SA Sx, E1, GDV Sx

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SA Sx, E1, GDV Sx
2012-09-07 19:34:22

SA Sx, E1, GDV Sx
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  1. What characterizes GDV syndrome?
    • accumulation of gas in stomach
    • malpositioning of stomach
    • obstruction of eructation and pyloric outflow
  2. Is dilation or malpositioning more fatal?
  3. What are some risk factors for GDV?
    • large/giant breeds
    • deep/narrow chest
    • single meal/day
    • nervous/fearful
    • rapid ingestion/aerophagia
    • exercise after eating
  4. What are some clinical signs associated w/GDV?
    • cranial abdominal distention; tympanic abdomen
    • tachypnea, coughing, unproductive gagging
    • heavy salivation/foamy mucous, excessive drinking
    • MM ingurgitated/pale
    • splenomegaly/ altered position; weakness
    • altered cardiac/respiratory parameters; pacing/hiding
  5. What is stomach distension caused by air, fluid, food, and frothy mucoid substrate?
    gastric dilation
  6. What is the term for when the stomach twists abruptly on the long axis less than 180 degrees?
    gastric torsion (intermediate stage of GDV, often overlooked)
  7. What is the term for twisting over long axis of stomach greater than 180 degrees?
    gastric volvulus (causes esophagus and pyloric obstruction)
  8. what are 2 things necessary for GDV to occur?
    • failure of normal eructation
    • pyloric outflow dysfunction
  9. how can you visually discern between clockwise and counter clockwise rotation?
    clockwise is covered w/omentum
  10. how far can the stomach rotate counterclockwise? Clockwise?
    • counter: up to 90 degrees
    • clockwise: between 180-270
  11. Are GDV patients more likely to present in morning, afternoon or evening?
    68.7% in evening
  12. What are options for gastric decompression?
    • orogastric intubation (awake/sedation)
    • gastrocentesis (awake/regional anesth)
    • gastrostomy (local anesth) - least common
  13. What are landmarks on patient for measuring orogastric tube before intubation? once placed, should warm or cold water be introduced into the funnel?
    • tip of nose to last rib
    • cold water
  14. What does it indicate if a "ground coffee" substance come out from orogastric intubation?
    ischemic/sloughing mucosa
  15. What is the purpose of radiographs in these patients?
    distinguish dilation from dilation volvulus (do NOT delay therapy to take rads)
  16. what are 3 primary objectives of sx management of GDV?
    • reposition the stomach
    • assess severity of ischemic injury to stomach and spleen; resect any devitalized tissue
    • perform permanent gastropexy to prevent recurrence
  17. if stomach is properly repositioned, which side should pylorus be on (right or left)?
    right; and gastroesophageal junction not twisted
  18. how can you assess the vitality of the stomach tissue?
    • color (healthy is red/wine colored)
    • presence of pulsating vessels
    • peristalsis and bleeding from cut surface
    • palpate thickness of stomach wall
  19. Which gastropexy technique allows direct access to the stomach but is an older technique?
    tube gastrostomy
  20. which gastropexy technique is the strongest hold?
    circumcostal gastropexy
  21. which gastropexy technique secures a flap of the stomach wall around a piece of the transverse abdominus m.?
    belt loop gastropexy
  22. Which gastropexy technique is quick and commonly used as prophylaxis?
    incisional gastropexy
  23. which technique is the only one to enter lumen of stomach?
    tube gastrostomy
  24. Where does the surgeon place the tube for gastrostomy? what suture pattern secures the tube in place?
    • 1-2 fingers behind last rib on Rt side, lateral to nipple line
    • not to obstruct pylorus (removed in 5-7 days)
    • -chinese finger trap
  25. What is the basic idea behind incisional gastropexy?
    • only cut into seromuscularis at antrum (do NOT enter lumen)
    • suture this incision to the right body wall about 4cm to create adhesion
  26. What is basic idea for circumcostal gastropexy?
    incise over last rib, dissecting away mm & careful not to enter thorax; create flap from stomach seromuscularis (not to enter lumen) and suture flap around last rib
  27. What percent of patients who require partial gastrectomy die?
  28. What percent of patients with gastropexy will have recurrent GDV?
    less than 6.9%
  29. What is post-op feeding recommendations for GDV patients? What should client be told about feeding?
    • bland, low residue diet (enterocytes need nutrition - glutamine is required amino acid)
    • several meals per day; high protein diet, low volume and no exercise after eating; adequate fiber and bone product, low fat
  30. If GDV patient does not have gastropexy, how likely is it the condition will recur?
    75-80% recur
  31. What is relationship between myocardial depressant factor and post op care?
    MDF leads to preventricular contractions; MDF is product of ischemia, esp. from pancreas -- ECG monitoring post-op
  32. When is post-op mortality highest? (how many days post-op) mortality is due to what?
    • during first 4 days post op
    • gastric necrosis, rupture and peritonitis; or secondary source like cardiac arrhythmias