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


POSTOPERATIVE COMPLICATIONS

After surgery, monitor the dog for arrhythmias, DIC, hypotension, and peritonitis. All these complications result from the pathophysiology of GDV.

Shock after surgery is usually caused by inappropriate treatment before surgery, blood loss during surgery, anesthesia effects, or fluid sequestration due to ileus. Septic shock can result from toxins and bacterial absorption from gastric mucosa necrosis and peritonitis.

Negative prognostic indicators are gastrectomy with splenectomy, hypotension, DIC, arrhythmias, and peritonitis.9,15,20 Gastrectomy alone is not a prognostic indicator for survival, but it increases the risk of complications (peritonitis, arrhythmias, hypotension).15

Ventricular arrhythmias are common in patients with GDV, especially within 36 hours after surgery. They result from poor myocardial perfusion, ischemia, acidosis, an electrolyte imbalance, a thromboembolic event, or myocardial depressant factor. Treatment requires correction of acid-base and electrolyte imbalances and hydration. Lidocaine (2 to 4 mg/kg as a slow bolus given intravenously, followed by a constant-rate infusion of 50 to 100 μg/kg/min) is the drug of choice for the treatment of ventricular tachycardia. Hypokalemia, blood loss, and DIC need to be recognized and treated accordingly.15 Gastric rupture three to five days after surgery occurs rarely and is due to inappropriate assessment of the viability of the stomach at the time of surgery. Gastritis secondary to mucosal ischemia is treated with famotidine and sucralfate.

PREVENTION

Gastric volvulus can be prevented with a preventive gastropexy (see "Just Ask the Expert: What's the best prophylactic gastropexy technique?"). This procedure is recommended for dogs at high risk for GDV. It can be performed at the time of spay or neuter, around 7 or 8 months of age. Preventive gastropexy does not interfere with stomach motility. It can be performed laparoscopically.24

It is also recommended to feed dogs two or three times a day and not exercise dogs for one hour after feeding.

Eric Monnet, DVM, PhD, FAHA, DACVS, DECVS
Department of Clinical Sciences College of Veterinary Medicine and Biomedical Sciences
Colorado State University
Fort Collins, CO 80525


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Source: VETERINARY MEDICINE,
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