Small Animal Sx- GDV 1

wilsbach's version from 2015-11-04 18:44

GDV arriving

Question Answer
how is GDV charaterized?syndrome is characterized by accumulation of gas in the stomach and malpositioning of the stomach with obstruction of eructation and pyloric outflow
what is Gastric dilatation without rotation like?no burping, belching or any other way to get rid of gas bc pylorus is obstructed
what does GDV stand for?Gastric dilatation - volvulus
whats particularly awful about the "volvulus' part of GDV?twisting of stomach twists vessels-- cut off blood supply
you should be doing constant monitoring, esp to make sure...heart, lungs, and brain are perfused
how does Gastric dilatation without rotation happen?no burping, belching or any other way to get rid of gas bc pylorus is obstructed, or dog eats a TON of food at once...
how urgent is GDV?Considered a clinical-surgical emergency with a High mortality rate (15-28%, was 42%). Its physiopathology can involve all types of shock
whats going on with the chronic form of GDV?chronic form - goes on for a long time, dog tends to vomit and nothing comes out and survives but theres a lot of damage to the stomach that occurs, fibers of stomach may not go back to normal precision, recurrent episiodes
ideal situation for GDV is having them stabilized. What if you cant?better if stabilized, try to optimize if you can, sometimes you cant even get that and you just gotta go into sx
which vessels should you be gaining IV access to if a dog comes in with GDV? which vessels should you not use?USE external JUG! BIG VESSELS! if you ligate them theyll be ok. cephalic if you must. DONT USE SAPHENOUS!! stagnation of blood from diaphragm backwards, so useless.
you need a well organized crash cart, as well as a funnel and a bucket--why?funnel to lavage stomach, bucket to recover lavage fluids
why cant you use the saphenous for venous access in a GDV?the swelling of the stomach from the trapped gas blocks venous flow from vena cava and portal vein, so blood flow of entire back of animal is compromised
possible etiological causes of GVD?etiology UNKNOWN. however, could be due to.. delayed gastric emptying, laxity of ligaments (ones that connect stomach to wall as well as gastrosplenic), commercial diets
RISK FACTORS for GDV?Large/ Giants breeds, Deep/narrow chest, Single meal, Nervous/fearful, Rapid ingestion/aerophagia, Exercise after eating
can cats get GDV?yes!
why might there be altered cardiovascular and resp parameters?stomach pressed against heart, great vessels, diaphragm
how might the spleen be affected by GDV?splenomegaly, or altered position
what type of saliva might you see with GDV?foamy mucus (can also have heavy salivating/drooling)
mega list of CSs in powerpoint... read it overwee
Gastric Dilatation--> stomach distension caused by?air, fluid, food, and a frothy mucoid substrate
why can gastric dilation with no volvulus still cause huge problems?theres no twisting but theres a huge stomach pushing forward and causing pain >> ileus. Then, bacteria are starting to replicate from ileus (no peristalsis gives them a chance to stay in one place and replicate), normal peristalsis helps stop bact from establishing
what is Gastric Torsion? how often is this seen?when the stomach twists abruptly on the long axis, and rotation is LESS THAN 180 degrees and there is no complete obstruction. this stage can be overlooked because there is no complete closure of the gastro-esophageal junction
what is Gastric Volvulus?twisting takes place over the long axis of the stomach, and rotation of the gastro-esophageal junction is greater than 180 degrees, with esophageal and pyloric obstruction
torsion vs volvulusvolvulus >180*, torsion <180*,
how can you tell there is volvulus the moment you open the abdomen?everything is covered in omentum
what are the 2 things that are necessary for GDV to occur?(1) failure of normal eructation (2) acute pyloric outflow dysfunction
what are the degrees the stomach rotates if it goes in a clockwise fashion? counterclockwise? which happens more often?clockwise rotation is usually between 180* and 270*. counterclockwise is 90*...almost always a clockwise rotation (the worse one of course)
which would you rather have- clockwise or counterclockwise rotation?COUNTERclockwise bc only goes 90* (instead of 180-270) so less damage (counteract the awful with a counterclockwise turn)
if the stomach is covered in omentum, which way did it rotate?clockwise (180-270*)
why should you never rapidly rotate the stomach back once exposed?reperfusion injury
you can't rotate the stomach right away due to reperfusion injury, but what can you do while you start to try to?vessels are twist, caudal vena cava cant empty, lots of pressure against the heart and lungs after turning the stomach a quarter of the way, let blood flow through the liver a few times while animal is "stabilizing"
what can you do to help decompress the stomach quickly?release air with a large bore needle
what is the problem that this picture is talking aboutthe gigantic rotated stomach is compressing the vena cava, so vessels not able to drain well.
