?
To prevent GDV recurrence
How should a gastropexy be performed?
Incisional gastropexy
Suture pylorus to right body wall
Place sutures closest to the thorax first and then move caudally.
When might you perform a tube gastropexy ?
Some dogs will be more likely to bloat after surgery
What post-operative care is required for patients who have undergone GDV corrective surgery?
Fluid therapy Potassium supplementation Analgesia Treatment for gastric ulceration Gastric motility drugs Antibiotics (to prevent endotoxaemia) Nutrition
What disease of the lungs is often present in dogs with GDV?
Aspiration pneumonia
What post-op complication can affect the heart?
What treatment is required?
Idioventricular rhythm
As long as BP is maintained, you don’t need to treat
What factors affect the prognosis of GDV patients post treatment?
Very good if no necrosis present
Survival rates around 70% with gastric necrosis
What client report is indicative of GDV?
abdominal distension with non-productive retching
How should a patient be stabilised before surgery?
Aggressive IV fluid therapy
What diagnostic imaging should be used to confirm GDV?
Right Lateral Radiograph
