Today's Veterinary Practice

JUL-AUG 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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50 GASTRIC DILATATION AND VOLVULUS PEER REVIEWED anti-inflammatory drugs are avoided because of the decreased gastric perfusion associated with GDV and the high possibility of gastric ulcers. Gastroprotectants, such as sucralfate, histamine-2 receptor antagonists, or proton-pump inhibitors, can be administered. Antibiotic administration for 2 to 3 days after surgery is often indicated based on the presumed risk for bacterial translocation. Postoperative monitoring includes blood pressure, urine output, and emesis watch. Gastric atony and delayed gastric emptying can occur after gastric dilatation, so antiemetics or prokinetics can be administered if vomiting or regurgitation is observed postoperatively. Continuous ECG should be closely monitored because more than half to three-quarters of patients experience postoperative arrhythmias within the first 12 to 24 hours after surgery, 17,19 although not all patients require antiarrhythmic therapy. Repeated blood analysis and electrolyte measurement help to guide fluid therapy. Rechecking coagulation profiles may be warranted in patients at risk for disseminated intravascular coagulation. Food and water may be offered several hours after surgery to an awake, alert patient. PROGNOSIS Animals treated surgically for GDV have an overall 10% to 28% mortality rate. 1,10,16–19 Poor prognostic indicators include the following: • Lactate level not responding to fluid resuscitation 12,13 • Need for splenectomy 17–19 • Gastric necrosis and need for partial gastrectomy 1,10,16–18 • Preoperative arrhythmias 17,18 • Increased time between clinical signs and admission 16,19 • Severity of physical condition at the time of presentation 10 • Hypotension at any time during hospitalization 19 • Peritonitis or sepsis 19 • Disseminated intravascular coagulation 19 SUMMARY The immediate goals of stabilization of a patient with GDV are fluid resuscitation to correct hypovolemia and gastric decompression to make the patient as stable as possible for anesthesia. Surgical goals are prompt gastric repositioning, critical evaluation of the abdominal viscera, and right- sided gastropexy. With timely surgery, the prognosis for most patients is fair. Negative prognostic indicators include gastric perforation, the need for splenectomy and partial gastrectomy, lactate levels that do not respond to fluid resuscitation, and preoperative arrhythmias. FIGURE 5. Completed right incisional gastropexy. In A, the cranial aspect of the incision is oriented to the right. B is a laparoscopic image after completion of a laparoscopic- assisted right incisional gastropexy. A B To see the references for this article, please visit tvpjournal.com. Desiree Rosselli Desiree Rosselli, DVM, DACVS (Small Animal), is a surgeon at VCA West Los Angeles Animal Hospital. She received her doctor of veterinary medicine degree from the University of California Davis. She completed a rotating internship at the University of Wisconsin-Madison, a surgical specialty internship at Dallas Veterinary Surgical Center, and a residency in small animal surgery at the University of Georgia. Following her residency, she was employed as a clinical instructor at the University of Georgia.

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