GDV Flashcards
Which breeds are predisposed to GDV?
Large, deep-chested breeds
Which breed is the poster child for GDV?
Great dane
What is the approximate mortality rate for GDV?
15-30%
What are common clinical signs of GDV?
Non-productive retching/vomiting, abd distension, hypersalivation
What is the pathophysiology of GDV?
Counter-clockwise rotation of the stomach (view from Cr to Ca in dorsal recumbency)
How does volvulus of the stomach cause cardiovascular problems?
Venous compression, congestion, and local blood perfusion compromise to the stomach (necrosis)
Which vessels can be torn d/t a gastric volvulus?
Short gastric vessels
What do the short gastric vessels connect?
Connect stomach and spleen
What type of shock does GDV cause?
Obstructive or hypovolemic
What radiographs are diagnostic for GDV?
R lateral
What sign do we see on R lateral radiographs that is definitive of GDV?
“Double bubble”
What is the likelihood that a Great Dane will develop GDV in its lifetime?
37%
What other factors of a dog’s lifestyle predispose them to GDV?
Anxiety, very fast eaters
What arrhythmia is most likely assoc. w/GDV?
VPCs
When are arrhythmias assoc. w/GDV most likely to occur?
Especially after surgery
What will a GDV blood gas analysis show?
Metabolic acidosis
How do you stabilize a GDV patient?
2 large bore cephalic catheters + shock dose crystalloid fluids, decompress stomach
Why should you try to avoid putting catheters in the saphenous veins of a GDV?
Caudal venous return is poor
What is the shock dose of crystalloid fluids in a dog?
80-90mL/kg
What are pros of using an orogastric tube to decompress the stomach?
More effective emptying
What are cons of using an orogastric tube to decompress the stomach?
Requires heavy sedation, tube might not pass, possible esophageal trauma/rupture
What are pros of trocarization to decompress the stomach?
More rapid intervention, does not require sedation
What are cons of trocarization to decompress the stomach?
Limited decompression, risk of lacerating gastric wall, puncturing spleen
What lactate levels might predict gastric necrosis?
Greater than 6mmol/L
What lactate levels are generally associated with a good prognosis?
Less than 6mmol/L
What is the goal of GDV surgery?
Fully decompress and reposition the stomach
When you enter the abdomen of a GDV, what will you see?
Omentum drape covering the stomach
How can you prevent a GDV from occuring/reoccurring?
Gastropexy
Which gastropexy technique poses a risk for future abdominal surgery on the dog and why?
Incorporating - tacks stomach to ventral body wall, so if another ex lap is performed, risk of accidentally cutting into stomach when opening the abdomen
What are negative prognostic indicators for GDV?
Lactate >6mmol/L, need for gastric resection/splenectomy, long onset of signs to presentation, recumbency at presentation
If gastropexy is performed, what is the rate of GDV recurrence?
4%
If gastropexy is NOT performed, what is the rate of GDV recurrence?
50%
How can you prevent GDV?
Prophylactic gastropexy in predisposed breeds during other routine procedure
Which gastropexy technique is considered “best”?
Incisional b/c suture to abd wall and easy
Why do you want a R lateral radiograph to dx GDV?
Gas will fill left displaced pylorus
How do you reposition the stomach when correcting a GDV?
Push down on fundus, grab pyloric antrum and rotate stomach counterclockwise
How might the esophagus appear on radiographs of a GDV?
Dilated from aerophagia
Which pain control drugs should you use for GDV?
Opioids for minimal CV effects
What drug can scavenge reactive oxygen species to help prevent reperfusion injury?
Lidocaine
How soon after repositioning the stomach will peristalsis begin again?
Almost immediately if tissue still healthy
Where is gastric necrosis most likely to occur?
Greater curvature near short gastric arteries
If the spleen is also twisted, how do you treat it?
DO NOT UNTWIST, splenectomy
Does a gastropexy prevent dilation?
No
Which gastropexy technique is considered the “strongest”?
Circumcostal
What type of gastropexy technique is reserved mostly for prophylactic treatment?
Laparoscopic-assisted
Death following GDV usually occur within how much time post-op?
Usually within 4 days
What are the main causes of death following GDV surgery?
Shock, gastric necrosis –> peritonitis, cardiac arrhythmias
When is it necessary to treat post-op VPCs?
HR >180bpm, multifocal VPCs
How do you treat a VPC?
Lidocaine
