17/08/2021
GDV is an acute, life-threatening disorder in dogs, characterized by abnormal twisting of the stomach on its mesenteric axis, with subsequent gastric gas accumulation and distention. Sequelae of GDV can include decreased venous return to the heart, hypovolemia, gastric ischemia
PRESENTATION OF CASE
3 yr old (55kg) saint bernard ,lethargic,tachypnea, bloated stomach ,
clinical findings
excessive drooling, vomiting white froth or trying, unsuccessfully,
to vomit, prolong capillary refill time , pale m.m and dyspnea
diagnostic test to be done:
X-RAY is used to differentiate simple dilation from dilation to volvulus.
found( double bubble or C sign )appearance in x ray shown in following picture
blood hematology: cbc was normal with low plt count and LFT,KFT value in normal range
PLAN OF ACTION
(TIPS)
1st step is to make owner aware about the condition of dog and how serous it is and take them into confidence, before proceeding further
• IV fluids: balanced isotonic crystalloids (i prefer RL ) note: vascular access is obtained with large-gauge IV catheters Cephalic vein should be used because of the lack of blood flow from the caudal half of the body.
• Oxygen supplementation: particularly in patients with poor perfusion measures (provided by open chamber and using of mask)
• Analgesia: opioids are used for visceral pain relief and to reduce the stress to patient( i prefer Butorphanol (0.4mg/kg im) or buprenorphine (0.01 to 0.05mg/kg s\c) note: CAN USE FLUNIXINE MEGLUMINE AS IT IS HAVING SCAVENGING PROPERTY TO COUNTRACT THE FREE RADICAL INJURY OTHERWISE USING MELONEX OR ANY OTHER NSAID MAY CAUSE DELAY MUCOSAL HEALING OF G.I TRACK
• Antibiotics: broad-spectrum, particularly in patients with suspected gastric necrosis and gastric leakage(in delay cases above 6-8hr of bloating or twisting of stomach) use triple antibiotic before proceeding for surgery( my preference is amoxicillin+salbectum+enrofloxacine+metronidazole)
ANEASTHESIA
induction with propofole 4mg/kg (give over one minute of time or till able to Tracheal intubation is done)
maintenance was done under sevoflurane with 4% MAC in Closed Circuit with 1.5 to 2 litr/min oxygen flow rate
tried to done Gastric decompression by passing a smooth-surfaced orogastric tube but didn't made it
SURGERY
made large mid-line incision from xyphoid to p***s
Surgery has 3 goals
1. Reposition the abnormally positioned stomach. Typically, a clockwise volvulus has occurred; therefore, the fundus was pushed dorsally while pulling the pylorus ventrally and toward the right.
2. Critically evaluate the abdominal viscera. Allow time for organs to reperfuse, and confirm correct gastric positioning.
3. Performed a right-sided gastropexy (Incisional gastropexy was done in this case) to create a permanent adhesion between the pyloric antrum and the adjacent right body wall.
closing was done in routine manner
follow up
fluid therapy with antibiotics and opiods for 7 to 10 dyas