why must fluid levels be monitored super carefully and be changed even after the procedure?worried about kidneys! look out for urine output--- if below 500mmhg, can get kidneys shutting down. so make sure kidneys are ok.
how should you derotate the stomach? why?a quarter at a time to try to minimize reperfusion injury, and let them re-stabialize a little at a time
how/when will peristalsis restart?once you derotate the pt when you pinch the intestines they will slowly recover the peristalsis
when do most GDVs present?NIGHT is most common time (68.7%) followed by afternoon, followed by morning
what are three methods for gastric decompression? (do you put the animal under for each?)Orogastric intubation (awake/ sedation narcosis). Gastrocentesis (awake or not) Gastrostomy (local anesthesia?)
if you are going to try orogastric intubation, what should you do before you start and what should you be careful of?mark tube outside of body apprx where you wanna be so you know where you are when you are shoving a tube down there (8th-9th IC space). (use marker, not tape which can loosen) DO NOT USE forceful pushing of tube to pass--> it can perforate bueno
what is Gastrocentesis?stick a needle/trochar into stomach through abd wall
what is/what do you do in Gastrostomy?temporarily (flank approach/incision) creation of new opening- stomach exposed. but you do it in any position the stomach is in.. will need to put stomach back into normal position
downside of gastrostomy?when you get ready for sx, need to close the stomach whole, then reposition the stomach, then do sx. takes too much time
how should you prepare the tube for orogastric intubation, and how can you prevent biting and occlusion?(dont forget to mark length beforehand) make sure to lube! put 2-3 additional holes so there is not occlusion, and you can place a roll of tape between their incisors and pass it through the core to keep them from biting down
where is the esophageal hiatus?8th-9th intercostal space (where you want your tube to be)
when you are trimming extra holes into the orogastric tube, what rules should you keep in mind?only 2 or 3max holes, make sure they arent more than 20% of circumference
if you successfully pass the orogastric tube, you will hear and smell...hear a hissing sound and the air will smell like concentrated acid
after you successfully pass the orogastric tube, what do you do?get your funnel and your bucket- angle dog up with head up at 45* angle and lavage stomach with water (he recc cold water to numb a bit and and reduce chances of vomiting)...then lie them back down on the table and place bucket at end of tube hanging down, have assistant squeeze dog from behind to help get fluids out into bucket
if you get thick saliva and brown coffee-ground looking fluid in your bucket after lavaging the pts stomach, what do you think it means?mucosa sloughed off- denuded mucosa of stomach
when do you remove the orogastric tube?not till after sx
do you do orogastric tube or gastrocentesis first?gastrocentesis is PLAN B- do when you cant pass the tube
with what tools do you perform a gastrocentesis?LARGE BORE catheter ( that are LONG 14/16g (like horse caths) NOT a trochar.
what should you be very aware of and percuss to try to locate when doing a gastrocentesis?DO NOT HIT THE SPLEEN! percuss abdomen for most tympanic area look out for dull sounds, could be spleen
explain how to do the gastrocentesissterile procedure- clip+ scrub! insert cath, percuss, remove stylette, hear hiss and smell the acidy smell...then push abd wall gently and *hold cath as you do so (pushing it along with the belly)*
how do you make sure that the catheter you use for the gastrocentesis doesnt get occluded?cut in extra holes (shouldnt not be larger than 30% of circumference)!!! bc otherwise can BREAK in the dog
gastrostomy is the last ditch effort if you cant do anything else (no good but described in literature) what technique would you use?grid paracostal approach
Clinical Signs of Patients at Risk?Dyspnea with abdominal component, Debilitated, decreasing consciousness, dec HR, inc resp rate followed by a reduction, hackles raised
if you see a dog with GDV suddenly raise their hackles, arch back, stretch out legs... what should you be prepared for?CPR- usually do this right before they die. **DONT FORGET TO TURN OFF ANESTHETIC GAS
what kinda priority do you have with taking radiographs of a GDV patient?do not delay therapy for an X-ray!!! radiographs are used to distinguish gastric dilatation from gastric dilatation volvulus- which means obtaining radiographs is not therapeutic, the patient must be stabilized first…(dont do rads first!)
