Today's Veterinary Practice

JUL-AUG 2017

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44 GASTRIC DILATATION AND VOLVULUS PEER REVIEWED weakness, or collapse may be observed. Dogs can present anywhere on a spectrum of clinical signs, from alert and wagging their tail, with normal pulse quality and only mild abdominal distention, to collapsed, in decompensated shock, or even dead. 10 DIAGNOSTIC TESTS Abdominal radiography, particularly the right lateral projection, is diagnostic for GDV. A healthy dog typically has no gas in the pylorus in right lateral recumbency. Conversely, in a dog with GDV, the stomach is dilated with gas, and radiography depicts the hallmark sign of compartmentalization (the "double bubble") that signifies craniodorsal displacement of the pylorus, as shown in Figure 1 . Ideally, an orthogonal projection (dorsoventral view) is also acquired, depending on patient stability. Presence of pneumoperitoneum suggests gastric rupture. Ideal blood analysis consists of complete blood count, serum chemistry, and a coagulation profile. Efficiently obtaining the results from these diagnostic tests is sometimes not possible; therefore, point-of-care assessment is often more practical: packed cell volume/ total solids; blood glucose; and venous blood gas, including electrolytes and lactate. Lactate, a marker of hypoperfusion and anaerobic metabolism, has been evaluated as a prognostic tool in patients with GDV. Study findings are summarized in Table 1 . 11–14 Overall, higher lactate values are more suggestive of gastric necrosis and have a negative correlation with survival, particularly if hyperlactatemia does not substantially improve after fluid resuscitation. Regardless of the lactate value, surgical intervention is always recommended. Blood pressure and electrocardiography (ECG) are useful diagnostic tools to assess patient stability, monitor effectiveness of volume resuscitation, and evaluate for cardiac arrhythmias (see Preoperative Treatment and Stabilization ). Thoracic radiographs can also be obtained in the preoperative period. Historically, this has been recommended in older patients to check for thoracic FIGURE 1. A 12-year-old male neutered German shorthaired pointer presented for abdominal distention and acute-onset retching. This right lateral abdominal radiograph shows compartmentalization and craniodorsal displacement of the pylorus, the hallmark sign of GDV. TABLE 1 Prognostic Variables Associated With Plasma Lactate STUDY SURVIVAL GASTRIC NECROSIS de Papp et al, 1999 11 ; 102 dogs 99% survival with lactate <6 mmol/L Median lactate was 6.6 mmol/L in dogs with gastric necrosis 58% survival with lactate >6 mmol/L Median lactate was 3.3 mmol/L dogs without gastric necrosis Zacher et al, 2010 12 ; 64 dogs 23% survival with final lactate >6.4 mmol/L 10% survival with absolute change in lactate ≤4 mmol/L 15% survival with percentage change in lactate ≤42.5% Green et al, 2011 13 ; 84 dogs Significant relationship with initial lactate <4.1 mmol/L for predicting survival Significant relationship with initial lactate >2.9 mmol/L for predicting gastric necrosis Decrease in lactate ≥50% in 12 h was good indicator for survival Beer et al, 2013 14 ; 78 dogs Initial lactate ≥7.4 mmol/L was 88% accurate for predicting outcome Initial lactate ≥7.4 mmol/L was 82% accurate for predicting necrosis

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