Post-op management of GDVs

Question 1

What are the main post-op complications of GDVS?

Answer 1

**Ischaemia repurfusion injury**
Hypovolaemia
AKI
Aspiration pneumonia
Pain
Gastric ulceration
Cardiac abnormalities

Question 2

What are poor prognositic indicators for GDVs?

Answer 2

Hypothermia
Longer time from signs to admit
Need for splectomy/ partial gastrectomy
High lactate
Sepsis
Peritonitis
Hypotension at any time

Question 3

How can you check for peritonitis?

Answer 3

aFAST daily whilst in hospital

There will likely be a fair amount of fluid, can tap it though, then check for peritonitis from analysis

Question 4

How would glucose levels be in a septic peritonitis?

Answer 4

Low in the abdominal fluid

Question 5

What is lidocaine and how is it useful in GDVs?

Answer 5

Type II Na chanel blocker
Possibly useful to prevent IRI if given pre decompression
Pain killer
Anti arrhythmic - definitely give if seeing R on T phenomenon

Question 6

How should you monitor the heart post-op?

Answer 6

ECG for the first 24-48 hours

If abnormal - check for electrolyte issues first

Question 7

How can you manage GI dysfunction post-op?

Answer 7

Antacids - sucralfate or proton pump inhibitor
Metoclopramide if ileus is present
Early enteral nutrition

Question 8

What happens in IRI?

Answer 8

Paradoxical tissue damage - caused by reactive oxygen species formed in previously ischaemic tissues - often this leads to cell death