GDV- Exam 2 Flashcards
Gastric Dilatation
distention of stomach w/ fluid, food or gas
What is the tx route for gastric dilatation?
Medical tx
Gastric dilatation volvulus
Enlargement of stomach associated w/ rotation on its mesenteric axis
What is the tx route for gastric dilatation volvulus?
Sx tx
What are the only two proven predisposing factors in dogs w/ GDV?
First degree relative w/ hx of GDV
Increasing age
What are some factors related to diet that are thought to contribute to GDV?
Increased volume of food fed SID Dry kibble Fats/oils in first four ingredients Raised food bowl Fish/egg DECREASE risk
T/F: Playing/running after eating has been shown to increase chances of GDV?
FALSE- recent studies shows that exercise has no play in GDV development
What is the poster child for GDV?
Great dane- large, deep chested dogs
40% increased risk in this breed
What abdominal sx can predispose development of GDV?
Splenectomy
Connection between stomach & spleen through short gasttric a
What affect does GDV have on the lungs?
V-Q mismatch- pressure against diaphragm leads to this
How is the CV system affected in a patient with GDV?
Stomach twists on the caudal vena cava leading to poor perfusion and resulting in myocardial damage
What is a major concern for when the GDV is corrected sx?
REPERFUSION INJURY
What is the most common direction of GDV?
Clockwise rotation
Pylorus moves along ventral abdominal wall to left side
What is the defined rotational angles when differentiating torsion from volvulus?
Torsion: < 180 degrees
Volvulus: > 180 degrees
What is a differential when talking about clockwise vs. counterclockwise rotation GDV?
Stomach covered by omentum in clockwise rotation
Describe the movement of the stomach in a counterclockwise rotation
Pylorus moves dorsally to lie adjacent to esophagus
What is commonly presented in a patient with counterclockwise GDV?
Chronic GI signs
What is a CS seen in patients with GDV that the patient does to help relieve gastric pain?
Praying posture
What percentage of GDV patients will end up with arrhythmias and what type?
> 50% will end up with arrhythmias
VENTRICULAR
What is the most important step in treatment of a GDV patient?
STABILIZATION
Aggressive fluid therapy in jugular or cephalic veins
Why should the hind limbs be avoided when administering fluids to a patient with GDV?
decreased blood flow back to the heart due to pressure on caudal vena cava
What are the initial fluid therapy choices vs. maintenance fluid therapy choices?
Initial: crystalloid or hypertonic saline
Maintenance: crystalloids and colloids (maintain BP)
Continue fluids until GDV resolved
Why are lactate levels important to check on a GDV patient?
measures perfusion, prognostic indicator for dogs doing well/poorly with GDV
What is the goal of tx for GDV patient?
Stabilize CV, respiratory and renal systems FIRST
What is the rate of fluids initially given to a patient with GDV?
90mL/kg
25% initially given and then re-evaluate
What is the first choice method used for gastric decompression?
Stomach tube decompression (OG tube)
If an OG tube cannot be passed initially, what can be done in order to allow the OG tube to be successfully passed?
Trocharization and then tube
Done at most tympanic site
Watch for the SPLEEN
What is a landmark used when selecting your OG tube size?
Xiphoid
The following are examples of what:
Acetylcysteine, vitamin C, vitamine E, desferoxamine, and lidocaine
Free radical scavengers
What is the technique used for gastric repositioning?
push down on fundus w/ right hand –> grasp pyloric antrum w/ left hand and rotate stomach counterclockwise
How can confirmation of proper reduction be performed?
Examine the gastroesophageal junction
What is a standard criteria of gastric viability in GDV patients?
peristalsis- should immediately resume after correction
What is another common indicator of viability in GDV sx correction?
Gastric slip
What is the most common part of the stomach that has gastric necrosis?
Greater curvature near short gastric arteries
What are three complications involving the spleen in a GDV patient and which two require splenectomy for tx?
Venous congestion (self-limiting) Vessel thrombosis (splenectomy) Splenic torsion (splenectomy)
What is the % of recurrence of GDV w/ or w/out pexy?
W/ pexy: 4%
W/out pexy: 50%
T/F: Gastropexy prevents dilatation from occurring again?
FALSE- prevents volvulus from occurring
But if dilatation occurs again- it wouldn’t be considered emergency-just need to relieve pressure
Describe an incisional gastropexy
Incise seromuscular layer in gastric antrum and R abdominal wall –> suture R abdominal wall to gastric incision w/ simple continuous pattern
Mucosa NOT penetrated
Minimum of 3 cm long incision in transversus abdominus
Describe a circumcostal gastropexy
Strongest w/ most potential risks
Seromuscular flap around 13 rib
What are risks of circumcostal gastropexy?
Rib fractures and pneumothorax
What are two prophylactic gastropexy procedures?
Laparoscopic-assisted
Endoscopic assisted
T/F: Prophylactic gastropexy prevents dilatation
FALSE
How long should a GDV sx patient be NPO post-op?
12-24 hrs.
How long should you monitor a patient for arising arrhythmias post-op GDV sx
24 hrs
When would you expect a post-op GDV death?
in the first 4 days
What are electrolyte disturbances seen with GDV patients?
Hypokalemia
Hypochloremia
What are the expected arrhythmias for GDV patients?
Ventricular arrhythmias caused by myocardial ischemia
