Ch 91 stomach Flashcards

Question

Pyloromyotomy and Pyloroplasty

Answer 1

- focused on removing outflow obstruction and normalizing gastric outflow - Conventional and laparoscopic pyloromyotomy and pyloroplasty have been described - studies have reported no change to slowed gastric emptying after these pyloric procedures....

Answer 2

Fredet-Ramstedt Pyloromyotomy - Longitudinal incision through serosa and muscularis extending 1-2cm orad and aborad of the pylorus - Allows protrusion of submucosal surface to protrude and enlarge - Use limited - restriction must be limited to the serosa or muscularis layer Heineke-Mikulicz Pyloroplasty - Full thickness longitudinal incision centred on the pylorus and closed transversely Y-U Pyloroplasty - Y-shaperd full thickness incision with arms over the antrum/pylorus and body extending through pylorus and onto duodenum - U-flap pulled aborally to close as a U

Answer 3

Pylorectomy and gastroduodenotomy

Answer 4

- neoplasia confined to the pyloric region - ulceration of the outflow tract - some cases of pyloric hypertrophy

Answer 5

- Bile duct (identified by manual expression of the gallbladder) - Pancreatic ducts - Vascular supply to the stomach and duodenum | common bile duct and its opening can be stented during sx

Answer 6

Study of 24 dogs: - 18 survived 14 days - 10 died by 3 months - Hypoalbuminaemia (62.5%), anaemia (58.3%) | also depenedent on underlying dz

Answer 7

Partial gastrectomy with gastrojejunal anastomosis - Side-to-side anastomosis (openings of stomach and duodenum are closed, loop of jejunum is anastomosed to the greater curvature of the stomach) - Cholecystoenterostomy usually required - Prognosis very poor…

Answer 8

- food and water may be initiated as early as 12 hours after surgery in patients that are not actively vomiting - loss of intestinal motility is suspected, electrolytes (particularly potassium and magnesium) should be evaluated - treatment with a prokinetic agent such as metoclopramide - ileus, a nasogastric tube may be used to intermittently decompress the stomach and trickle feed the patient, which may stimulate gastric motility. - feeding tube > nasoenteric tube

Answer 9

- esophageal hiatus is formed by the musculature of the medial portion of the lumbar crus of the diaphragm - hiatial hernia = organs herniate through the esophageal hiatus into the mediastinum - Four types **Pathophysiology** - previously thought that increased intraabdominal pressure function as a “flutter valve” for the intraabdominal portion of the esophagus to prevent gastroesophageal reflux. - dogs with hiatal hernia considered deficient of “flutter valve” because of displacement of the gastroesophageal junction into the thoracic cavity. - however, Pratschke et al. showed that gastroesophageal anatomy in dogs is inconsistent and documented that 8 of 12 dogs examined had no abdominal portion of the esophagus. - aquired hernia: Patients with upper respiratory obstruction have decreased intrathoracic pressure during inspiration that may contribute to esophageal reflux and hiatal herniation (BOAS) pinchcock effect (hosgood) - The crural muscle fibers of the diaphragm surrounding the esophageal hiatus generally form a sphincter-like structure that has a pinchcock effect. - Contraction of crura at hiatus contributes to intraluminal pressure at the gastroesophageal junction and helps maintain gastroesophageal competence - For GER and regurgitation to occur, there may be a failure in hiatal assistance with gastroesophageal competence

Answer 10

cause remains unknown, multifactorial, factors involved include: - GA event associated with 46%-65% of cases (most common cause) > reduced LES - sliding hiatial hernia - reduced gastroesophageal junction pressure, - esophagitis, - obesity, - increased distensibility of the gastroesophageal junction, - prolonged esophageal clearance - delayed gastric emptying - failure in hiatal assistance with gastroesophageal competence (brachycephalics) Tx PPI - lack of empirical evidence in dogs and cats, but compelling evidence from studies in people, - does not decrease gastric reflux, but may prevent injury by increasing the pH of the refluxate. ACVIM consensus ulcer Tx - ranitidine BID is inferior to PPI omeprazole BID - tapered after prolonged use of >3-4 weeks. (to avoid rebound hypersecretion) - no evidence that misoprostol decreases GUE - No evidence that combining sucralfate with PPI or H2RA for treatment of GUE is beneficial

