L94a: GDV in dogs

what is gastric dilation volvulus?

life-threatening disorder in which abnormal twisting of the stomach on its mesenteric axis, with subsequent gastric gas accumulation and distention

what is GDV commonly referred to as?

bloat or gastric torsion

what are the characteristics of simple gastric dilation in dogs (simple bloat)?

1. distentsion of the stomach alone

2. can resolve on its own

what is an intrinsic factor?

an internal characteristic of an animal (anatomy or physiology) that increases its likelihood of a disease or condition developing

extrinsic factor

an external or environmental factor that increase the likelihood of a disease or condition developing

what intrinsic factors predispose dogs to GDV?

1. large deep chested dogs

2. dogs with a deep and narrow thoracic cavity

3. genetics

4. middle to older aged dogs

what breeds are predisposed to GDV?

1. irish setters

2. standard poodles

3. german sheperds

4. great danes

5. doberman pinschers

what extrinsic factors predispose dogs to GDV?

1. eating one large meal rather than small meals

2. rapidly eating food

3. stress or anxiety

4. vigorous exercise immediately after eating

list the overview of GDV.

1. gas accumulation in the stomach

2. stomach rotation

3. obstruction of blood flow

4. splenic displacement and vascular damage

5. gastric wall ischemia and necrosis

6. systemic circulatory collapse

7. multi-organ failure and acidosis

8. re-perfusion injury and sepsis risk

what local effects can occur from GDV?

1. displacement of duodenum and pylorus

2. avulsion of gastrosplenic ligament 

3. splenic infarction

4. ischemia in the gastric wall

what organ systems are affected by GDV?

1. cardiovascular

2. respiratory 

3. gastrointestinal

4. lymphatic system

5. coagulation dysfunction

what leads to a hypovolemic state in the heart due to GDV?

significant decrease in venous return to the heart

what does hypovolemic shock from GDV result in?

organ hypoxia, tissue damage, and death from decreased cardiac output to organs

what leads to cardiac arrhythmias due to GDV?

decreased myocardial perfusion and increased inflammatory mediators

how is the respiratory system affected from GDV?

gastric dilatation and increased intra-abdominal pressure severely reduces the total thoracic volume leading to decreased lung volume and poor ventilation

what is the most commonly affected area by gastric necrosis from GDV?

fundus

what part of the lymphatic system is affected by GDV?

spleen

what are the intestinal effects from GDV?

1. loss of movement of intestinal contents

2. causes dysbiosis

3. sequestration of fluids and protein loss

what coagulation dysfunction can occur from GDV?

disseminated intravascular coagulation

what effects can happen when cardiac output decreases from GDV?

1. reduced perfusion to tissues

2. acidosis and metabolic imbalances

3. hyperlactemia

4. oliguria to anuria

what happens when the stomach is surgically repositioned after GDV?

reactive oxygen species are released and inflammation occurs, potentially leading to further tissue injury

what re-perfusion injuries are caused by reactive oxygen species?

1. endothelial damage of blood vessels

2. disseminated intravascular coagulation

3. systemic inflammatory response syndrome

what are the early signs of GDV?

1. restlessness or pacing

2. panting

3. retching/vomiting (non-productive)

4. hypersalivation

5. distension of abdomen

6. abdominal pain

what are the progressive signs of GDV?

1. tachycardia

2. rapid shallow breathing

3. weak pulse

4. dark red mucous membranes

5. severe abdominal distension

6. depression

7. cardiac arrhythmias

what are the severe/late signs of GDV?

1. hypothermia

2. coma

3. collapse

4. evidence of metabolic disturbances

5. white or blue mucous membranes

why is GDV considered an emergency?

1. stomach can perforate and spleen can die

2. compromised blood flow can risk death of other organs

3. poor ventilation

what is used to help diagnose GDV?

1. signalment and physical exams

2. blood analysis

3. radiography (not often necessary)

4. ECG

when is a radiography performed in a patient with GDV?

only when patient is stable

what is a radiograph used to determine in patients with GDV?

location of pylorus to determine gastric dilation from gastric voluvulus

what does volvulus result in?

displacement of the pylorus dorsally to the left

what does the radiograph show?

gastric volvulus displacing pylorus to dorsal left

what does the radiograph show?

displacement of pylorus from gastric voluvulus

what are the therapeutic goals of GDV?

• restore and support circulation

• decompress the stomach

• establish if volvulus or simple dilation is present

• provide prophylaxis

what are the treatment options for gastric decompression?

1. stomach tube

2. percutaneous trocarisation

what surgical techinque are we going to do to fix GDV?

gastropexy

what is the survival rate if dog is diagnosed and treated quickly from GDV?

98%

what type of diagnosis do we give for a dog that has gastric necrosis from GDV?

guarded prognosis 66% survival rate

what signs of GDV will give a poor prognosis of the dog?

1. evidence of DIC

2. sepsis

3. heart arrhythmias

4. severe damage or perforation of stomach

what test is essential to confirm the diagnosis of GDV?

radiograph