Gastric Dilatation Volvulus (GDV)

What breed does GDV mostly affect

Large breed, deep-chested dogs - Great Dane is the most commonly affected breed

Clinical signs of GDV

Non-productive retching/vomiting

Abdominal distension

Restless/nervous pacing

Painful

Increased RR

Signs consistent with shock/cardiovascular collapse - tachycardia, weak pulse, pale MM, prolonged CRT, depressed to comatose mentation

How do we diagnose GDV

Right lateral radiograph - gastric compartmentalization of air or “double bubble”

before i forget - add a radiograph pic of GDV in a flashcard somewhere

What is GDV and what is it caused by

Rotation of stomach counterclockwise when viewing from cranial to caudal in dorsal recumbency

Can be stated that stomach rotates clockwise when viewed caudal to cranial (or opposite)

How can GDV lead to hypovolemic shock

Air accumulates in stomach which prevents venous return to the heart via vena cava

Basically, when the stomach gets bigger or bloated, it puts pressure on the vena cava in the heart and prevents blood from returning to the heart, so less blood gets pumped out

How can GDV lead to hypovolemic shock

Air accumulates in stomach which prevents venous return to the heart via vena cava

Basically, when the stomach gets bigger or bloated, it puts pressure on the vena cava in the heart and prevents blood from returning to the heart, so less blood gets pumped out

Signalment of pts who likely have GDV

Large to giant breed dogs, deep-chested dogs

Middle-aged to older

Great Dane, GSD, Rottweiler, Irish Wolfhound

Other predisposing factors - related to a dog that had GDV, anxious dogs, very fast eaters

Signalment of pts who likely have GDV

Large to giant breed dogs, deep-chested dogs

Middle-aged to older

Great Dane, GSD, Rottweiler, Irish Wolfhound

Other predisposing factors - related to a dog that had GDV, anxious dogs, very fast eaters

What can be seen on an ECG with GDV pts

Arrhythmias common before and especially after surgery

VPCs* - ventricular premature contractions

What kind of blood gas values can be observed in GDV pts

Metabolic acidosis + / - respiratory compensation

May have hypercapnia from gastric distension and impaired ventilation

How to diagnose GDV

ECG

Blood gas levels

Radiographs*

How do we stabilize GDV pts

• Place 2 large-bore cephalic catheters

• Shock dose crystalloid fluid therapy (LRS, Normo-sol - 80-90 ml/kg in fractions NOT the whole thing until resuscitation)

• Monitor BP and ECG

• Lactate levels may provide insight to prognosis

What are the 2 ways to decompress the stomach

1. Orogastric tube

2. Trocarization

What are pros to doing an orogastric tube to decompress the stomach

More effective emptying

What are cons to suing an orogastic tube for GDV pts

Requires heavy sedation, tube may not pass, possible esophageal trauma/rupture

What is trocarization also known as

Gastrocentesis - inserting a large bore needle or catheter through abdominal wall into stomach to release gas

What are pros of trocarization

More rapid intervention, does not require sedation

What are cos of trocarization

Limited decompression, risk of lacerating the gastric wall, puncturing the spleen

Where would we do trocarization

Trocarize at point of maximum tympany (thump noise i think), but we can’t be suer if spleen is on the left or the right so be careful

What is the goal of surgery in GDV cases

Fully decompress and reposition stomach, evaluate viability, resect any necrotic tissue

Assess spleen

Perform gastropexy to prevent recurrence

What is a gastropexy

Fixing the stomach to the gastric wall so it doesn’t rotate again

What are the types of gastropexy DVMs can do

Incisional, circumcostal, belt-loop, tube

What is prognosis of GDV cases

75-90% reported survival with surgery and post-op care

What are usually indicators for a bad or negative prognosis for GDV cases

Lactate > 6 mmol/L

Need for gastric resection

Long onset of signs to time of presentation (5-6 hrs)

Recumbency at presentation

How likely is recurrence if gastropexy is done

4%

How likely is recurrence if gastropexy is not done

50%

What is the prevention for GDV

Prophylactic gastropexy - traditional, endoscopically assisted gastropexy, or laparoscopically assisted gastropexy