Answer 11

* Type I: “Sliding” - Intermittent movement of gastrooesophageal junction into the thoracic cavity * Type II: “Paraoesophageal” - The gastrooesophageal junction remains in a normal position and a portion of the fundus herniates beside the oesophagus * Type III: Combination of I and II * Type IV: Herniation of abdominal organs other than the stomach

Answer 12

Shar Peis Eng Bulldogs

Answer 13

- positive-contrast esophagram (gastro-oesophageal junction within thorax) - Fluoroscopy is of benefit in cases of type I - endoscopy - maneuver to increase the transdiaphragmatic pressure gradient during esophagoscopy (also see reflux esophagitis)

Answer 14

Reducing acid secretions - H2 receptor blockers: ranitidine, cimetidine, famotidine - H/K-ATPase inhibitor omeprazole Oesophageal protection - Sucralfate (polyaluminium sucrose) Prokinetics - Metoclopromide or cisapride (increase gastric emptying and enhance lower oesophageal tone) Diet - Low fat diet fed more frequently or from elevated height 8/15 dogs had complete resolution with medical management (trial recommended b4 sx, not as successful in congenital)

Answer 15

**Phrenoplasty** - hiatal reduction - there are no set standards for hiatal diameter - horizontal mattress sutures of 2-0 monofilament nylon dorsally and ventrally through the crura surrounding the esophageal hiatus without transection of the phrenicoesophageal ligament - care not suture vagal n **Oesophagopexy** - partial-thickness incision in the left side of Oesophagus and sutured to diaphragm incision **Left-sided fundic incisional gastropexy** Prognosis is good! | left hepatic triangular ligament transected visualize esophageal hiatus

Answer 16

- monitored for dyspnea associated with pneumothorax - Worsening of regurgitation after surgery from overreduction of the hiatus, which can be confirmed with contrast esophagography

Answer 17

- Retrograde (orad) invagination of the stomach into the oesophagus without displacement of the gastrooesophageal junction - GSD are overrepresented (over 50% of cases) - More than 75% were in dogs younger than 3 months

Answer 18

- cause of gastroesophageal intussusception is not well understood - though to be predisposed by esophageal abnormalities, including megaesophagus, abnormal esophageal motility, and laxity of the esophageal hiatus - Vomiting and regurgitation are the most common clinical signs - majority of affected dogs have evidence of esophageal disease, including megaesophagus, enlarged esophageal hiatus, and abnormal esophageal motility. dx - invaginated stomach within the caudal esophagus > confirmed by endoscopy - contrast esophagram

Answer 19

- Ventral midline coeliotomy with reduction of intussusception and left sided +/- right sided gastropexy - historically high Mortality rate 95% , More recent individual case reports are more promising

Answer 20

- Anatomically based pyloric outflow obstructions - congenital or acquired. - Congenital (pyloric stenosis): generally muscular, in brachycephalic breeds < 1 year. - Acquired: mucosal or a combination, small breeds - BOAS have documented endoscopic diagnosis of pyloric mucosal hyperplasia and pyloric stenosis CS - intermittent vomiting +/- Regurgitation and hypersalivation dt esophagitis Dx - retention of gastric contents after a fast of greater than 8 hours on rads - ultrasound (affected by pateint position) - mucosal hypertrophy, endoscopic examination may be very helpful in making the diagnosis + biopsy

Answer 21

Chronic air dilation of the stomach (secondary to URT dz) cause increased intragastric pressure, secondary secretion of gastrin and gastric acid, resultant production of cholecystokinin and secretin which have a trophic effect on the antral and pyloric mucosa

Answer 22

- muscular hypertrophy alone > pyloromyotomy - mucosal or combined > transverse (Heineke-Mikulicz) or Y-U pyloroplasty - bilroth I (pyloric resection and gastroduodenostomy) PX - outcome after surgical correction of benign conditions of the pylorus is very good (>80% excellent) | Full-thickness biopsy of pylorus should be performed in every case

Answer 23

- Endoscopic removal of gastric foreign bodies has become much more common and has variable success rates: one STUDY 10 of 36 dogs required subsequent gastrotomy - Electrolyte and acid-base abnormalities are common secondary to the vomiting: hypochloremia is present in >50% of cases - dx: important to avoid barium sulfate if gastric perforation is suspected (free abdominal air present) - Ultrasonography Complications - esophagitis secondary to reflux and vomiting. prognosis - very good if there is no evidence of perforation. - perforation > depends on the severity of peritonitis

