Gastric dilatation and its surgical management in dogs

Surgical management of gastric dilatation in dogs

1. SURGICAL MANAGEMENT OF GASTRIC DILATATION IN A DOG Dr. G. DHANARAJ MVM 20035 (VSR)

2. SIGNALMENT 1.5 Years old female Rajapalayam dog Weight – 16.8 kgs White colour

3. CLINICAL PRESENTATION H/O Anorexia and vomitions Absence of defecation for the past two days Temp - 99.7⁰F CMM -Slightly congested Other physiological parameters - Normal Abdominal distension observed clinically

4. ULTRASOUND EXAMINATION Impression: Severely distended stomach with echogenic material and gas.

5. RADIOGRAPHIC EXAMINATION

6. LABORATORY FINDINGS

7. GDV Small Intestine Volvulus Diaphragmatic Hernia Ascites GASTRIC DILATATION DIFFERENTIAL DIAGNOSIS CONFIRMATORY DIAGNOSIS

8. Stabilisation of the animal Decompression of stomach Gastropexy Postoperative care SURGICAL PROCEDURE

9. ANAESTHESIA Body weight:16.8 kgs Premedication: Inj. Butorphanol – 0.8 ml I/V Inj. Diazepam – 0.6 ml I/V Induction: Inj. Propofol – 5 ml I/V Passed the stomach tube Maintenance: Isoflurane –vaporiser setting 2 - 2.5 and oxygen flow rate -1 lit/minute Surgical Procedure Contd.,

10. Surgical Procedure Contd …

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15. Surgical Procedure Contd …

16. POSTOPERATIVE EVALUATION Day - 1 Day - 10

17. DISCUSSION Gastric dilatation/Bloat: A condition in which stomach extended beyond its limits Incidence-common –deep and narrow thorax Rajapalayam -deep chested dog

18. ANATOMIAL CHANGES DURING GASTRIC DILATION AND VOLVULUS (180  clockwise rotation along the long axis of oesophagus )

19. DISCUSSION contd … Great Dane Weimaraner Saint Bernard German Shepherd Irish and Gordon Setters Doberman pinscher Breed Predilection

20. Unknown Anatomical Factors – Deep & Narrow Thorax in Large & giant breed Contributing Factors Ileus Trauma Primary Gastric Motility Disorders Vomition Stress DISCUSSION contd … Etiology

21. Male sex, increasing age, Under weight Activity following a meal L owered food bowel encouraged swallowing of air (known as “aerophagia”) Raised food bowl F aster speed of eating habits Larger volume of dry food per meal DISCUSSION contd… Risk Factors

22. Pathophysiological events during gastric dilation with volvulus

23. Differential diagnosis GDV Small Intestine Volvulus Diaphragmatic Hernia Ascites DISCUSSION contd … DISCUSSION contd…

24. DISCUSSION contd… Differential Diagnosis – GDV

25. DISCUSSION contd… Differential Diagnosis – SMALL INTESTINAL INTUSSUSCEPTION

26. Differential Diagnosis - DIAPHRAGMATIC HERNIA DISCUSSION contd…

27. DISCUSSION contd… Differential Diagnosis - ASCITES

28. Stabilisation Decompression Gastropexy DISCUSSION contd… Treatment

29. Hypertonic fluids – 4-5 ml/kg over 5-15 minutes Colloids – 5-10 ml/kg over 10-15 minutes Broad spectrum antibiotics – cefazolin, Ampicillin, Enrofloxacin Proton Pump Inhibitors – Pantaprazole NSAIDs - Meloxicam DISCUSSION contd… Stabilisation

30. Orogastric intubation – D iffering patient positions such as sitting, standing, lying down. To relive gas and flush with warm water to avoid redilatation If Decompression fails immediate surgical intervention DISCUSSION contd… Decompression

31. INCISIONAL GASTROPEXY BELT-LOOP GASTROPEXY CIRCUMCOSTAL GASTROPEXY TUBE GASTROPEXY MUSCULAR FLAP GASTROPEXY GASTROCOLOPEXY DISCUSSION contd… DIFFERENT TECHNIQUES OF GASTROPEXY

32. DISCUSSION contd … Different Techniques of Gastropexy - INCISIONAL GASTROPEXY -

33. DISCUSSION contd … Different Techniques of Gastropexy - BELT - LOOP GASTROPEXY -

34. DISCUSSION contd … Different Techniques of Gastropexy - CIRCUMCOSTAL GASTROPEXY -

35. Different Techniques of Gastropexy - INCORPORATING GASTROPEXY - DISCUSSION contd…

36. POSTOPERATIVE CARE Premature Ventricular Contractions – Lidocaine 2mg/kg upto 4mg/kg Maintained in fluids till the animal fed orally Broad spectrum antibiotics Gastric Protectants Antiemetic if reuired NSAIDs DISCUSSION contd…

37. Premature Ventricular Contractions – Lidocaine 2mg/kg upto 6mg/kg Disseminated Intravascular Coagulopathy (DIC) – Clotting Parameters Sepsis and Peritonitis – If devitalised tissue adequately not removed DISCUSSION contd… COMPLICATIONS

38. Prognosis Gastric dilatation without volvulus is better than GDV Mortality rate is 45 % and if intervention is immediate it is as low as 10% Poor when gastric necrosis or perforation occurs or if surgery is delayed DISCUSSION contd …