GDV

Question 1

Describe acute gastric dilatation

Answer 1

• stomach is in the normal position but very distended

- usually associated with over-eating

Question 2

Describe chronic gastric volvulus

Answer 2

• partial turn or misplacement of pylorus
• causes decreased ability of eructation or increased gastric retention
• gastropexy to fix

Question 3

Describe the pathophysiology of GDV

Answer 3

• stomach fills with gas or fluid, which alters sphincter position
• pylorus moves to the left as the rest of the stomach moves to the right

Question 4

What are the cardiovascular effects of GDV?

Answer 4

• compression of veins (decreased BP)
• secretion of catecholamines (vasoconstriction)
• arrhythmias
• reperfusion injury

Question 5

What are the respiratory effects of GDV?

Answer 5

• distension puts pressure on diaphragm

- decreased excursions results in accumulation of CO2 (acidosis)

Question 6

What are the GIT effects of GDV?

Answer 6

• reduced blood supply to mucosa of stomach results in sloughing off and necrosis
• bacterial translocation and septicemia

Question 7

What are the metabolic effects of GDV?

Answer 7

• poor tissue perfusion
• cellular hypoxia
• anaerobic metabolism
• increased lactate
• metabolic acidosis
• liver/kidney buffer

Question 8

What are the immune effects of GDV?

Answer 8

• hypoxemia causing mucosal ischemia
• loss of protective barrier
• bacterial translocation
• damage to lymphatics
• portal hypertension

Question 9

What are the renal effects of GDV?

Answer 9

• vasoconstriction results in decreased GFR
• decreased urine (oliguria)
• acute renal failure

Question 10

What is the typical history associated with GDV?

Answer 10

• looking/biting at abdomen
• “praying” position
• non-productive retching
• distended abdomen

Question 11

What are the physical findings of GDV?

Answer 11

• distended, painful, tympanic abdomen
• active retching
• hypersalivation
• tachypnea, tachycardia
• collapse

Question 12

What are the laboratory findings associated with GDV?

Answer 12

• increased WBC
• increased ALT, bilirubin, BUN/Cr
• hypokalemia
• hypoglycemia
• increased lactate
• DIC

Question 13

Which radiographic view is diagnostic for GDV?

Answer 13

right lateral

Question 14

What are the treatment options for GDV?

Answer 14

• fluids (shock doses)
• decompression
• pain management
• antimicrobials and radical scavengers
• surgery

Question 15

What are the methods of gastric decompression?

Answer 15

• orogastric tube
• trocharization
• emergency gastrostomy

Question 16

What are the disadvantages of trocharization?

Answer 16

• will not decompress stomach as well as tube
• risk of lacerating stomach
• can push needle into another organ

Question 17

Which type of drug is contraindicated in GDV patients?

Answer 17

glucocorticosteroids

Question 18

Describe gastric de-rotation

Answer 18

• check position and palpate esophagus
• push stomach dorsal and to the left
• pull pylorus to the right
• pass stomach tube

Question 19

How do you check for gastric wall viability?

Answer 19

• presence of peristalsis
• pink/red serosal color
• palpate for thinning or friability
• pulsation of vessels
• bleeding of cut surfaces

Question 20

What does gastric necrosis normally occur in GDV?

Answer 20

along greater curvature of the stomach

Question 21

What are the techniques for a partial gastrectomy?

Answer 21

• cut and sew
• stapling
• partial invagination

Question 22

Describe gastric invagination

Answer 22

• necrotic section sloughs off and is digested
• risk of gastric ulceration
• can obstruct gastric outflow

Question 23

How is splenic viability evaluation?

Answer 23

• venous congestion
• vessel thrombosis
• splenic torsion

Question 24

Describe incisional gastropexy

Answer 24

• incision on right ventro-lateral wall
• roll the wall over and make incision through peritoneal and muscular layers
• lay pyloric antrum against this area and suture incisions together

Question 25

Describe belt loop gastropexy

Answer 25

- parallel incisions through peritoneal and muscular layer to create tunnel - create belt/flap off pyloric antrum - tie suture to end of flap and feed through the loop, then reattach to stomach

Question 26

Describe circumcostal gastropexy

Answer 26

- make tunnel around last rib - create belt/flap off pyloric antrum - feed flap around the rib

Question 27

Describe tube gastropexy/gastrostomy

Answer 27

- stab incision into stomach and pass catheter - tighten purse string around catheter - other end comes out abdomen - place multiple mattress sutures - secure tube with finger trap

Question 28

Describe incorporating gastropexy

Answer 28

- stomach wall is incorporated in linea alba incision | - not recommended

Question 29

Describe laparoscopic-assisted gastropexy

Answer 29

- dorsal recumbency - pull stomach up to abdominal wall - make incision into abdominal cavity and exteriorize that section of the stomach - do an incisional gastropexy

Question 30

Describe endoscopic-assisted gastropexy

Answer 30

- place scope in esophagus and stomach - use tip of scope to push antrum into right abdominal wall - drive large suture through skin to hold stomach - make incision into stomach adjacent to suture

Question 31

What are the causes for post-op death?

Answer 31

- shock - gastric necrosis - reperfusion injury - arrhythmias

Question 32

What is done for post-op care?

Answer 32

- NPO for 24 hours - continue fluid for 24 hours - correct hypoK, hypoCl and metabolic acidosis - H2 blockers - coating agents - analgesics

Question 33

When is treatment of VPCs indicated?

Answer 33

- associated with weakness or syncope - persistent tachycardia - pulse deficits or poor pulse quality - multifocal VPCs

Question 34

Which drug can be used to help reverse VPCs?

Answer 34

Lidocaine

Question 35

What is the prognosis for GDV?

Answer 35

- a leading cause of death in large breeds - 10-33% mortality rate - recumbent patients have higher mortality - lacate levels > 6 mm/L indicate higher incidence of gastric necrosis