Answer 24

**Gastric adenocarcinoma (42-90%)** Belgian Shepherd, Rough-coated Collie, Staffys Metastatic rate 70% Three forms: - Diffuse infiltration (“linitus plastica”) - non-distensible, scirrhours stomach wall - Groups of ulcerated mucosal plaques - Discrete polypoid mass | occur most frequently in the pyloric antrum

Answer 25

ddx: 1. adenocarcinoma 2. sarcomas and stromal GIST leiomyosarcoma, fibrosarcoma, and gastric extramedullary plasmacytoma. 3. lymphoma 4. benign (Leiomyoma and adenomatous polyps) 5. fungus dx - imaging: dentification of possible metastatic disease. The cause, however, cannot be differentiated based on any imaging modality - endoscopic examination and biopsy: may not adequately diagnose compared to full thikeness biopsy.

Answer 26

**Gastric lymphoma** Prognosis depents on grade. Low grade can have good prognosis with chemotherapy with MST 704d Intermediate- and high- grade usually rapidly progressive and fatal

Answer 27

Arise from the cells of Cajal c-kit positive (differentiates them from lyomyosarcomas)

Answer 28

Poor… - 2/21 dogs lived longer than 9 weeks with combo of Bilroth I/II, partial gastrectomy or no treatment | mets in 75%

Answer 29

**Renal and hepatic disease** - Decreased hepatic degradation of gastrin and histamine - Derangement of mucosal bloodflow due to portal hypertension and thrombosis - Decreased renal clearance of gastrin? **NSAIDs and glucocorticoids** - 2 mechanisams (direct and systemic) - COX-inhibition resulting in decreased PG production resulting in decreased mucosal bloodflow, epithelial mucous production, bicarb secretion and epithelial turnover. - now believed that gastric injury secondary to NSAID administration is the result of combined COX-1 and COX-2 inhibition, interaction between NSAID and phospholipids, and subsequent uncoupling of mitochondrial oxidative phosphorylation - Although COX-2 selective agents were developed to spare the prostaglandins beneficial for gastric mucosal protection, these COX-2 selective agents have also been associated with gastric ulceration - Direct topical effect of weakly acidic and lipid-soluble NSAID on gastric mucosa - Glucocorticoids exact mechanism, however, is unknown | and neoplasia

Answer 30

aimed at decreasing gastric acidity and promoting mucosal protective mechanisms. **Histamine (H2) Receptor Blocker** - Cimetidine, ranitidine, famotidine **Proton pump inhibitors** - Omeprazole, pantoprazole (substituted benzimidazoles that covalently bind H/K-ATPase enzyme, blocking its activity) - Absorbed in alkaline environment (proximal duodenum) - Administed 1hr before a meal **Sucralfate** - In acidic environment dissociates. Octasulphate portion forms a thick paste that binds electrostatically charged proteins in the base of ulcers - “Biological bandaid” - protective barrier, inactivates pepsin, absorbs bile acids - stimulates local PG release **Misoprostal** - SYnthetic analogue of PGE1 - Increases bicarb secretion, mucous production and mucosal bloodflow - Decreased H/K-ATPase pump activity via decreased intracellular cAMP - Can help to prevent ulcer formation but does not have an effect on treating current ulcers **surgery** - removal and full-thickness biopsy - partial gastrectomy vs Billroth I. - Alternatively, a serosal patch to reinforce the gastric wall. - Correction of the underlying cause is critical. - ongoing medical mgmt

Answer 31

A non-beta pancreatic islet cell tumour, associated with hypersecretion of gastrin antral G cells, resulting in gastric hyperacidity and ulceration

Answer 32

pathophys - most often secondary to NSAID or neoplasia (primary or gastrinoma) Dx - radiography: loss of abdominal detail and free abdominal gas - Abdominocentesis is indicated in animals with free peritoneal fluid (dx sepsis) - ultrasound or scope prognosis - dependent on underlying cause, severity of peritonitis, and overall condition of the animal

Answer 33

- life-threatening syndrome, large-breed, deep-chested dogs in which the stomach rotates on its axis, trapping air within its lumen. - pylorus and proximal duodenum move ventrally and then cranially (hepatoduodenal ligament is stretched), then migrating from right to left, which creates a fold in the stomach, - coming to rest on the left, dorsal to the esophagus - Trapped air increases intragastric pressure, > decreases venous flow through the abdomen by direct compression. - Portal hypertension, systemic hypotension, and cardiogenic shock result.

