lecture 2 : gastric dilation and volvulus 2 Flashcards
(38 cards)
Surgery should be performed as soon as
patient is _______ and is required even if stomach is _____
stable and decompressed
pre op management of GDV
- IV Fluids
- Antibiotics
- Oxygen
- Correct significant electrolyte & acid-base
abnormalities - Gastric Decompression as needed
- ECG to monitor for cardiac arrhythmias
Instrumentation & Equipment
- Foal nasogastric tube & stomach pump
- Suction machine & sterile tubing
- Poole suction tip
- Laparotomy pads
- Balfour retractor
- “Spay pack”
- TA Stapler
steps of surgical technique
- Patient placed in dorsal recumbency
- A ventral midline incision is made from xyphoid to
pubis to facilitate a full exploratory celiotomy - Prep big! (Include mid-thorax to pubis)
——–Modify to accommodate tube gastropexy if anticipated - Always count sponges before incision and before
closing
O.R. personnel
*Surgeon
*Scrubbed assistant
*Anesthetist / unscrubbed assistant
goals od surgery: 1. Assess Viability
- Inspect the stomach and spleen to identify
and remove damaged or necrotic tissue
goals od surgery: 2. Decompression/Derotation
- Decompress the stomach and correct
malpositioning
goals od surgery: 3. Gastropexy
- DO IT!!!
Reported rate of recurrence rate of 80%
without gastropexy.
during the abdominal exploratory, evaluate and palpate what in the abdomen?
- assess vascular supply to the spleen
———Splenectomy if indicated - palpate the stomach wall and pylorus
- “run” the bowel & assess other viscer
secondary assessments if gastric viability
- Check for torsion of the gastrosplenic Ligament
- Palpate intra-abdominal esophagus to ensure
that stomach is derotated
be sure to check to see if there is any _______
- Rupture of the Short Gastric Arteries is
common and may result in - Blood loss
- Gastric infarction/necrosis
how is the blood flow broken down in this part of the body
- 80% of the arterial blood flow is to the mucosa
- 20% is to the muscularis and serosa
t/f: Observation of the mucosal color is a
reliable indicator of gastric wall viability
false, it is not a reliable indicator
helpful hints for GDV sx
- Decompress the stomach before repositioning
- Intraoperative manipulation of the cardiafacilitates
an assistant passing the Orogastric tube - A small gastrotomy incision can be performed to
empty the stomach
gastric viability factors: color of seromuscular layer
- red to purple: consider it viable
- green to black: probably nonviable
gastric viability factors: fluorescence dye
unreliable at low flows
gastric viability factors: tubular thickness
Palpate thickness in antrum compared to
dorsal fundus - necrotic areas feel “thin”
gastropexy techniques : securing ventral antrum to right body wall
- Tube gastropexy (when stomach continues to
inflate intra-operatively) - Circumcostal
- Incisional (Muscular Flap)
- Belt-loop
tube gastropexy
- Ileus
- Decompression
- Feeding +/-
Circumcostal
Gastropexy
- Stronger than most
techniques - Technically more difficult
- Increased Surgery Time
- Increased complications
what gastropexy technique is this
Belt Loop Gastropexy
incisional gastropexy
- 3 to 5 cm incision through the
seromuscularis - 8 to10 cm from the pylorus in an avascular
area of the pyloric antrum - 3 to 5 cm incision in the right ventrolateral
abdominal wall caudal to the last rib
Always check to see that your gastric incision will
reach the selected area of abdominal wall
________ making the abdominal wall incision.
BEFORE
describe top and bottom arrow
top -Preferred location of 3-5 cm
gastropexy incision.
bottom-Preferred location of
gastrotomy incision
