Gastric dilatation-volvulus: Controlling the crisis - Veterinary Medicine
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Gastric dilatation-volvulus: Controlling the crisis
Although widely recognized, gastric dilatation-volvulus is still not fully understood. This overview provides up-to-date information on the possible causes, risk factors, diagnosis, and treatment of this life-threatening syndrome.


VETERINARY MEDICINE


EMERGENCY TREATMENT

Emergency medical treatment of hypovolemic shock and gastric decompression is required before surgically treating GDV.

Treating shock

Place venous catheters of the largest gauge possible in the cephalic veins or jugular vein to deliver shock doses (90 ml/kg) of intravenous fluid. Deliver isotonic fluids in increments of one-fourth of the shock dose, and evaluate the patient's response after each one-fourth bolus. Adjust the rate and volume of fluids administered according to the assessment of several clinical parameters: heart rate, pulse, mucous membrane color, capillary refill time, and central venous pressure. Colloids at a dose of 4 ml/kg are recommended during hypovolemic shock treatment.19 Blood gas and electrolyte evaluations are required before acid-base and electrolyte imbalance corrections are attempted. A dog presented with a GDV can be either alkalotic or acidotic, hypokalemic or normokalemic.14

Gastric decompression


2. An orogastric tube is measured from the chin to the xiphoid.
Gastric decompression is attempted first with an orogastric tube after initiating fluid therapy. The amount of gastric distention, the patient's level of compliance, and the degree of volvulus are factors that contribute to the ability to pass the tube. The difficulties or easiness of passing the tube does not have a diagnostic value for the magnitude of the volvulus. Perforation of a compromised stomach can happen with placing an orogastric tube, but measuring from the chin to the xiphoid before introducing the tube may help prevent stomach perforation (Figure 2). To help intubation, it may be beneficial to stand the dog on its hindlimbs.

If the intubation is successful, stomach lavage is required to empty the stomach. Evaluate the color and content of the fluid coming back after stomach lavage. Hemorrhagic fluid or black necrotic tissue fragments are indications of stomach wall necrosis.

If intubation is not successful, percutaneous gastrocentesis with 18-ga needles is an option to decompress the stomach. Percutaneous gastrocentesis is performed on the right side. It is important to make sure the spleen has not been displaced in the right side of the abdomen. Percussion over the site of gastrocentesis with a dull sound would tend to indicate that the spleen has been displaced. If the spleen is present, gastrocentesis cannot be performed. Abdominal contamination is a risk after percutaneous gastrocentesis, especially if large trocars are used. After percutaneous gastrocentesis, orogastric intubation can be tried again.

Additional emergency care

Cardiac rhythm needs to be evaluated before surgery. Atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia are the most common arrhythmias associated with GDV.9,15,20,21 Usually the arrhythmias occur postoperatively. Correction of acid-base imbalances might help correct the arrhythmias. A blood gas analysis will be required to understand the acid-base status of the patient since dogs with GDV can be acidotic or alkalotic.14


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Source: VETERINARY MEDICINE,
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