Answer 34

- not completely understood. **risk factors** 1. purebred large or giant breed 2. increased thoracic depth-to-width ratio 3. relative with GDV 4. feeding fewer meals per day, 5. eating rapidly 6. increased hepatogastric ligament length 7. exercise or stress after a meal 8. +/- splenectomy (studies conflict) - fact that gastropexy seems to prevent GDV supports that volvulus occurs before the dilatation (rotation prevent eructation and pyloric outflow) - mechanism for gas entrapment in the stomach before rotation is not understood - gastric dilatation without volvulus does occur after gastropexy in some dogs

Answer 35

*Blood Flow* - Gastric distention increase intraabdominal pressure and decreases venous flow throughout the abdomen. - **venous return** from the caudal vena cava is reduced > cardiogenic shock - compression of the portal vein > portal hypertension > venous stasis, mucosal death and **bacterial translocation** throughout GIT - **Portal hypertension** impact hepatic reticuloendothelial function > decreased clearance of bacteria and endotoxins - Pressure on the diaphragm from the distended stomach makes inspiration more difficult and further **decreases oxygen delivery**. *Cardiac Dysfunction* - inadequate coronary vessel flow + myocardial depressant factor, results in **myocardial ischemia**. - Resultant cardiac arrhythmias further decrease systemic perfusion. - **Electrocardiographic abnormalities** are reported in 40% to 70% of dogs - Concentrations of serum cardiac troponin, markers of myocardial ischemia, are increased in dogs with GDV *Gastric Wall Necrosis* - stomach wall capillaries are collapsed secondary to intragastric pressure > **necrosis of the gastric mucosa** - Increased pressure + systemic hypotension = full-thickness gastric wall necrosis in some dogs. *Bacterial Translocation* - translocation occurs from gut that are poorly perfused, one study did not document increase in bacteremia in GDV cases (Perioperative antibiotic may have impacted the findings in this study) *Reperfusion Injury* - **Reperfusion injury** associated with correction stomach and return of normal blood flow has been documented - oxidative stress and antioxidant capacity change with GDV

Answer 36

CS - abdominal distention, unproductive vomiting or retching, restlessness, and hypersalivation - decompensatory shock include pale mucous membranes, bradycardia, cold extremities, depressed mentation, and hypothermia. RADS - **right lateral recumbency** to confirm the diagnosis - pyloric malposition with entrapment of air within the pylorus and gastric fold - Pneumoperitoneum (perforation vs iatrogenic centesis) bloods - CBC: [haem], stress leuk, thrombocytopaenia - biochem: elevated liver kidney enzymes, electrolytes - lactate: helpful in evaluating perfusion, monitoring resuscitation efforts, and possibly predicting survival > values of survivors and nonsurvivors overlap, and thus care must be taken when applying specific cutoff values to individual patients.

Answer 37

* Plasma lactate over 6mmol/L 88% specific and 61% sensitive for gastric necrosis. In same study, 99% of dogs with lactate below 6 survived vs 58% above 6 * Initial lactate cutoff 7.4mmol/L 82% accurate (50% sen, 88% spec) for gastric necrosis and 88% accurate (75% sen, 89% spec) for predicting outcome * 90% of dogs with initial lactate of 9.0mmol/L or less survived * Survival rates significantly increased in dogs with final lactate 6.4 or less (91% survival), absolule change in lactate of 4mmol/L or more (86% survival), percentage change in lactate of 42.5% or more (100% survival)

Answer 38

- directed at stabilizing patients before surgery. **Fluid therapy** - most critical component (patients are hypotensive) - multiple IV access (ideallt CVC) - ideal to provide rapid resuscitation with a crystalloid solution (expand intrvalscular volume) - NaCl, lactated Ringer's or hypertonic saline 7% - maintaining volume ideally with oncotic support.... - measuring the patient's response to therapy using systemic parameters such as heart rate and blood pressure Continuous electrocardiography - Treatment of **arrhythmias** if they result in pulse deficits or poor peripheral perfusion or are likely to progress to fibrillation - **vasopressor** therapy - **Oxygen** supplementation (saturation of hemoglobin) - Broad-spectrum **antibiotic** therapy gastric **decompression** - orogastric intubation (passage of the tube into the stomach may be difficult, ideally sedated or if moribound) - percutaneous placement of an over-the-needle catheter or a trocar (area of greatest tympany)

