10/19/2016
Chief Complaint:
"Kiya" An 8 year old female spayed Weimaraner presents for an hour history of restlessness, gagging, non productive vomiting, retching, and a distended abdomen
What's your diagnosis?!?
Gastric-Dilation-Volvulus (GDV)
-This is a life threatening condition and perhaps the #1 surgical emergency that we deal with in our canine patients. Time is crucial for this condition exercising the importance of the rule in emergency medicine "the golden hour"
Although the underlying pathophysiology is not well understood as far as the inciting cause; the stomach fills with gas (inhaled air? Gas producing organisms? Couple with abnormal motility and peristalsis ?) as this progresses, the stomach will flip on its axis resulting in a partial to complete torsion. Regardless of the degree, this puts severe compromise to the patient by further inhibiting the escape of gas and fluid, the stomach dilates more and more while comprising the nerve intervation and blood supply to the spleen And stomach. Cardiovascular compromise to the vital organs is also severe as the distended stomach impedes blood flow through the vena cava; resulting in hemodynamic and hypovolemic shock.
In severe conditions; the spleen may need to be removed (splenectomy) and even resections of particular portions of the stomach of which carries a guarded to poor prognosis.
Recovery can be straightforward or met with life threatening complications such as severe infection (peritonitis), re-perfusion injury, DIC, cardiovascular injury, arrhythmia's and even acute death.
Risk factors include large, deep chested breeds such as the Weimaraner, Great Dane, German Shepherd, Standard Poodles, Setters. However; I have seen it in small labs, a shar-pei and even a terrier/chihuahua mix!!
There is Known s*x predisposition, and tends to be in older dogs.
A Prophylactic gastropexy (surgical procedure where the body of the stomach is permanently attached to the right body wall) is recommend for these high risk breeds at the time of spay/neuter. Other management strategies that may help reduce the incidence are avoiding feeding in elevated feed bowls, minimize stress/panting, avoiding exercise after feeding, and feeding multiple times per day compared to once.
Back to Kiya...Upon presentation, she was minimally responsive, non ambulatory, weak to no femoral pulses, cyantotic mucous membranes ( indicating a severe lack of perfusion/oxygenation).
She was triaged to the back where IV catheters were placed strategically; one in her cephalic vein (front limb) and saphenous vein (hind limb) with the goal to rapidly volume expand and profuse the front and back of her body. Radiograph taken for confirmation (see below), Large IV fluid boluses were initiated, pain management with hydromorphone and lidocaine CRI (for cardioprotective, GI motility and analgesia) were started along with full anesthetic monitoring as was was induced for surgery.
Just prior to this attempts were made to pass a stomach tube as well as a percutaneous gastric decompression were attempted however her state was so critical the decision was made to get her into the OR immediately.
Thoughts of utter fear ran through my mind...in the these moments of panic and chaos I was very quickly and intensely humbled for what my clients must go trough with their very own precious pets in such a compromised state...a range of feelings and emotions came over me that I WILL NEVER forget as this experience will undoubtably influence me with empathy and patience for my patients and clients for the rest of my career....
Reality continued to knock; this was MY own precious angel where seconds mattered to save her life; I went into emergency veterinary mode. My husband and dear friends came to be with me. Beverly prayed with me as she was prepped for surgery..."this is no different Shayna, then a clients dog, where the fundamentals remain the same...let the Holy Spirit, your training, your experience and expertise guide your medical decisions and surgical hand..." the lord is right next to you and so are we...amen. All the while my "patient" was prepped for surgery by a skilled team of technicians and anesthetists. As I watched them prepare her during my surgical scrub and prep I let those words prevail in my mind, and I had to do what I had to do.
It was go time, from that moment forward a "routine" GDV surgery was performed. She ended up having a 360 degree torsion of her stomach which is uncommon and likely played a huge role at how critical she became in only a matter of hours.
Thankfully, Due to this prompt recognition and aggressive actions the aforementioned complications commonly encountered with a GDV were minimal for her. The damage done to her spleen and stomach was minimal. Cardiovascular compromise was avoided and her recovery was uneventful and speedy!
Nearly two months later, she's back to herself perhaps even better then before and enjoyed last weekend hunting, running through fields and continues to be my biggest fan, side kick and earth angel💙
Thank you LORD foremost, friends/family and Kiya for teaching me this valuable lesson.
