Page 797 - Cote clinical veterinary advisor dogs and cats 4th

378 Gastric Dilation/Volvulus

the last rib and ventral to the hypaxial SQ, or IM q 8h or 1-2 mg/kg/d IV as a • Recurrence of volvulus if gastropexy is not
muscles over the region of most obvious continuous infusion, or cisapride 0.1-0.5 mg/ performed properly
VetBooks.ir ○ Using a large-bore needle or needle- after gastropexy, without evidence of gastric Recommended Monitoring
distention.
kg PO q 8h) if recurrent bloating occurs
• ECG: ventricular arrhythmias common
outflow obstruction.
styleted catheter (e.g., 16 or 14 gauge)
directed ventrally and slightly cranially,
within 36 hours of surgery
penetrate all layers of the body wall and • Pain management is important (e.g., fentanyl • Blood pressure (p. 1065)
3-5 mcg/kg/h), but nonsteroidal antiinflam-
stomach. When successful, the procedure matory drugs are contraindicated. • Serum chemistry and electrolyte concentra-
should produce a hissing sound associated tions: correct hypokalemia, hypoglycemia
with a release of fetid-smelling gas through Nutrition/Diet • PCV/TS: hemoconcentration indicates need
the needle. • Enteral/oral feeding can begin the day after for increased fluid therapy. Anemia can occur
• Immediate surgery to derotate the stomach surgery if the patient is not vomiting. from bleeding of torn short gastric vessels.
and return it to a normal position • Several recommendations are made to prevent • Physical parameters: mucous membrane
○ Placing traction on the pylorus and elevat- gastric bloat after discharge or to prevent color, capillary refill, pulse quality, heart
ing it while putting downward (dorsal) GDV in dogs that have not had a gastropexy: rate, temperature, respiratory effort, lung
pressure on the fundus aids derotation ○ Divide feedings into several small meals auscultation, abdominal distention, bruising
in a counterclockwise direction (most but each day.
not all cases are rotated clockwise). ○ Do not feed dry kibble. PROGNOSIS & OUTCOME
○ Evaluate stomach and spleen for irrevers- ○ Avoid stress during feeding.
ible vascular compromise and necrosis. ○ Avoid heavy activity immediately after • GDV patients treated surgically have ≈15%
○ Perform partial or complete splenectomy eating or drinking. mortality rate.
if splenic necrosis, infarction, or torsion. ○ Do not elevate feeding bowl during eating. • Gastric necrosis and need for gastric resec-
Perform resection of necrotic areas of ○ Regular moderate activity outside may tion or splenectomy with or without partial
stomach. decrease risk. gastrectomy are associated with increased
○ Perform gastropexy of pyloric antrum to mortality rate.
the right body wall. Possible Complications • Increased risk of death if
• Medical treatment alone (repeated intubation, • Cardiac arrhythmias ○ Clinical signs are present for > 6 hours
trocarization) has been uniformly ineffective • Reperfusion injury before exam
and is not recommended. • Gastric necrosis, perforation, and peritonitis ○ Hypothermia is present
can occur if devitalized gastric tissue is not ○ Hypotension is present
Chronic Treatment excised. ○ Peritonitis is present
• Postoperative potassium supplementation if • Gastric ulceration ○ DIC is present
hypokalemic (do not exceed 0.5 mEq/kg/h • Esophagitis and regurgitation ○ Preoperative arrhythmias are present
IV [p. 516]). • Gastroparesis and ileus • Serum lactate level in dogs with GDV (see
• If ventricular arrhythmias are noted on the • DIC above)
electrocardiogram (ECG [p. 1033]) • Aspiration pneumonia ○ 99% survival if < 6 mmol/L at presentation
○ Is hypokalemia present? If so, institute • Acute kidney injury ○ Initial values may not be as predictive
potassium replacement immediately. • Recurrence of dilation as lack of improvement in values after
Ventricular arrhythmias are refractory to
treatment with lidocaine, procainamide,
and other antiarrhythmics when hypoka-
lemia is present.
○ Hypomagnesemia may also predispose
patient to ventricular arrhythmias.
○ Is anemia, hypoxemia, or acidosis present?
Many ventricular arrhythmias resolve
spontaneously if systemic abnormalities
are corrected.
○ Is the heart rate rapid (>160 beats/min)
or the pulse weak despite addressing the
systemic abnormalities? If so, consider
treatment with lidocaine (p. 1457). If
arrhythmia and tachycardia continue for
days, treat with oral sotalol 0.5-2 mg/kg
q 12h.
• Treat peritonitis (p. 779) if gastric perforation
has occurred (fluids, antibiotics, abdominal
lavage ± drainage).
• Treat gastric ulceration: proton pump inhibi-
tors (omeprazole 0.7-1 mg/kg PO q 12-24h
or pantoprazole 0.7 mg/kg IV q 24h) with or
without H2-receptor antagonists (famotidine
0.5-1 mg/kg IV, IM, SQ, or PO q 12-24h,
or ranitidine 0.5-2 mg/kg IV, IM, SQ, or
PO q 8-12h) and sucralfate slurry (0.5-1 g/ GASTRIC DILATION/VOLVULUS Lateral abdominal radiograph of a dog with gastric dilation/volvulus.
dose PO q 6-8h) Characteristic septation (arrows) of the gastric shadow is seen. A displaced, gas-filled antrum is cranial to the
• Use drugs that increase gastric motility arrows (left on this image), whereas a gas-filled fundus is caudal (arrows are within it). A gas-filled esophagus and
(e.g., metoclopramide 0.2-0.4 mg/kg PO, evidence of ileus in the form of distended, gas-filled small intestine can be seen. (Courtesy Dr. Richard Walshaw.)

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