Answer 39

- preoxygenation - rapid control of the airway at the time of induction - avoidance of agents cardiovascular depressants or arrhythmogenic - hydromorphone, propofol - fentanyl-lidocaine CRI intraoperatively, will reduce MAC of inhalation agents - position patient to reduce compression | lidocaine if arrythmias present

Answer 40

Goals: reposition the stomach, remove necrotic tissue, and create a permanent adhesion - decompressed completely with orotube before derotate - Gastric rotation of 90 to 360 degrees has been reported, with rotation of 180 to 270 degrees most common > ID pylorus - Palpation of the gastroesophageal junction should identify whether the stomach has been completely derotated. - exploration of the abdomen is indicated to identify any other abnormalities - stomach and spleen are then evaluated for viability - necrosis common > greater curvature, fundus and body - gastric wall thickness (as estimated by palpation), serosal surface color, presence of peristaltic waves, and bleeding after serosal incision were 85% accurate in determining gastric wall viability - gastropexy | esophagus suctioned if reflux occurs.

Answer 41

ensure adequate hydration; correcting electrolyte abnormalities; treating cardiac arrhythmia - peritonitis, - sepsis, - DIC (plasma transfusion) - ileus (metoclopramide or intermittent gastric decompression via a nasogastric tube) - vomiting

Answer 42

Incisional: 0% Circumcostal: 4.3% Gastrocolopexy 3/20 (15%)

Answer 43

* Clinical signs for more than 6hr * Gastrectomy * Splenectomy * Hypotension * Gastric necrosis * Pre-op arrhythmias * Peritonitis * Sepsis * DIC Overall survival 73-90%

Answer 44

- increased duration presentation > surgery (decrease in mortality presumably reflects time spent stabilizing) - preoperative plasma lactate concentration below 6.0 mmol/L was associated with a 99% survival rate in one study, or improvement of at least 4mmol/L - cut point value for myoglobin of 168 ng/mL, almost 90% of dogs survived

Answer 45

- 29-fold decrease in mortality rate compared with dogs that had not undergone gastropexy - Dogs underwent laparoscopic evaluation of the gastropexy site at 1 month (n = 10) and 6 months (n = 9) after the gastropexy technique. All dogs had confirmation of firm adhesion at the gastropexy site,

Answer 46

Stapled were significantly weaker at 7 days after surgery but were not different in mean tensile load to failure at 30 days post-op

Answer 47

- 0.4% directly associated complications – hemorrhage (2/3), infection (1/3) - no long-term gastric dilatation, GDV or GI signs - gastropexy malpositioning and bowel entrapment not observed

Answer 48

Circumferential esophageal hiatal rim reconstruction involved apposition of the medial margins of the left and right pars lumbalis dorsal to the esophagus (reconstructing the dorsal margin) and ventral to the esophagus (reducing the ventral hiatal aperture and completing the circumferential reconstruction) + oesophapexy substantial laxity of the left and right pars lumbalis and failure of dorsal coaxial alignment were observed Long-term follow-up information was available for 19 dogs: regurgitation had resolved in 16 dogs and occurred once weekly in 3 dogs. No ongoing medication was required for any dog.

Answer 49

number of suture lines → no effect on strength (load to failure ~53.5N) - longer incision → high load to failure (4cm 57.3N vs 2cm 49.7N)

Answer 50

41 dogs, retorspectiive delayed surgery = initial decompression, delay by mean 22.3h (5.25-69.75) → 3/35 (9%) mortality rate - time from presentation to surgery not associated with gastric necrosis or mortality - single plasma lactate and %change lactate associated with gastric necrosis and mortality - Intraoperative identification of gastric necrosis was associated with nonsurviva mortality rates reported for dogs undergoing immediate surgical correction of GDV (7.5% to 18%).

