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E2- GDV Flashcards

(78 cards)

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1
Q

Definition of dilation/dilatation

A

“bloat”

distension of the stomach with fluid, food, and or gas (pressure on caudal vena cava if distension is huge)

MEDICAL- induce vomiting, antonausea meds

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2
Q

Definition of dilatation-volvulus

A

enlargement of the stomach associated with rotation on its mesenteric axis (maalposition/Twisting)

SURGICAL

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3
Q

Risk factors for GDV

A

***Dogs with first degree relative w/ hx of GDV***

increasing age

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4
Q

Dietary things that increase chances of GDV?

A

increase volume of food fed once daily

dry kibble

fats/oils in 1st four ingredients

raised food bowl

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5
Q

What dietary thing decreases the risk of GDV?

A

fish or egg supplements

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6
Q

What is the relationship b/t exercise and GDV?

A

used to think it was a risk factor, BUT now it is seen that it has no impact

no definitive conclusion

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7
Q

GDV breed dispositions

A

Great Danes

GSD, Irish setter, Doberman

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8
Q

GDV body conformation risks?

A

increased thoracic depth to width ratio

deep chested dogs!

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9
Q

Temperment association with GDV

A

“happy” dogs- decreased risk

increasing anxiety, aggression to ppl, spending 5 hrs a day with O = increased risk bc of stress

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10
Q

Should dogs undergoing a splenectomy get a gastropexy as well due to increased risk?

A

no supporting evidence

only 6-8% chance of developing GDV

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11
Q

Describe the event causes a reperfusion injury

A

period when blood flow to tissue is absent followed by return of blood flow

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12
Q

What type of by-product accumulates during a reperfusion injury?

A

anaerobic metabolism by-products

accumlation of cellular waste products, toxins and toxic oxygen radicals

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13
Q

What happens once reprofusion is restored?

A

toxins are released into general circulation

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14
Q

Factors of reprofusion injury

A
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15
Q

Gastric displacement most common direction?

A

CLOCKWISE rotation

torsion is <180º rotation

volvulus is >180 rotation

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16
Q

Less common directoinal rotation?

A

counterclockwise rotation

rare <5% of cases

displacement <90º

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17
Q

Clockwise displacement- pylorus moves along the ______

A

ventral abdominal wall to the left side

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18
Q

Clockwise displacement- what is the stomach covered by?

A

omentum

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19
Q

Counterclockwise displacement- the plyorus moves where?

A

pylorus moves dorsally to lie adjacent to esophagus

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20
Q

Counterclockwise displacement- the greater curvature lies where?

A

along the midline

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21
Q

Counterclockwise displacement- is the stomach covered by omentum?

A

NO

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22
Q

Many Counterclockwise displacement GDVs are presented with history of ____

A

chronic GI signs

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23
Q

Clinical signs of GDV

A

acute

restlessness

hypersalivation

“praying” posture- taking pain away from abdomen

vomiting- nonproductive retching

weakness

collapse

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24
Q

GDV physical exam findings

A

distended, painful, tympanic abdomen (acute abdomen)

