Term
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Definition
-"bloat" can technically just mean a build-up of gas and/or food
-GDV refers to torsion and volvulus as well |
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Term
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Definition
Torsion: twisting along the long axis of an organ like the esophagus, portion of intestine; like wringing out a towel
Volvulus: twisting of a pendulous organ like the stomach, or the mesentery and intestines together |
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Term
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Definition
-abdominal distension
-ptyalism (salivation)
-attempted vomiting (dry heaving)
-abdominal pain
-abdominal tympany
-nervous/restless/eventually depressed behavior
-shock
-dyspnea
-prolonged CRT
-pale MM
-DIC |
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Term
| What does DIC stand for? What does it mean? |
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Definition
Disseminated Intravascular Coagulopathy
-tissue necrosis occurs from torsion/volvulus
-body uses tons of clotting factors and platelets on necrotic tissues
-no surviving this, even with transfusions |
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Term
| Aside from GDV, another common cause of DIC is what? |
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Definition
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Term
| How might a GDV patient show signs of abdominal pain? |
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Definition
-restlessness
-jerking of abdomen
-looking at abdomen frequently |
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Term
| A patient developing DIC might show what signs on the skin? |
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Definition
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Term
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Definition
-volvulus: abnormal twisting of intestines and esophagus
-spleen and pylorus move out of position
-blood supply to stomach/spleen is twisted
-tissue necrosis starts when cells are depleted of O2 |
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Term
| What organ is attached to the spleen? Where is this attached? |
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Definition
| spleen attached to greater curvature of stomach |
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Term
| What organ's blood flow is affected when the stomach twists out of position? |
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Definition
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Term
| The pylorus is normally located where? |
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Definition
-normally on the R side, oriented caudally
-GDV: rotates cranially and to L side |
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Term
| The stomach of a dog with GDV usually rotates how? |
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Definition
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Term
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Definition
-definitely heredity and deep-chested dogs (large or giant breeds)
-large meals/drinks? speed of ingestion? aerophagia?
-exercise?
-swelling of dry kibble?
-food bowl position?
-stasis of gastric motility?
-rolled during anesthesia |
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Term
| Why might GDV occur more in the evening/night? |
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Definition
-owner comes home from work
-dog eats big meal
-they go out to play
-pendulous, full stomach twists around during exercise |
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Term
| One study suggests that something commonly thought of as a preventative for GDV, may not actually make a difference. What was that? |
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Definition
-raising food/water bowls
-but harmless change, so why not do it?
-doing so may prevent aerophagia |
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Term
| Why would soaking dry kibble possibly help prevent GDV? |
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Definition
-prevent swelling of food in stomach
-if dog normally eats 1c dry food, maybe it will only eat 1c soaked food |
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Term
| How are we supposed to roll animals during anesthesia? |
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Definition
sternally, not dorsally
-may not actually matter |
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Term
| What does deep-chested mean? What are some examples of deep-chested breeds? |
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Definition
-dog's chest is taller than it is wide
-eg Great Dane, German Shepherd, (Standard Poodle?) |
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Term
| Stasis of gastric motility means what? When might this occur? |
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Definition
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Term
| Goals of Therapy for GDV: |
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Definition
-prevention/reversal of shock with fluids; corticosteroids controversial
-immediate relief of gastric distention (decompression)
-stabilize pt until Sx |
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Term
| Why are corticosteroids controversial in the treatment of GDV? |
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Definition
-spare cell membranes, may postpone endotoxic shock by delaying the bursting of devitalized cells
-also delays healing, which may be bad if pt is undergoing Sx |
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Term
| Methods of gastric decompression: |
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Definition
-stomach tube (1st choice)
-trocarization
-gastrotomy Sx
-recurrence ~75% without gastropexy |
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Term
| What is trocarization? How is it performed? |
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Definition
-using a large bore needle behind the last rib to relieve distension of stomach
-performed on L side (because spleen flipped to R) |
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Term
| Notes on stomach tube for gastric decompression: |
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Definition
-insert from tip of nose to last rib
-don't force tube down, only works with mild torsion
-may be enough to push stomach back into regular position
-can lavage / pump stomach to remove food, necrotic tissue
-use mouth gag
-pick up back end to remove juices |
