The GDV dog

Question 1

Define GDV

Answer 1

Gross gaseous distension of the stomach with rotation
of the stomach around the long axis of the
oesophagus

Question 2

Pathogenesis

Answer 2

Failure of eructation –> dilatation
Delayed/impaired gastric emptying –> dilatation
How dilatation leads to volvulus and vice versa is uncertain

Question 3

End results of GDV - 3

Answer 3

• metabolic derangements
• arrhythmias
• inflammation, endotoxaemia, DIC

Question 4

How does GDV lead to hypovolaemic shock?

Answer 4

Obstruction of CdVC -> decreased venous return to heart, decreased cardiac output –> hypovolaemic shock

Question 5

How does GDV cause gastric wall necrosis?

Answer 5

increased gastric pressure and avulsion of short gastric vessels ->mucosal heamorrhage and ischaemia and gastric wall necrosis

Question 6

Why do you get poor ventilation with GDV?

Answer 6

cranial pressure on diaphragm

Question 7

Why do you get splenic necrosis?

Answer 7

stretching and avulsion of splenic vessels and splenic torsion –> splenic necrosis

Question 8

Outline emergency treatment of hypovolaemia

Answer 8

restoration of intravascular blood volume, place large bore catheters in both cephalic veins, give a shock dose (90ml/kg isotonic fluids).
AIM = to decrease HR and improve pulse quality

Question 9

Which radiographic sign is diagnostic for GDV?

Answer 9

Division of the stomach into two compartments by a soft tissue band. (take a right-lateral radiograph (i.e. right side of dog is on the table)). ). Normally stomach is within costal arch. Distended stomach = caudal to the costal arch.

Question 10

Why shouldn’t you put catheters in the saphenous vein in such cases?

Answer 10

because you have a compromised vena cava and the fluids wouldn’t reach heart to be pumped round

Question 11

treatment of choice = ?

Answer 11

gastric decompression by orogastric tube

Question 12

What is the second best treatment option if you cannot pass the orogastric tube?

Answer 12

take the dog to surgery, decompress the stomach by passing a catheter (percutaneous gastric decompression). Remember to avoid the spleen!

Question 13

What is the sign of GDV during exploratory laparotomy?

Answer 13

the omentum covers the stomach (see image on right. Normally it doesn’t) . Stomach has moved from RHS to LHS

Question 14

What should you check for after repositioning the stomach? What colour will this be?

Answer 14

necrosis of any abdominal organ. very red= bruised. brown/white = necrotic

Question 15

Why doesn’t it matter if the short gastric arteries tear during GDV?

Answer 15

blood supply ensures the fundus is still supplied with blood

Question 16

What surgery is essential to prevent recurrence of GDV?

Answer 16

gastropexy

Question 17

What are the different types of gastropexy?

Answer 17

incisional gastropexy or belt loop gastropexy

Question 18

What is the feeding method of choice after gastropexy?

Answer 18

gastrostomy feeding tube (use chinese finger trap suture to hold in place)

Question 19

What are the indications for the different types of gastropexy?

Answer 19

 tube gastrostomy so stomach can be deflated and nutrition can be provided - use in chronic cases
 Incisional gastropexy - easiest and fastest so best for new grad. make sure incision is long enough (at least 3cm). recommended.
 belt-loop gastropexy - lowest rate of GDV recurrence but more fiddly.

Question 20

Suggest some post-op care for after gastropexy - 7

Answer 20

o fluid therapy
o potassium supplementation
o analgesia
o treatment for gastric ulceration - sucralfate
o gastric motility drugs - continuous metaclopramide
o ABs
o nutrition (when eating = on way to recovery)

Question 21

Biggest lung problem associated with GDV =

Answer 21

aspiration pneumonia

Question 22

post-op complication that can affect the heart = ? Prognosis?

Answer 22

idiopathic ventricular tachycardia = increased HR due to premature ventricular complexes. As long as bp and HR are fine, animal will recover from these without treatment normally.

Question 23

GDV prognosis (with and without gastric necrosis)

Answer 23

• quoted survival rates vary between publications
• survival has improved with increased ICU facilities in recent years
• without gastric necrosis, survival rates of up to 98% have been reported
• with gastric necrosis, survival rates of 66% have been reported

Question 24

7 important points to remember for GDV cases:

Answer 24

• if a client reports abdominal distension and non-productive retching, see their dog immediately
• aggressive IV therapy is essential for pre-op stabilisation
• a right lateral radiograph confirms the diagnosis
• do not place excessive force on a stomach tube
• check all abdominal organs for ischaemic necrosis (death due to loss of blood supply)
• gastropexy is essential
• post-op intensive care is as important as surgery