The GDV dog Flashcards
Define GDV
Gross gaseous distension of the stomach with rotation
of the stomach around the long axis of the
oesophagus
Pathogenesis
Failure of eructation –> dilatation
Delayed/impaired gastric emptying –> dilatation
How dilatation leads to volvulus and vice versa is uncertain
End results of GDV - 3
- metabolic derangements
- arrhythmias
- inflammation, endotoxaemia, DIC
How does GDV lead to hypovolaemic shock?
Obstruction of CdVC -> decreased venous return to heart, decreased cardiac output –> hypovolaemic shock
How does GDV cause gastric wall necrosis?
increased gastric pressure and avulsion of short gastric vessels ->mucosal heamorrhage and ischaemia and gastric wall necrosis
Why do you get poor ventilation with GDV?
cranial pressure on diaphragm
Why do you get splenic necrosis?
stretching and avulsion of splenic vessels and splenic torsion –> splenic necrosis
Outline emergency treatment of hypovolaemia
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
Which radiographic sign is diagnostic for GDV?
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.
Why shouldn’t you put catheters in the saphenous vein in such cases?
because you have a compromised vena cava and the fluids wouldn’t reach heart to be pumped round
treatment of choice = ?
gastric decompression by orogastric tube
What is the second best treatment option if you cannot pass the orogastric tube?
take the dog to surgery, decompress the stomach by passing a catheter (percutaneous gastric decompression). Remember to avoid the spleen!
What is the sign of GDV during exploratory laparotomy?
the omentum covers the stomach (see image on right. Normally it doesn’t) . Stomach has moved from RHS to LHS
What should you check for after repositioning the stomach? What colour will this be?
necrosis of any abdominal organ. very red= bruised. brown/white = necrotic
Why doesn’t it matter if the short gastric arteries tear during GDV?
blood supply ensures the fundus is still supplied with blood
What surgery is essential to prevent recurrence of GDV?
gastropexy
What are the different types of gastropexy?
incisional gastropexy or belt loop gastropexy
What is the feeding method of choice after gastropexy?
gastrostomy feeding tube (use chinese finger trap suture to hold in place)
What are the indications for the different types of gastropexy?
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.
Suggest some post-op care for after gastropexy - 7
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)
Biggest lung problem associated with GDV =
aspiration pneumonia
post-op complication that can affect the heart = ? Prognosis?
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.
GDV prognosis (with and without gastric necrosis)
- 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
7 important points to remember for GDV cases:
- 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