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Term
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Definition
-if can't trocarize
-use scalpel / lg needle to make incision into stomach, release gas/foods |
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Term
| After performed gastric decompression, recurrence is __%, unless _____ is performed. |
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Definition
| recurrence 75% unless gastropexy performed |
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Term
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Definition
-surgically securing the stomach is a permanent(?) position to the abdominal wall
-prevent GDV from occuring / recurring |
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Term
| When trocarizing an animal, it is important to avoid the ____. Do this by inserting the trocar on the __ side. |
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Definition
| avoid spleen, trocar on L side (spleen flipped to R) |
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Term
| What part of the stomach should be adhered to the abdominal wall during gastropexy? |
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Definition
| -near pylorus, because it moves around the most |
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Term
| How is gastropexy oerformed? |
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Definition
-scarify serosal tissue of stomach by pylorus and of abdominal wall (rub til it bleeds)
-suture together and surfaces will heal together |
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Term
| When is splenectomy indicated in GDV patients? |
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Definition
-when spleen very devitalized
-depends on how soon GDV case caught
-can live without spleen |
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Term
| Why might gastropexy not be a permanenet fix? |
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Definition
-lots of tension in area
-stomach can detach from abdominal wall |
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Term
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Definition
-watch for arrhythmias (ECG 2-3d)
-pulse deficits
-endotoxemia, DIC = lethal complications
-NPO 12-24 hrs at least
-restart feeding with water and gruel
-70% deaths occur within 4d of Sx |
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Term
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Definition
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Term
| Why might a GDV patient get arrhythmias? |
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Definition
| heart muscle irritated by endotoxins |
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Term
| __% of deaths in GDV patients occurs when? |
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Definition
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Term
| What food did Dr. Keller suggest feeding after GDV Sx? |
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Definition
| p/d- high protein, little residue |
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Term
| Home advice for prevention of GDV: |
|
Definition
-avoid large meals; several small meals per day
-soak dry kibble to prevent expansion in stomach
-prevent exercise after eating/drinking
-raise food or water bowls?? |
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Term
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Definition
| -removal or resection of diseased/non-viable section of intestine with end-to-end attachment |
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Term
| If you scrub in for an anastomosis Sx, what might you be doing? |
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Definition
| -clamping ends of bowel with fingers |
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Term
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Definition
| -making an incision into the intestines, often for FB or tumor removal |
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Term
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Definition
| the surgical removal of part of an organ or structure |
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Term
| Reasons why an enterotomy might be performed: |
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Definition
-intussusception
-tumor
-FB
-ischemia
-necrosis |
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Term
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Definition
| necrosis caused by lack of O2 to tissues |
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Term
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Definition
| when a portion of bowel telescopes into another portion |
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Term
| What animals are more likely to get FBs? |
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Definition
-cats: linear foreign bodies, check under tongue
-puppies: indiscriminant chewers |
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Term
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Definition
| lack of O2 to cardiac muscle; heart attack |
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Term
| How does intussusception feel during PE? How to confirm? |
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Definition
-sausage-like on palpation
-hard to Dx with rads
-can come and go |
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Term
| What happens to the intestines with a linear FB? |
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Definition
-the SI lining is like velvet, sticks to FB
-SIs become accordion-like
-can see "pleats" on rads |
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Term
| Where to look if you suspect a cat has a linear FB? How to visualize this spot? |
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Definition
-under tongue; can wrap around base
-press under mandible, tongue lifts up |
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Term
| What two things to rule out if puppy is having GI problems? |
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Definition
-parvo
-FB bodies (indiscriminant chewers) |
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Term
| Possible negative side effect of anastomosis Sx? |
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Definition
| strictures, aka abnormally smaller lumen |
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Term
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Definition
| stangnant bowel, lack of peristalsis |
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