GDV, splenectomy, GI foreign bodies Flashcards
Ischemic pancreas produces
myocardial depressant factor.
stages of shock in GDV
Approximate number of hours from beginning of GDV occurence to bad prognosis?
After 5 hours passes from GDV occurence, prognosisis BAD!
※Lactate < ? generally survives
※Lactate > ? related with gastric necrosis
※Lactate > ? necrosis, mortality high
※Lactate < ? survival rates are high
※Post op after fluids > ? mortality high
※A less than < ?% change in lactate = no chance of survival
※An over > ?% change in lactate = patients 100% survived
※Lactate < 4.1 generally survives
※Lactate > 6 related with gastric necrosis
※Lactate > 6.35 necrosis, mortality high
※Lactate < 9 survival rates are high
※Post op after fluids > 6.4 mortality high
※A less than < 42.5% change in lactate = no chance of survival
※An over > 42 % change in lactate = patients 100% survived
For initial stabilization of GDV, use Isotonic crystalloids with a bolus shock dose of
90 ml/kg
KEEP IN MIND! Blood gas analysis should be performed
before fluid therapy for balancing acid base ratios
GDV patient can be in hypokalemia or normokalemia.
Main steps of GDV surgery (4)
- Rotation of the stomach back to normal position
- Removal of the necrotic area of stomach
- Splenectomy if any doubt at all about its state
- Gastropexy
You can remove what percentage max of the stomach after necrosis in GDV?
maximum 60%
What side of the dog should the surgeon stand on when GDV clockwise?
on the right of the dog
% of dogs presented with GDV that need gastrectomy.
20% of dogs presented with GDV need gastrectomy.
cranial pole of spleen supplied by
3-4 short gastric arteries
You start at these when doing splenectomy.
With suspected non-radiopaque foreign body on abdo xray - what measurements do you perform?
Determination of small intestinal diameter to vertebral body ratio - in dogs compare it to the L5 vertebral body height in dogs. Values greater than 1.6
are suggestive of obstruction.
In cats, a ratio of the maximum small intestinal
diameter to vertebral end plate height of L2
greater than 4 indicates a high likelihood of
intestinal obstruction.
Using contrast agent for identification of FB obstruction - how frequently should you radiograph?
In dogs, radiographs should be taken immediately
after barium administration and at 15 and 30 minutes, 1, 2 and 3 hours, and periodically thereafter.
In cats, barium passes through the GI tract more rapidly, take radiographs at 0, 10, 20 and 30 minutes, 1 hour, and hourly thereafter until the barium reaches the colon and the stomach is empty.
Four views (VD, DV, and left and right recumbent laterals) should be taken immediately and at least a VD and lateral view should be taken at each time thereafter.
How should you close an enterotomy?
Semjonov/Nick taught closing in one layer with either simple interrupted or continuous.
Some recommend schmieden for 1st layer, lembert for 2nd layer but this combo will narrow the lumen.
Seralp Uzun recommends cushing in 2 layers and says take a swab of the incision, after the first suture-layer, for bacteriology and swab again after 2nd layer.
* first layer of sutures should bite through all layers (yes, also in stomach)
* second layer of sutures should bite through muscularis and serosa
Other options Seralp says are cushing + lembert and schmieden + lembert.
mucosa, submucosa, muscular layer, serosa
name the layers of the stomach and intestines
mucosa
submucosa
muscular
serosa
After closing an enterotomy, the surgeon can place omentum over the sutured site to provide blood
supply and help prevent peritonitis.
For omental patch, a pedicle of greater omentum may be wrapped around the incision line and tacked to the serosa with
two simple interrupted sutures.
