GDV and Gastropexies Flashcards
What is the aetiology of GDV?
Aetiology is multifactorial and remains poorly understood – how and why it develops is poorly understood
What are some extrinsic factors as part of the pathogenesis for a GDV?
- Diet
- Post prandial exercise (1-2 hours after feeding)
- Pre-prandial exercise (1-2 hours before feeding)
- Single daily feeding - better to feed several times a day!
- Hospitalisation – stress. Some dogs can have big separation anxiety, this can go on to cause it
- etc.
What are some intrinsic factors as part of the pathogenesis for a GDV?
- Breed (deep-chested), large breeds – may well have some relations to dimensions of the chest
- Body size
- Thoracoabdominal dimensions
- Gastric volume
- Gastric position
- Gastric ligament laxity (hepatoduodenal & hepatogastric) – difficult to know what is and isn’t normal
- Eructation control
- Pyloric canal function
- A parent (1st degree relative) who has experienced a GDV – offspring are more likely to have a GDV if their parents have had one – advice is not to breed from them.
- Temperament & “happiness”
- etc.
What are some breeds most at risk for a GDV?
What are some theories as to the aetiology of a GDV?
- Aerophagia - condition of excessive air swallowing
- Abnormal oesophageal motility – cannot eructate air back up?
- Dysphagia
- Gas or fluid accumulate in stomach and the normal means of relief (vomiting, regurgitation, pyloric function) have become inoperative
Explain how the stomach rotates with a GDV
Generally (in GDV) the stomach rotates in a clockwise manner when viewed from the surgeon’s perspective (dog on its back, clinician at dogs side facing cranially. (rotation can be 90-360 degrees)
Talk about it in sternal recumbency, as looking at the dog.
Clockwise 180-360 degree torsion, can rarely go opposite way around
Does volvulus or dilation come first?
What occurs passively?
Gastric dilatation usually precedes volvulus; twisting occurs passively due to the alteration of anatomical relationships by the progressively ballooning stomach
- Clockwise; most common, max rotation of 270-360 degrees
- Anti-clockwise; rare, max rotation of 90 degrees
Does the stomach rotate clockwise or anti-clockwise most commonly?
- Clockwise; most common, max rotation of 270-360 degrees
- Anti-clockwise; rare, max rotation of 90 degrees
WHat happens when the stomach starts to dilate?
Discuss with regards to the omentum
Some debate as to whether they get a torsion first and then dilate
As it dilates, body of stomach pushes its way dorsal and the pylorus and antrum start to become ventralised, come to critical point where it will definitely twist and go over the top – once it has gone over the top, it wont resolve itself – needs manually putting back.
Spleen has gone somewhere! Spleen associated with greater curvature. Position of spleen can be quite variable
Greater omentum – fine leaf structure, ventral leaf emanates from ventral. dorsal leaf originates from root of mesentery, so when stomach twist, its twists into omental bursa – single leaf of omentum overlying the dilated stomach
What is the spleen associated with anatomically?
Spleen associated with greater curvature
What are some resultant pathophysiological events of a GDV?
- Hypovolaemia
- Endotoxaemia
- Hypoxia
- Cardiac dysfunction
- Gastric ischaemia & mucosal necrosis
- Splenic ischaemia/infarction
What are some pathophysiological events that occur at the stomach with regards to blood supply and flow etc?
- Gastric wall blood supply disrupted
- As the greater curvature of the stomach is displaced the gastric branches of the splenic artery can avulse
- Haemorrhage & ischaemia result
- Perfusion pressure falls
- Mechanical obstruction to vessels
- Thrombi
- Gastric necrosis (most commonly greater curvature)
- Poor venous return from vena cava due to pressure put on it
- Portal vein has lots of pressure put on it
- If blood slowed down hugely, get clotting and thrombi develop – can get gastric necrosis if these are here for a long tiem. Especially at greater curvature
What are some pathophysiological events that occur at the spleen with a GDV?
- Displaced as greater curvature moves
- Venous congestion
- Splenic artery avulsions can occur
- Infarction developing
- Thrombi can develop
- Splenic torsion
- Mostly end up with massively distended spleen which may no longer have a working blood supply due to thrombi formation in the arteries, even after you have untwisted
With a GDV, where are some obstructed blood flows?
- Caudal vena cava
- Hepatic portal vein
What is the pathophysiology of systemic events with regards to blood flow, venous return, HR, perforations etc?
- Blood flow obstruction
- Caudal vena cava
- Hepatic portal vein
- Venous return decreased and CO falls
- HR increases
- Myocardial oxygen demand increases
- Myocardial oxygen delivery is falling
- Poor perfusion & stasis
- Arrhythmias
- Ischaemic reperfusion injury (IRI) – can be as bad as the situation before you tried to fix it
- Gastric perforation
- Septic peritonitis
- Disseminatied intravascular coagulation (DIC)
- Systemic Inflammatory Response Syndrome (SIRS)
What are some systemic events that can occur with a GDV that can cause a poorer prognosis?
How can you get around these?
- Gastric perforation
- Septic peritonitis
- Disseminatied intravascular coagulation (DIC)
- Systemic Inflammatory Response Syndrome (SIRS)
- If these develop, poorer prognosis!
- All of these things can be reduced in their likelihood by trying to deal with the case promptly – the longer its left, the more complications are likely!
What is the overall diagnosis of a GDV?
- Presenting signs
- Assess severity of shock
- Electrolytes
- Acid/base status
- Electrocardiogram
- Radiography
- Breed disposition – owners are often quite aware
What are the presenting signs for a GDV?
- Progressively expanding and tympanic abdomen
- Giant breeds - ribs covers stomach
- Dog depressed, may be recumbent
- In ‘shock’, CRT prolonged, pale
- Tachycardia, poor pulses, tachypnoea
- Dog exhibiting signs of pain
- May shown signs of non-productive retching/vomiting
- Restless
What are the therapeutic goals for treating a GDV?
- Restore and support the circulation
- Provide oxygen to help its oxygen demand on its heart and circulation to rest of periphery
- Decompress the stomach
- Is it GD or GDV?
- Still likely to operate on it!
- Surgical planning – to try to untwist and then come up with a way to prevent it happening again
- Prophylactic gastropexy
What does the initial management of treatment for a GDV consist of?
Initial management consists of trying to stabilise the patient;
- Fluid therapy
- Decompression
- ECG – treat dysrhythmia (?)
- Corticosteroids (?) – some give IV steroids as ‘wont do harm’ but less likely these days
First priority is to treat the shock
What is important about obtaining IV access when treating a GDV?
- Rapid IV access is important
- Address the circulatory compromise
- Two large bore i/v cannulae in cephalic veins – need to give fluids at a fairly fast rate!
- Consider other sites of access
What do you see on a radiograph in a dog with a GDV?
Reverse C or double bubble appearance
Right lateral survey film – reverse C or double bubble appearance
What does it mean if you can see a single leaf of omentum overlying the stomach?
Single leaf of omentum overlying the stomach – must have a torsion if you can see this
What is a belt loop gastropexy?
Raise a seromuscular flap based off GREATER curvature and pass it through a flap made on the RIGHT abdominal muscle wall and link them together
What is an incisional gastropexy?
Linear incision on pyloric antrum through seromuscular layers, then similar incision on abdominal wall through peritoneum and muscle, then stick the 2 incisions together
What is an incorporting gastropexy?
What is the problem with it?
Part of stomach wall put into closure of linear alba
Portion of seromuscular layer into linear alba – could do this to unpick it all tomorrow to redo it better, but cannot be long term. As if the dog has surgery again, the next surgeon might cut through the stomach!!