Answer 51

Finney and Jaboulay pyloroplasties for benign gastric outlet lesions. 13 - hypertrophic, ulcer, mass 9 hand-sewn Finney pyloroplasty and 4 stapled Jaboulay pyloroplasty. No major complications were recorded 25% persistent vomiting after Heineke-Mikulicz pyloroplasty Finney pyloroplasty - side-to- side anastomosis between the gastric antrum, the pyloric area and the proximal part of the duodenum Jaboulay - side-to- side anastomosis between the gastric antrum and the proximal part of the duodenum, excepting pylorus is preserved, - technically not a true pyloroplasty, but rather an antroduodenostomy that bypasses the affected pylorus

Answer 52

Prospective. 40. NIRF to assess gastric viability in GDV Subjective > 17 viable and 3 nonviable NIRF > 4 dogs (showed more diseased vs subjective 3 dogs, and picked up one more) surgeon’s margins were altered in 3/20 dogs NIRF can identify histologically confirmed nonviable gastric tissue. Clinical significance: to support the implementation of NIRF use of inotropes to correct intraoperative hypotension may artifactually affect tissue fluorescence. Further study warranted Histopathology was not performed in the remaining 16 GDV dogs

Answer 53

60 dogs. Prospective, 3 groups: double-layer inverting continuous pattern (DLI) , double-layer simple continuous pattern (DLS), full-thickness single-layer simple continuous pattern (SLS) The survival rate did not differ among the 3 groups 1 month postoperatively, and major complications were not observed. CLINICAL RELEVANCE Using a full-thickness single-layer pattern is a safe alternative for gastrotomy closure preoperative peritonitis > double-layer sutures are likely recommended. | larger study needed

Answer 54

Pet health insurance reduces the likelihood of presurgical euthanasia for GDV in AUS. 69 dogs. The majority of non-insured dogs (63%) were euthanised before surgery, while none of the insured dogs were euthanised Euthanasia prior to treatment was most common cause of death in non-referred dogs with GDV

Answer 55

460 dogs were surgically treated and 276 dogs were humanely killed. survival rates of patients operated on by general surgeons and specialists were 81.7% and 88.7%, respectively results suggested that admission time was statistically significantly related to the survival rate. Dogs operated on by specialist surgeons had a significantly higher survival rate compared to those operated on by general surgeons. Clinicians should aim to stabilise and complete surgical correction of GDV as soon as possible to decrease the mortality.

Answer 56

retrospective, clinical study 1 cranial and 1 caudal to the continuous suture line, going full thickness into the stomach to ensure engagement of submucosa superiority of one technique over the other cannot be determined on the basis of this study.

Answer 57

acute strength (failure load and work to failure) 37 pig cadavers The MIG had higher failure load and work to failure compared to SIG. All failures were caused by gastric tissue tearing. CLINICAL RELEVANCE The MIG is biomechanically superior to SIG and may provide more security

Answer 58

supporting the gastrointestinal tract when gastrointestinal tissue viability is questionable or resection is not feasible. Further prospective clinical evaluation studies would be indicated to determine whether the muscle flap remains viable

Answer 59

reinforcement of staple line after partial gastrectomy → improved biomechanical properties (improve resistance to leakage) Partial gastrectomy constructs were assigned to one of three closure techniques (n = 8 per group): group 1, stapled closure with a 90-mm thoracoabdominal stapling device and a 4.8-mm staple cartridge; group 2, hand-sewn double-layer inverting suture closure with 3-0 glycomer 631; and group 3, staple line reinforcement with an inverting Cushing suture pattern.

Answer 60

- paramedian incisional complications in 78/411 (19%) - seroma 12.4%, SSI 3.9%, excessive scar tissue 2.2% - resolution of complications in 75/78 (96.2%) - odds of complications 2x for single-incision-port lap-assisted gastropexy vs multi-port

Answer 61

retrospective 9/11 (82%) concurrent NSAID and CCS or higher dose/frequency/length of NSAID administration - 8/11 (73%) survived to discharge - all cases peritoneal effusion and peritonitis upon abdominal entry - ulcer size and location not associated with mortality - mortality: potential trend with hyperlactatemia; not associated with positive culture, associated with need for post-op vasopressors Primary closure may be associated with a high success rate in dogs with full thickness gastroduodenal ulcers.

Answer 62

successful identification of tumors: CT 92%, U/S 69% - CT more sensitive for identifying lymphadenopathy and location of tumours

Answer 63

outcomes of GDV surgery after rapid (90min) vs prolonged (>5hr) stabilization - immediate group → higher likelihood of death under anaesthesia - survival rates: to discharge: immediate 70/89 (78.6%); delayed (82.2%) 1m post: immediate 68/89 (76.4); delayed 55/73 (75.34%) - hyperlactatemia 24hr after initiation of fluid therapy associated with increased mortality **No survival benefit was detected as a result of proceeding to surgery after either a rapid or a prolonged medical stabilization.**

Ch 91 stomach Flashcards

(94 cards)