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Gastric Dilatation and Volvulus (view source)
Revision as of 16:31, 23 August 2010
, 16:31, 23 August 2010no edit summary
Once the patient has been stabilised, the volvulus should be surgically reduced via a cranioventral midline laparotomy. The aims of surgery include gastric decompression and repositioning, assessment of the abdominal organ viability, removal of necrotic tissue and gastropexy. Gastrectomy of devitalised tissue may be required and splenic damage due to avulsion or torsion may require partial or complete splenectomy.
Once the patient has been stabilised, the volvulus should be surgically reduced via a cranioventral midline laparotomy. The aims of surgery include gastric decompression and repositioning, assessment of the abdominal organ viability, removal of necrotic tissue and gastropexy. Gastrectomy of devitalised tissue may be required and splenic damage due to avulsion or torsion may require partial or complete splenectomy.
Although many types of gastropexy have been described, the belt-loop and circumcostal techniques are the most commonly used in GDV surgery. Use of tube gastrostomy is associated with a higher morbidity rate due to alteration of gastric motility and development of cellulitis around the tube.
Although many types of gastropexy have been described, the belt-loop and circumcostal techniques are the most commonly used in GDV surgery. Use of tube gastrostomy is associated with a higher morbidity rate due to alteration of gastric motility and development of cellulitis around the tube.
==Post-operative complications and care==
The most common complications following GDV sugery include cardiac arrhythmias, shock, hypokalaemia and surgical complications such as dehiscence. Ventricular tachycardia is the most common abnormal rhythm and continuous ECG monitoring is recommended for the 24-48 hours following surgery. The haemodynamic, acid-base and electrolyte balance should also be closely monitored. If vomiting occurs the patient should be evaluated for possible peritonitis.
==Prognosis==
==Prognosis==
Simple GDV mortality rates are around 15%. Patients suffering from gastric necrosis, gastric resection or splenectomy have a higher mortality rate at over 30%. Gastric necrosis can be predicted by measuring plasma lactate. Values >6mmol/l indicates necrosis.
Simple GDV mortality rates are around 15%. Patients suffering from gastric necrosis, gastric resection or splenectomy have a higher mortality rate at over 30%.
==References==
==References==
*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
*King, L. and Hammond, R. (1999) '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' ''BSAVA''
*King, L. and Hammond, R. (1999) '''BSAVA Manual of Canine and Feline Emergency and Critical Care''' ''BSAVA''
*Tivers, M. and Brockman, D. (2009) '''Gastric dilation–volvulus syndrome in dogs 1. Pathophysiology, diagnosis and stabilisation''' 31(2):66 ''In Practice''
*Tivers, M. and Brockman, D. (2009) '''Gastric dilation–volvulus syndrome in dogs 1. Pathophysiology, diagnosis and stabilisation''' 31(2):66 ''In Practice''
*Tivers, M. and Brockman, D. (2009) '''Gastric dilation–volvulus syndrome in dogs 2. Surgical and postoperative management''' 31(3):114 ''In Practice''
*Tivers, M. and Brockman, D. (2009) '''Gastric dilation–volvulus syndrome in dogs 2. Surgical and postoperative management''' 31(3):114 ''In Practice''
*Wingfield, W. E. (2001) '''Veterinary Emergency Medicine Secrets''' ''Elsevier Health Sciences''