• Veterinary Gastrointestinal surgeryVeterinary Gastrointestinal surgery(Part-II)(Part-II)

• Presented byPresented by• Dr. Rekha PathakDr. Rekha Pathak• Senior scientist , IVRISenior scientist , IVRI

The photographs have been collected from different sources i.e. Internet,

text books etc

Gastric acute dilatation and Gastric acute dilatation and torsiontorsion

• Gastric dilatation- Gastric dilatation- volvulus (GDV)volvulus (GDV)

• Only dilation Only dilation common in puppies common in puppies

• Overeating/ Overeating/ parasitismparasitism

• Larger and giant Larger and giant breeds – deep breeds – deep chestedchested

• Overeating – Overeating – relieved by relieved by induced induced vomiting or vomiting or passing stomach passing stomach tubetube

• Parasitism Parasitism

• Pica Pica

• Postprandial Postprandial activity activity

• Delayed gastric Delayed gastric emptying- emptying- pyloromyotomypyloromyotomy

• PathophysiologyPathophysiology

• Rotation after dilationRotation after dilation

• Aerophagia – source of Aerophagia – source of intragastric gasintragastric gas

• Distended stomach (gas Distended stomach (gas + fluid) – more prone to + fluid) – more prone to rotationrotation

• Prevents eructation – Prevents eructation – esophagus and emptying esophagus and emptying from duodenumfrom duodenum

• Distension increasesDistension increases

•Presses the caudal vena/ portal Presses the caudal vena/ portal vein – reduced venous return – vein – reduced venous return – red. CO. – red. Tissue perfusion red. CO. – red. Tissue perfusion and shockand shock

•Ischemic bowel – release toxins- Ischemic bowel – release toxins- endotoxemia-shock and endotoxemia-shock and hypotensionhypotension

•Red. Ventilation- pressure on Red. Ventilation- pressure on diaphragmdiaphragm

•Acid base and electrolyte Acid base and electrolyte disturbancedisturbance

•Myocardial ischemiaMyocardial ischemia

•Rotation of stomach – Rotation of stomach – strangulation of gastric vessels- strangulation of gastric vessels- edema and anoxia –gastric wall edema and anoxia –gastric wall ulceration and necrosisulceration and necrosis

• Clinical signsClinical signs• Acute onset of cranial abd. DistentionAcute onset of cranial abd. Distention• VomitingVomiting• Profuse salivation-painProfuse salivation-pain• Prolonged CRT, Pallor, weak pulseProlonged CRT, Pallor, weak pulse• Shock (pooling of blood in spleen due to Shock (pooling of blood in spleen due to

rotation of splenic vessels, hypovolemia rotation of splenic vessels, hypovolemia and hypotension)and hypotension)

• DyspneaDyspnea

• RG signs: differentiate simple gastric RG signs: differentiate simple gastric distension from GDVdistension from GDV

• Gas filled stomach- 50-75% - splenic Gas filled stomach- 50-75% - splenic position is normal if no volvulus position is normal if no volvulus

• In GDV –pylorus is located In GDV –pylorus is located cranial/dorsal – fundus cranial/dorsal – fundus

• Position of spleen may not be normal Position of spleen may not be normal

• A tissue density A tissue density line dividing the line dividing the gas filled stomach gas filled stomach into compartmentsinto compartments

• VD - pylorus is VD - pylorus is near or near to the near or near to the left of the midlineleft of the midline

• Gastric perforation- Gastric perforation- pneumoperitoneupneumoperitoneumm

• Clockwise 270 Clockwise 270

• Anticlockwise 90Anticlockwise 90

• Preoperative Preoperative carecare

• Gastric Gastric decompressiondecompression

• Needle Needle trocarization 18 trocarization 18 G needleG needle

• Thrust on rt. Or Thrust on rt. Or left wall – point left wall – point of greatest of greatest distensiondistension

• 2-3 needles – 2-3 needles – relieves gas relieves gas component of component of distensiondistension

• Alternatively – if Alternatively – if not effectively not effectively reduced – stomachreduced – stomach

• Pass the s.tube Pass the s.tube through mouth through mouth gag- resistance is gag- resistance is encountered in encountered in gastro esophageal gastro esophageal junction –rotate junction –rotate and advanceand advance

• Removal of Removal of intragastric gas – intragastric gas – trocarization- trocarization- corrects the gastro corrects the gastro esophageal angle-esophageal angle-allows passage of allows passage of S. tubeS. tube

• Passage of st Passage of st doesn’t mean doesn’t mean absence of g. absence of g. rotationrotation

• Withdraw the tube Withdraw the tube after after decompressiondecompression

• Sometimes for Sometimes for decompression – decompression – temporary Gastrotomy temporary Gastrotomy is constructedis constructed

• Close the Gastrotomy Close the Gastrotomy wound and proceed for wound and proceed for surgical correction of surgical correction of rotation rotation (Decompression (Decompression doesn’t always result in doesn’t always result in normal gastric position)normal gastric position)

• Shock therapyShock therapy

• Surgical correction of volvulus Surgical correction of volvulus

• If surgery is delayed – gastric necrosis If surgery is delayed – gastric necrosis worsens worsens

• Reposition the stomach by derotating itReposition the stomach by derotating it

• Avoid injury to splenic v. (digital palpation Avoid injury to splenic v. (digital palpation of esophagus reveals the direction of of esophagus reveals the direction of rotationrotation

• Pylorus is a good / useful landmark – firm Pylorus is a good / useful landmark – firm consistency)consistency)

• See the viability of gastric tissue – See the viability of gastric tissue – necrosed and non-viable – esp. the necrosed and non-viable – esp. the greater curvature is damaged greater curvature is damaged

• Serosal color, Serosal color, thickness of wall thickness of wall and vascular and vascular patencypatency

• Partial gastrectomyPartial gastrectomy• Hemoperitoneum - Hemoperitoneum -

centesis of centesis of abdominal cavity- abdominal cavity- splenic torsion and splenic torsion and gastric torsiongastric torsion

• Blue-black Blue-black areas/diffuse areas/diffuse petechial petechial /ecchymotic /ecchymotic stomach- stomach- gastrectomy not gastrectomy not indicated – becomes indicated – becomes normal after normal after decompressiondecompression

• Spleenectomy – Spleenectomy – damageddamaged

• Gastropexy- red. Rate Gastropexy- red. Rate of GDVof GDV

• Pyloric antral region is Pyloric antral region is fixed to the adjacent fixed to the adjacent rt. abdominal wallrt. abdominal wall

• Gastropexy is always Gastropexy is always performed on the rt. performed on the rt. Side of the stomach – Side of the stomach – some rotation – still some rotation – still occur- bet.left gastric occur- bet.left gastric wall and left abd.wallwall and left abd.wall