Small Animal Sx- GDV 2

wilsbach's version from 2015-11-04 18:50


Question Answer
hiatal hernia vs GDV pexyGDV: pexy on R at pyloric antrum. HERNIA: pexy on L at fundus
5 different options for gastropexys?(1) circumcostal gastropexy (2) belt loop gastropexy (3) incisional gastropexy (4) tube gastrostomy (5) incorporational abdominal closure
when do you want to consider doing an incorporational abdominal closure? what exactly are you doing?if your patient is crashing and you need to get out of there. When you are closing the abdominal wall, do a suture through the sera muscularis to prevent rotation
which is the strongest gastropexy?circumcostal gastropexy
which gastropexy is usually used prophylactically?the incisional pexy
**a ___ sided gastropexy reduces ___% risk of recurrance in GDVR sided, 92%
explain what's going on in a Tube Gastropexy?use a foley catheter (mushroom tip ie has an inflatable balloon). Tube will create an adhesion beween stomach and abd wall, and communication between lumen and outside. then when tube is removed, it will heal by 2nd intention from inside out.
where exactly is the tube placed in a tube gastropexy? where should you make sure is not obstructed?behind last rib, lateral to nipple line (L of mammaries if female) must not obstruct pylorus!
when do you remove a tube gastropexy?5-7 days
what is a awesome thing you can do with a tube gastropexy that you can't do with the other ones?easy access to medicate and feeding, can bypass the esophagus in case of esophageal sx
how do you suture the tube (in a tube gastropexy) into (___)<--where?use purse string on the pyloric antrum. Be sure not to occlude the pylorus
what kind of "tube" for a tube gasttropexy? If you want it to show up on rads, what can you do?A "mushroom/balloon" tip Foley catheter which is BIG (24, 26, 28, 30) bc large means you can decompress rapidly. Can fill little balloon with various materials to see it better on rads
talk over how to place a gastropexy tubeL to mammary glands if female.. push abd wall and make incision from protruding wall in...then from out-in put cath in (foley has balloon which can be inflated) at level of antrum, put in purse string suture. make circle big enough bc will make stab incision in center. once cath inserted, tie purse string, and then inflate ballooon. 32Fr is the gauging of the tube--bigger number is a bigger tube. can fill balloon with a little contrast material so can rad and see where tube is. lastly 3-4 stitches between stomach and abd wall to keep things in place
first the tube in a tube gastropexy is used to _________, then _________first use big tube bc used to DECOMPRESS (large tube=big number like a 32Fr). Then once tube is in, inflate balloon and then it will be used as an anchor to help antrum adhere to the body wall
what should you keep in mind when placing your purse string in the pyloric antrum?make sure it is big enough so when you make a stab incision into the antrum, you do not accidentally knick the suture you just put in
how can you inc the adhesiveness of the tube gastropexy even more?pass the tube 2-3 times through the greater omentum
how can you make sure the tube is anchored to the body wall very well from the outside?place chinese finger trap (can then lavage stomach/give meds/whatever)
how do you perform an incisional gastropexy (in short)at level of antrum make incision 4cm long though seromuscularis, let mucosa pop out, then bring that piece of stomach close to abd wall, make a same incision on abd wall on transversus abdominaus then suture distal wounds togeher. suture half incision and then tie, then suture proximal end
which is the strongest gastropexy?circumfrential/circumcostal
what is the minimum size you can make the incision in the incisional gastropexy?no less than 3-4 cm bc shrink and dont want it to break
if you do an incisional gastropexy, you might have to free up what ligament?gastrohepatic
does "scraping" the abdominal wall instead of incising and stitching it over work just as well but is less invasive?NO- it doesnt hold, dont do it
which gastropexy is the only one to enter the lumen?tube gastropexy
explain the process of a circumcostal gastropexy (in short)make tongue shaped flap or H shaped flap on the sera muscularis. Insicion over the last rib, place a stay suture on flap and pass it around the rib and suture it back. problems: time consuming bc you have to be careful to not puncture the diaphragm and cause pneumonthorax
which ribs do you usually use for the circumcostal gastropexy? what precaution should you take?dissect around 12th-11th ribs near the costo-chondral junction (go close to rib-- if you go farther, could be in thorax :( )
do you place the incision forward, behind, or on top of the rib for the circumcostal pexy?there is a nerve and vessel bundle behind each rib- just use the natural groove on the inner side of each rib to make a cut there, and then separate off to both sides to slide flap under rib
explain a "blunt dissection" circumcostal gastropexybluntly dissect part of stomach you want to thread detached rib through
how do you do a belt-loop pexy? **using transversus mm not the rib to loop the belt through
**what is the minimum size you should make the flap in the belt-loop circumcostal pexy? what important thing should you keep in mind?BASE OF FLAP should be 1.5 to 2 times the width of other end-- need GOOD BLOOD SUPPLY.