should you restrain a GDV dog?no...just added stress
what does GDV look like on a lateral view? how about the DV/VD<--which one, why?LATERAL= popeyes arm, smurfs hat. want DV and not a VD bc VD adds extra pressure and weight onto the lungs- VD looks like "double bubble"/compartmentalization (usually extends beyond 8th IC space)
once you've decompressed the stomach... what next?when decompressed, HR, RR, BP improve....then you need to do sx!! explain to owner this is a syndrome. if only decompression, can reoccur (even in a few hours), or end up with chronic torsion
sx management of GDV has what THREE PRIMARY OBJECTIVES?(1) reposition the stomach (stomach tubing?) (2) assess the severity of ischemic injury to the stomach and spleen and “resect” any devitalized tissue (3) perform a permanent gastropexy to prevent recurrence
When lavaging and then draining the stomach, what should you be cautious of?make sure dogs head is DOWN so they don't aspirate any liquid
do you wanna give abx to a gdv pt?YES! ileus-->bacterial translocation
if there is mucosal sloughing that you find upon lavageing, what are some things you can do to help this?use mucosal protectants if there is mucosal sloughing and proton inhibitors and special food (basically like ulers)
which vessels should you check when you have a GDV pt?check SHORT GASTRIC VESSELS
which two organs should you DEF check if the dog gets GDV?check SPLEEN AND PANCREAS
what is MDF? how does it relate to GDV?"myocardial depressant factor" is a polypeptide the pancreas can make if it's too pissed off which can be detrimental to the heart
what will gastropexy not fix?can still dilate
if there is splenic torsion, what should you do?remove spleen without untwisting or see if its still viable
how should you open abdomen for GDV sx?(remember to prepare entire area bc you dont know how much space youll need or what procedure youll need) make sure stab incision through linea alba....can start at level of umbilicus and then use grooved director to avoid hurting underlying organs
the first objective of of surgical management of GDV is?If the repositioning is correct, the pylorus should be back on the right and the gastroesophageal junction should not be twisted
how much fluid do you want to leave in the stomach after the lavage?NONE! the emptier the better for sx procedures
why is it so important to get any fluids out of the abdomen?lots of serosanguinous fluid, esp if vasculature has ruptured. lavage and clean this-- blood is a great medium for bact to grow.
why do you wanna make sure bladder is catheterized?bladder should be cath so know there is normal urine production (which is 1-2ml/kg/hr)
what is the second objecive of surgical management of GDV?stomach is assessed using the standard criteria of color, presence of pulsating vessels, peristalsis and bleeding from the cut surface. another useful technique is to palpate the thickness of the stomach wall--> devitalized areas will feel thinner than adjacent viable tissue
why do you not want to leave devitalized areas in?they can rupture?
which colors of tissue are ok to leave in, which arent?red to violet ok, green to black, prolly need to remove.
what can you do to possibly revive some of the color of the stomach? how do you check if tissue is viable?moist lap sponge with moist warm saline to help recover color. scrape surface gently with scalpel and see what comes out-- if dark and sluggish, no bueno. want good bleeding/ something reddish
if you see a "String of pearls" near the spleen, what do you think it means?spleen not working well (hemorrhagic lesions bc congestion and rupture of vessels- string of pearls-clots w/i vascular supply, hemorrhagic spleen)
what should and shouldnt you do if the spleen is twisted?DONT untwist-- will release tons of free radicals. knick it and see if the tissue is still viable
how can you assess the intestines?pinch test, CRT, assess peristalsis
where would you look to see if there was a pulse in the intestines?mesenteric side
how commonly are gastrostomies done now?not used anymore bc increases morbidity and mortality. but approach can be used for gastropexy
if the stomach is greatly expanded, might be hard to grab llinea alba- what do then?may have to go by umbilicus to make incision bc linea alba can be hard to grasp and then use grooved director. intstines can splooge out. omentum covering stomach indicates clockwise rotation. look at serosa and muscularis of stomach color.
normal urine production is?1-2 ml/kg/hr
why might the spleen be super big?engorged with backed up blood