Gastric Dialation Volvulus

Gastric Dialation Volvulus Prevention & Surgical Treatment

What is GDV? GDV occurs when a dogs stomach fills with gas, and then twists; occluding both entrance and exit (cardia and pylorus). The twisting of the stomach may cause the spleen and nearby major blood vessels to twist as well. Without emergency treatment, the gas-filled stomach will place pressure on the large blood vessels in the abdomen depriving tissues of blood and oxygen, leading to shock. The pressure of the gas on the stomach wall results in inadequate circulation and the stomach tissues will begin to die and may rupture. Digestion ceases and toxins accumulate in the blood, exacerbating the shock. When the blood supply to the major abdominal arteries is cut off, decreased cardiac output and low blood pressure result; which soon leads to shock as well.

GDV

GDV X-Ray

A Medical Emergency Even with immediate treatment, approx. 1525% do not survive

A Medical Emergency Prior to surgery

Pre-Surgical Treatment Immediate IV treatment for shock 

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Crystalloid and colloids, as well as shock level doses of fluids Antibiotics to prevent infection and corticosteroids for shock

Gastric Decompression  

Via stomach tube to remove air and undigested food If unsuccessful, a 16-18 gauge needle is inserted at the point of dissention in the right flank to remove gas

Goal of Surgery Decompress the stomach, return it to its normal anatomical position, evaluate the condition of organs such as the stomach, spleen and pancreas and perform a gastropexy to prevent recurrence of GDV 

If necrosis is seen, a splenectomy may be needed or removal of portions of the stomach or intestines

Preparing for Surgery Perform a wide clip of the ventral abdomen and aseptically prepare the area

Gastric Repositioning Gastric repositioning is achieved by pushing the body of the stomach down to the left while pulling the duodenum and pylorus ventrally and to the right Once the stomach is returned to the correct position, and orogastric tube is advanced into the stomach to finish decompression and gavage may be done to remove liquid and any solid contents

Evaluating for Necrosis Black, gray, or green discoloration of the serousal surface and a thin gastric wall are indicative of gastric necrosis. To assist in evaluation, arterial bleeding may be detected by making small stab incisions in the serosa. 

If necrosis is detected, then gastric resection is necessary

Gastric Resection Stay sutures and moist abdominal swabs are used to isolate the diseased stomach Stay sutures are placed at 5 cm intervals around the circumference of the necrotic tissue 

The omentum may need to be resected as well; in each ligature several centimeters of omental tissue can be secured

Hemoclips or ligatures are used to occlude gastric vessels and the full thickness of necrotic tissue is resected with scissors 

It’s important to manipulate the stay sutures to maintain orientation and to prevent spillage of gastric contents

Gastric Resection, con’t. Absorbable or delayed-absorbable 3-0 sutures are used in a simple continuous pattern and applied to the margins of the resected areas. On top of the first closure, a 2nd layer of 2-0 or 3-0 delayed or non-absorbable sutures in a continuous non-inverting pattern is applied The exposed gastric wall is then irrigated locally to help prevent peritoneal contamination Necrotic tissue may also be resected by use of a stapling device. The necrotic tissue is elevated until the healthy tissue margins are brought together, then stapled. The staples must only come in contact with healthy tissue. 

If possible, the stapled line is then overlaid with a 2nd inverting layer of sutures

Belt-Loop Gastropexy

This gastropexy involves creating a belt or tongue of tissue on the stomach

Next, a belt loop is created in the muscle wall of the abdomen on the right side

Then the belt or tongue of tissue created on the stomach is pulled through the beltloop of the abdominal wall and the belt is sutured onto the stomach, completing a beltloop gastropexy

Belt Loop Style Gastropexy

The 2nd Leading Cause of Death Behind cancer, this is the most common cause of death in large and giant breed dogs.

Risk Factors for GDV A large or giant breed dog, especially one with a narrow and deep chest. Dogs over 7yrs have twice the chance of bloating Fed one large meal a day Dogs who are stressed, hyper, nervous, or aggressive Having a first degree relative that has bloated Fed from raised food bowls Fed only one large meal a day Eat quickly

Symptoms of GDV Attempting to vomit, retching, gagging Hunched back or roached appearence Pacing, can’t setting, seems anxious Bloated or hard abdomen, lack of stomach sounds Excessive drooling (signs of pain) or foaming Whining, crying Trying to hide, can’t sit or lie down, Heavy or rapid panting Shallow breathing Pale or cold mucous membranes Looking at stomach or back