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Gastric Dilatation and Volvulus (view source)
Revision as of 09:07, 21 August 2009
, 09:07, 21 August 2009no edit summary
==Treatment==
==Treatment==
The most important first line treatments are [[Principles of Fluid Therapy|fluid therapy]] and gastric decompression
The most important first line treatments are [[Principles of Fluid Therapy|fluid therapy]] and gastric decompression.
===Fluid therapy===
===Fluid therapy===
Should be individualised to the patient due to the varying nature of the acid-base disturbances.
Should be individualised to the patient due to the varying nature of the acid-base disturbances. Large bore catheters should be placed into cephalic or jugular 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 stomach tube or by trocharizing the most tympanic area around the stomach with a 16 gauge catheter. Sedation may be required to allow the passage of the stomach tube. Suitable drugs for this include [[Opioids#Butorphanol|butorphanol]] or oxymorphone and [[Benzodiazepines#Diazepam|diazepam]].
Performed by introduction of a lubricated stomach tube or by trocharizing the most tympanic area around the stomach with a 16 gauge catheter. Sedation may be required to allow the passage of the stomach tube. Suitable drugs for this include [[Opioids#Butorphanol|butorphanol]] or oxymorphone and [[Benzodiazepines#Diazepam|diazepam]].
===Adjunct therapy===
===Treatment of endotoxic shock and reperfusion injury===
===Surgery===
===Surgery===
Surgery is aimed to reposition the stomach and spleen whilst preventing recurrence by performing a gastropexy. If gastric necrosis is present then a parital gastrectomy is required. Damage to the spleen via avulsion or torsion may need partial or complete splenectomy.
==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 necorsis can be predicted by measuring plasma lactate. Values >6mmol/l indicates necrosis (Specificity 88%, Sensitivity 66%)
==References==
==References==