Answers and Discussion
Case #5-- Gastric Dilatation-Volvulus
Answers and Discussions to the Questions:
| Confirm the diagnosis of GDV | Very stressful to the animal |
| Identify concomitant problems | Unlikely to change the clinical approach to managing the GDV |
| Identify complications associated with GDV | Trocarization as a means for decompression my lead to a false diagnosis of free gas in the abdomen |
| Protection in a medical liability suit | Expensive |
Describe your emergency priorities for "Duke".
Decompress the stomach
Treatment of shock
Surgery
Postoperative complications
pH = 7.440, PCO2 = 29.2, PO2 = 54.8, HCO3 = 19.1, ABE = -2.1, Sat O2 = 91.6, Barometric Pressure = 642
Normal acidbase: pH = normal, PCO2 = normal, HCO3 = normal, ABE = normal, O2 Sat = normal.
Ventilation: Normal (PCO2 is normal)
Oxygenation: Calculate the alveolar-arterial (A-a) oxygen gradient.
A = (642 - 47).21 - 29.2/0.8 = 88.45
a = PO2 = 54.8
A - a = 88.45 - 54.8 = 33.6
Interpretation: Acute respiratory distress syndrome
Many have created the false impression that the catheter must be in the cephalic or jugular vein. These beliefs are based upon the mistaken view that venous return is impeded with GDV. In fact, as you will see, decompression of the stomach is your first priority. This procedure will result in the normalization of venous return. Angiographic studies in the dog with GDV show adequate venous return via the segmental vertebral veins to the ventral vertebral sinuses, to the azygus vein and finally the cranial vena cava (see angiograms below).
The circumcostal or beltloop gastropexy are the most reliable surgical procedures for preventing gastric volvulus.
- Shock
- Hypokalemia
- Ventricular dysrhythmias
- Recurrence of gastric dilatation
- Surgical complications
Follow-Up: "Duke's" recovery from surgery was uneventful. He was discharged from the hospital 3 days later and continues to do well at home.
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