active retching

collapse

varying degrees of shock- compensatory & decompensatory

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25
What do we do for initial stabilization GDV?
Aggressive fluid therapy- large bore cephalic or jugular catheters (avoid hindlegs) initial fluids: crystalloids, hypertonic saline- colloid maintenance: crystalloids, colloids Blood pressure and EKG monitoring- shock 90mls/kg dog (25% right away)
26
How do we Dx GDV with lab findings?
CBC, Biochem, Lactate levels lactate levels \<6.0 increased survival
27
The **goal** of treatment for GDV is to..... followed by?
_stabilize cardiovascular, respiratory and renal systems initially_ -fluids, decompression, pain management then surgery and post surgical treatment
28
What is the first choice for GDV decompression?
**stomach tube decompression is 1st choice!** trocharization, then tube, sedation, gastric lavage
29
Why is gastric decompression important?
improves CV and respiratory function
30
When do we perform gastric decompression?
after/during fluid/volume support
31
What is important to remember with orogastric intubation?
bite block measure and mark tube length -xiphoid is good landmark advance tube slowly DO NOT force tube
32
T/F: gastric decompression can be performed with either sedation or general anesthesia
true
33
during gastric decomprssion, what do we do once the stomach tube is in stomach?
empty contents check effluent gastric lavage- 5-10mls/kg warm water, gavage pump (if they are not intubated, dont heavily sedate bc they can aspirate)
34
If we are initially unable to pass an orogastric tube what should we do?
trocharization- only releases so much, not all use large bore needle/catheter most tympanic site- **stomach is on LEFT SIDE** complications: spleen, leakage then repeat orogastric intubation
35
Assessment of orogastric tubing Vs trocharization
Tubing successsful 75.5% Trocharization successful 86% no evidence of gastric perforation one splenic laceration w/ trocharization _NO DIFFERENCE b/t both methods and survival!_
36
What does the radiograph show?
GDV- after stabilization
37
Why dont we put GDV dogs on their backs?
VD can predispose to reflux or aspiration
38
What types of pain control?
drugs with minimal CV effects Oxymorphone, fentanyl, buprenorphine
39
What can be used for free radical scavengers for the reperfusion injury?
Acetylcysteine Vitamin C, E & selenium Desferozamine -iron chelator Lidocaine- scavenger of reactive oxygen species (ROS), arrhythmias, CRI for pain control
40
When do we want to do surgery?
as soon as stabilized- the longer the torsion, the increase risk of lack of blood supply
41
Benefits of early surgery?
better prognosis gastric repositioning **improves bloodflow** surgery may be completes **before onset of arrhythmias**
42
What are the 5 factors when doing surgical management for GDV?
gastric repositioning assessment of gastric viability evaluate pylorus evaluate spleen gastropexy
43
Discribe surgical gastric repositioning
decompress the stomach if still distended push down on fundus w/ right hand grasp antrum w/ left hand and rotate stomach counterclockwise confirm proper reduction by examinging gastroesophageal junction (trying to bring pyloris from left side to the right side)
44
Assessment of gastric viability
"standard" criteria- color pink/red (black=bad), pulsation of blood vessels, bleeding from cut surface, peristalsis (movement is indicator of health) palpation of wall thickness surface oximetry
45
Gastric necrosis location
greater curvature near short gastric arteries
46
Gastric necrosis- hand suturing vs staples?
hand sutures associated with higher mortality staples are better?
47
Areas of necrosis are present in \_\_\_\_% of GDV cases
10%
48
Gastric perforation occurs when
the stomach wall is very thin non-viable tissue, remove the necrosis entire stomach necrotic? euthanize :(
49
Evaluation of the spleen with GDV sx?
venous congestion- self limiting vessel thrombosis- splenectomy splenic torsion- splenectomy
50
What are the chances of GDV reoccurring without a pexy surgery?
50% -it will happen again!!
51
What is the chance of recurrence with the pexy surgery for GDV?
4% - VERY LOW
52
T/F: gastropexy prevents dilation
FALSEE does NOTT
53
Goal of gastropexy?
permanent adhesion on right lateral body wall (pexy pylorus)
54
\_\_\_\_% success rate for most gastropexy techniques
95%
55
Incisional gastropexy procedure
incise the _seromuscular_ layer in gastric antrum and right abdominal wall- dont penetrate mucosa suture edge of abdominal wall to gastric incision w/ simple continuous pattern **3**-4cm oral to pylorus in the _transverse abdominus_ make the incisions so that pyloric outflow tract and proximal duodenum are not twisted or kinked
56
What type of gastropexy is this?
Belt loop gastropexy make a loop of stomach tunnel through transversus muscle
57
What is the strongest gastropexy technique?
circumcostal gastropexy
58
Describe the circumcostal gastropexy procedure
seromuscular flap placed around 13th rib technically demanding Risks: rib fractures (bc you make a flap & go around rib), pneumothorax
59
Laparoscopic-Assisted gastropexy
dorsal recumbancy single port-SILS port Two ports- camera port and instrument port (babcock forceps)
60
Endoscopic assisted advantages
equipment more widely available pyloric antrum accurately visualized gastropexy performed w/ standard surgical instruments
61
Endoscopic assisted limitations
expertise in gastroscopy required potential organ trauma
62
Reasons for doing propylactic gastropexy
breed risk- great danes esp if 1st relative had it identified risk factors owner requests it
63
Postoperative care for GDV
NPO for 12-24hrs Fluid and electrolyte replacement Monitor for **arrhythmias** for 24hrs after sx Pain control **Blood pressure monitoring -_hypotension_ at any time is risk factor for death** encourage limited exercise- get them up and walking
64
What is medical postop care for GDV?
anti-emetic: maropitant (cerenia) H2-receptor antagonists (nausea) -ranitidine, famotidine Sucralfate (coats stomach/esophagus)- 0.5-1gram PO BID or TID +/- metoclopramide- promotility
65
Deaths following GDV postop occur w/in\_\_\_\_\_
1st 4 days postop
66
Postop death from shock
hypovolemic septic- endotoxic
67
Postop death from gastric necrosis
gastric necrosis leads to peritonitis - unrecognized areas of necrosis - perforating ulcers - reperfusion injury
68
Electrolyte disturbances postop GDV
Hypokalemia- can induce or potentiate arrhythmias, muscular weakness, lethargy Hypochloremia- gastric sequestration
69
\_\_\_\_% of P will develop arrhythmia
50%
70
Cardiac arrhythmias occur _____ after onset of GDV
12-36hrs | (usually less intense in 24-72hrs)
71
Cardiac arrhythmias are typically what type?
**ventricular are most common**
72
Causes of cardiac arrhythmias
myocardial ischemia (decrease CO so myocardium gets irritated) electrolyte abnormalities acid-base alternatives vasoactive substances imbalance of autonomic nervous system
73
Types of arrhythmias with GDV?
premature ventricular contractions paroxysmal ventricular arrhythmias (runs) idioventricular rhythm (slow v-tach) ventricular tachycardia \>180HR multifocal PVCs → v fib
74
When do we treat arrhythmias?
V-tach with high rate (\>180-190bpm) pulse deficits poor pulse quality weakness multifocal PVCs
75
Lidocaine use for arrhythmias
bolus 1-2mg/kg IV q 5 mins constant rate infusion (maintenance) 25-80ug/kg/min
76
What electrolytes should we check for refractory arrhythmias?
potassium, magnesium, calcium
77
Pain relationship to refractory arrhythmias?
pain → arrhythmias so we need pain management
78
Survival rate for uncomplicated cases of GDV?
80-90% -very good

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