Changes

===Haematology===

===Haematology===

*Increased haematocrit

*Increased haematocrit

*DIC (thrombocytopaenia, increased firbin degradation products, prolonged patial thromboplastin time and reduced antithrombin III.

*DIC (thrombocytopaenia, increased firbin degradation products, prolonged patial thromboplastin time and reduced antithrombin III.)

===Biochemistry===

===Biochemistry===

===Diagnostic imaging===

===Diagnostic imaging===

Best performed after fluid therapy and gastric decompression. It allows distinction between GD and GDV:

Best performed after [[Principles of Fluid Therapy|fluid therapy]] and gastric decompression. It allows distinction between GD and GDV:

*Gastric dilatation: gas distension, on right lateral shows air in the fundus.

*Gastric dilatation: gas distension, on right lateral shows air in the fundus.

*Gastric dilatation and volvulus: pylorus moves dorsally and left with a compartmentalized stomach.

*Gastric dilatation and volvulus: pylorus moves dorsally and left with a compartmentalized stomach.

A right lateral view will show a large fundus ventrally, with a smaller gas filled pylorus located dorsally to that. These are seperated by a soft tissue strip. The contrast of the abdomen may be lost indicating peritonitis or haemabdomen. Gastric rupture would show as pneumoperitoneum and increased contrast.

A right lateral view will show a large fundus ventrally, with a smaller gas filled pylorus located dorsally to that. These are seperated by a soft tissue strip. The contrast of the abdomen may be lost indicating peritonitis or [[Haemoabdomen - WikiClinical|haemoabdomen]]. Gastric rupture would show as pneumoperitoneum and increased contrast.

==Treatment==

==Treatment==

===Fluid therapy===

===Fluid therapy===

Should be individualised to the patient due to the varying nature of the acid-base disturbances. Large bore (16 or 18 gauge) catheters should be placed into cephalic or jugular veins (ideally two into both cephalic veins). Shock doses of Compound Sodium Lactate (Lactated Ringer's Solution) (60-90ml/kg/h). Hypertonic saline can also be used. Monitoring of the situation should be done by regular blood pressure measurements, heart rates, PCV and total solids and urine output. Potassium can be supplemented to bags in the form of KCl after the initial shock doses.

Should be individualised to the patient due to the varying nature of the [[Essential Ion and Compound Balance and Homeostasis - Anatomy & Physiology#Acid / Base|acid-base]] disturbances. Large bore (16 or 18 gauge) catheters should be placed into cephalic or jugular veins (ideally two into both cephalic veins). Shock doses of Compound Sodium Lactate (Lactated Ringer's Solution) (60-90ml/kg/h). Hypertonic saline can also be used. Monitoring of the situation should be done by regular blood pressure measurements, heart rates, PCV and total solids and urine output. Potassium can be supplemented to bags in the form of KCl after the initial shock doses.

===Gastric decompression===

===Gastric decompression===

Performed by introduction of a lubricated premeasured (from nostril to last rib) stomach tube or by trocharizing the most tympanic area caudal to the ribs with a 14 to 16 gauge catheter. Sedation may be required to allow the passage of the stomach tube. Suitable drugs for this include [[Opioids#Butorphanol|butorphanol]], fentanyl or oxymorphone and [[Benzodiazepines#Diazepam|diazepam]].

Performed by introduction of a lubricated premeasured (from nostril to last rib) stomach tube or by trocharizing the most tympanic area caudal to the ribs with a 14 to 16 gauge catheter. Sedation may be required to allow the passage of the stomach tube. Suitable drugs for this include [[Opioids#Butorphanol|butorphanol]], [[Opioids#Fentanyl|fentanyl]] or oxymorphone and [[Benzodiazepines#Diazepam|diazepam]].

===Other treatment===

===Other treatment===

*For shock: Prednisolone sodium succinate or dexamethasone sodium phosphate.

*For shock: [[Steroids|Prednisolone sodium succinate]] or [[Steroids|dexamethasone sodium phosphate]].

*For bacterial translocation and endotoxaemia: Broad spectrum antibiotics (e.g. [[Cephalosporins|cephalosporin]] and a [[Fluoroquinolones|fluoroquinolone]]) should also be given at surgical induction through to the postoperative period.

*For bacterial translocation and endotoxaemia: Broad spectrum antibiotics (e.g. [[Cephalosporins|cephalosporin]] and a [[Fluoroquinolones|fluoroquinolone]]) should also be given at surgical induction through to the postoperative period.

*For cardiac arrythmias: indicated if weakness, sycope, tachycardia runs with R on T complexes, ventricular tachycardia at rates >150bpm. Treated by correcting acid-base, electrolyte and haemostatic disturbances. The treatment is lidocaine by bolus or continuous rate infusion or procainamide if they persist.

*For cardiac arrythmias: indicated if weakness, syncope, tachycardia runs with R on T complexes, ventricular tachycardia at rates >150bpm. Treated by correcting [[Essential Ion and Compound Balance and Homeostasis - Anatomy & Physiology#Acid / Base|acid-base]], [[Essential Ion and Compound Balance and Homeostasis - Anatomy & Physiology|electrolyte]] and [[Haemostasis - Pathology|haemostatic]] disturbances. The treatment is [[Local Anaesthetics#Lidocaine|lidocaine]] by bolus or continuous rate infusion or procainamide if they persist.

*For analgesia: Pure opiod of morphine, methadone or fentanyl.

*For analgesia: Pure [[Opiods|opioid]] of [[Opioids#Morphine|morphine]], [[Opioids#Methadone|methadone]] or [[Opioids#Fentanyl|fentanyl]].

*General: Oxygen supplementation if possible

*General: Oxygen supplementation if possible

===Anaesthesia===

===Anaesthesia===

Anaesthesia must be carried out with care even after the patient has been stabilised. There are limited protocols but included fentanyl and diazepam bolus or titrated propofol. Maintenance can be achieved with the use of isoflurane and sevoflurane in oxygen however nitrous oxide should be avoided due to third spacing. Regular routine monitoring of urine production, blood pressure, central venous pressure, PCV, total solids, blood gas and serum electrolytes. High rates of fluids should be used to maintain tissue perfusion and arterial blood pressure

Anaesthesia must be carried out with care even after the patient has been stabilised. There are limited protocols but included [[Opioids#Fentanyl|fentanyl]] and [[Benzodiazepines#Diazepam|diazepam]] bolus or titrated [[Propofol|propofol]]. Maintenance can be achieved with the use of [[Isoflurane|isoflurane]] and [[Sevoflurane|sevoflurane]] in oxygen however [[Nitrous Oxide|nitrous oxide]] should be avoided due to third spacing. Regular routine monitoring of urine production, blood pressure, [[Blood Pressure#Central Venous Pressure|central venous pressure]], PCV, total solids, blood gas and serum electrolytes. High rates of fluids should be used to maintain tissue perfusion and arterial [[Blood Pressure|blood pressure]].

===Surgery===

===Surgery===