**why must the base of the flap of the belt loop technique be ___ (size?) why??1.5 times the the width of the tip. if not, there is not good blood supply--> ischemia--> necrosis--> dehisesence
which technique/method of pexy is usually done for the prophylactic pexys?LAPROSCOPIC procedure, which usually uses the incisional technique (prophy procedure usually done during OVH of predisposed breeds)
what is the prog of the pt if they require partial gastrectomy?35% of patients requiring partial gastrectomy die
if you want to possibly try to revive from tissue, how might you do it?place warm wet cloth on- helps with vasodilation
single or double suture in the pyloric antrum? body of stomach?antrum- single bc not enough room. Stomach has lots of room, so double
describe the closure for a gastrectomyperforating inverting or nonperforating on top or do simple cont appositional for hemostatic suture pattern then inverting nonperf on top this is a 2 layer closure as opposed in the pyloric antrum theres a lot of room in the stomach to double suture as opposed to pyloric antrum
explain what gastric Invagination is..what is another name for it? why woudl you rather do this than gastrectomy? aka Gastrorrhaphy. Instead of gastrectomy, you just leave a big chunk of tissue in the stomach lumen that gets debrided by the stomach. put 2 inverting non-perf suture lines on top of each other. faster than doing the gastrectomy (and dont really go into lumen, and less blood loss) [my notes said: instead of removing debilitated tissue, just push it inward and suture on top of it 2 layers of inverting stitches]
why should you be careful when you are inverting the stomach for a gastrorrhaphy?careful when invert- usually working towards body of fundus. careful with blood supply from gastric vessels from greater curvature
describe how you can use staples for a gastrectomyproduces 2 lines of staggered staples, cut over the stapler and remove a piece of tissue that you're taking out, slight eversion of the edges = chance for eventual adhesion
**what is the gastropexy you can do without major sx?gastropexy via GRID approach (easy and fast)
describe how you do a gastropexy via GRID approach?prophylactic method, on the right hand side. separate the mm fibers along their direction. incision at the level of pylorus of the sera muscularis without entering the lumen. suture the gastric wall to the transversus abdominus. good for gastropexy of clients that come for castration. DO THIS FIRST THEN CASTRATION. put pt in left lateral recumbency.
with gastropexy, what are the chances of recurrance?LESS THAN 5%!!
where do you know to make the incision for the gastropexy via GRID approach?go 1-2 fingers behind the curvature of the last rib with a grid approach and make the incision straight there
when do CV problems occur with GDV?post op (remember, MDF from pancreas)
6 important things to do with your post op care?intensive monitoring, fasting / enteral nutrition / bland diet / low residue, antibiotics, surgery control, cardiologic control (MDF), pain control
should you be feeding them after GDV sx?NPO 6-12 hrs but theres a need for *****glutamine to maintain the enterocytes so give AD thats rapidly absorbed and very energetic. can feed pt with a tube if you did the tube gastrectomy
when do the major post op problems (like dehisence) happen? when should you do your follow up based on this?3-5 day = dehiscence, contamination, etc so do your rechecks before then like the next day (pts should come back the next day)
how many fluids should you be giving post op, and why is it super important to monitor fluids and such?1-2 ml/kg/hr fluids monitor else kidney shut-down due to ups and downs of BP
should you give abx? if so, what?DEFINITELY. pt has been through shock w severe damage to the abdomen. metronidazole is recommended for the gr - bacteria (clostridium live at liver of liver/hilus so kill them off!)
what should you be monitoring the heart for post-op?(concerned about MDF aka myocardial depressant factor made by the panc when it is in distress) this MDF can cause PVC (premature ventricular contractions) and then fibrillation
how should you educate your clients on how to feed their pet after a GDV?several meals a day (3-4 meals a day at first, and then never less than 2xday). special diet (AD is good), high-protein (>30%) diet, particularly of raw meat. if feeding dry food, avoid foods that contain fat as one of the first four ingredients. LOW VOLUME of food. dry food that includes rendered meat meal with bone product. reduce carbohydrates (dog biscuits). adequate amount of fiber, no strong exercise after eating, and control water intake after meals
how much does prophylactic sx reduce mortality?like 29x
If gastropexy is not performed,___% of dogs will develop GDV again. 75.8
how does the height of the food dish affect the risk of bloat?Raising the food dish more than doubled the risk for bloat
how does the speed at which the dog eat affect bloat?Very fast eaters had a 38% increased risk of bloat
how does age affect the risk of bloat?Risk increased by 20% with each year of age.
how does family history affect the risk of bloat?having a first-degree relative (parent, sibling or offspring) that had bloated increased a dog's risk by 63%.
postop mortality is higher during the first ___ days after surgery4
what are primary sources of postop mortality? secondary?(1) Primary: gastric necrosis (why you dont wanna leave debilitated tissue), rupture and peritonitis (2) Secondary: cardiac arrhythmias (50.6%)
***Describe the Gastropexy for GDV (where with what structure)?Gastropexy for GDV is on the RIGHT at the PYLORIC ANTRUM
***Which fits the definition of Gastric Torsion? (a) Rotation of 90* (b) Rotation of 180* (c) Rotatioin of 260*(d) Rotation of 360*Rotation of 90* **Gastric Torsion is rotation less than 180* and there is NO COMPLETE OBSTRUCTION**
***What is the term for rotation of the gastro-esophageal junction greater than 180* with esophageal and pyloric obstruction? Gastric Volvulus
***What two things are necessary for GDV to occur?Failure of normal eructation, Acute Pyloric outflow dysfunction
***When using the belt loop technique in GDV patient, which is correct? (a) The tip of your flap should be twice as large as the base (b) The base of your flap should be 1.5-2 times the tip (c) The base and tip of the flap should be the same sizeThe base of your flap should be 1.5-2 times the tip
***What percent of patients requiring a partial gastrectomy survive?65% survive --> **35% of patients requiring it Die**