Lecture 16 2/14/25 Flashcards
What are the common clinical signs of GI obstruction?
-vomiting
-lethargy
-abdominal pain
-abdominal distension
-diarrhea
What abnormalities are seen on bloodwork in patients with GI obstruction?
-dehydration
-electrolyte abnormalities
-organ inflammation
-possible sepsis
How is GI obstruction diagnosed?
imaging; radiographs or ultrasound
What are the steps to GI obstruction treatment?
-start fluids and analgesics prior to surgery
-foreign body removal or visceral resection and anastamosis
How do you determine whether to do a foreign body removal or a resection and anastomosis in the intestines?
-if intestine is healthy, perform removal surgery via enterotomy
-if intestine is unhealthy, perform resection and anastamosis
How much intestine should be removed during a resection and anastomosis?
3 to 5 cm of healthy tissue on either side when possible
What is a linear foreign body?
material is fixed at one end while the free end extends into intestines; peristalsis causes intestinal plication
Where do linear foreign bodies typically fix in dogs and cats?
cats: around tongue
dogs: pyloric antrum
What are the mortality rates for linear foreign bodies?
less than or equal to 20% in dogs; around 37% in cats
What is typically seen on radiographs in animals with linear foreign body?
-stacked, bunched intestine
-crescent shaped gas pockets
What are the steps to surgical removal of a linear foreign body?
-release proximal/fixed end
-perform one of more enterotomies to remove foreign body; pull end gently and cut off when tight
-check for necrosis; perform resection and anastomosis as necessary
What are the characteristics of intussusception?
-one segment of intestine slips inside of another segment, causing obstruction and vascular compromise
-usually an underlying cause, such as parasites, neoplasia, increased peristalsis, or viral enteritis
-resection and anastomosis often required
What is the classic ultrasound finding in intussuscpetion?
bullseye appearance of intestine
What are the characteristics of manual reduction for intussusception?
-can only be done if intestinal wall is healthy and vessels are patent
-can attempt reduction with gentle traction
-usually unsuccessful
What is enteroplication?
tacking the intestines together with simple interrupted sutures
What are the characteristics of enteroplication?
-can be performed if there is hypermobility and intraoperative re-intussusception
-does not reduce complication rates and may even cause complications
What are the characteristics of mesenteric volvulus?
-german shepherds are predisposed
-present with acute shock and abdominal distension
-immediate surgery is needed
-mortality is around 100%
What is the etiology of GDV?
unknown
What is the pathophysiology of GDV?
-initial gas distention from aerophagia +/- fermentation
-pylorus moves ventrally and to the left with increasing gastric distension
-portal vein, caudal vena cava, and gastric vessels are compressed
-visceral blood flow and cardiac return are compromised
What are predisposing factors for GDV?
-deep chested, large breeds
-first degree relatives with GDV
What are potential correlated factors with GDV?
-fearful temperaments
-aerophagia or distension
-thin dogs
-dietary changes/high fat dry food
-elevated feedings
-previous splenectomy
What are acute clinical signs of GDV?
-abdominal distension
-non-productive retching
-hypersalivation
-panting
-shock
-acute death
What are the chronic clinical signs of GDV?
-intermittent vomiting
-diarrhea
-weight loss
-discomfort
What is the primary way to diagnose GDV?
-large breed dog presents with bloated tympanic abdomen; cannot vomit and are in shock
-orogastric tube passes with difficulty through the lower esophageal sphincter and relieves tension
What are other tests to consider in a patient you believe is presenting with GDV?
abdominal radiographs
-ECG for arrhythmias
-lactate/BUN/creatinine/glucose
-electrolytes
-CBC and platelet count
-coagulation panel
What is the typical sign of GDV on radiographs?
reverse C shape when patient is in right lateral recumbency
What are the preoperative/operative treatment steps for GDV?
-fluids via jugular or cephalic catheters
-analgesics +/- sedatives
-IV antibiotics
-decompress stomach if possible
-treat serious arrhythmias
-correct electrolyte abnormalities
-perform permanent gastropexy
What are the steps to gastric decompression?
-pass a lubricated orogastric tube into the stomach while avoiding esophageal perforation
-percutaneous gastrocentesis may be needed to permit tube passage
What are the presurgical preparation steps?
-assisted ventilation
-clip and prep both the abdomen and caudal thorax
What are the steps of GDV surgical correction?
-derotation and exploration; pull pylorus ventrally and to the dog’s right
-decompress stomach if it will not rotate back
-partial gastrectomy if necrosis is present
-permanent gastropexy in all dogs
What are the steps to an incisional gastropexy?
-identify the gastric body, antrum, pylorus, and incisure
-make a 3-5 cm long incision through the seromuscular layer of the pyloric antrum
-expose and incise the right lateral peritoneum and transversus abdominus muscle just caudal to the ribs and 4-6 cm lateral to the abdominal incision
-take a bite of the cranial end of the peritoneal incision and the pyloric end of the antral incision and tie them together, leaving the suture end long
-sew the dorsal sides of the gastric and peritoneal incisions together with a continuous pattern
-continue the pattern along the ventral incisional edges and tie to the original suture end
What are the treatment options for gastric necrosis?
-gastric inversion
-gastrectomy
When is euthanasia required in GDV treatment?
when there is questionable blood supply, extensive swelling, and ischemia
What is the post-op care for GDV patients?
-IV fluids
-analgesics
-ECG, electrolytes, PCV/TP, and lactate monitoring
-gastric acid reduction
-antibiotics if presence of necrosis or contamination
-offer food when awake
What is the prognosis for GDV patients?
-mortality rate ranging from 11-18%
-mortality risk increases with longer duration, greater vascular compromise, hypotension, peritonitis, coagulopathy, and procedure done in general practice
-gastric atony and continued bloating can occur
-70% recurrence without permanent pexy
When should prophylactive gastropexy be performed?
-dogs with chests deeper-than normal for their breed
-dogs with relatives that had GDV
-great danes
