Hello, my name's Zoe, and I am, I'm a soft tissue surgeon. I'm going to speak to you today, about abdominal emergencies in small animals. So there's a range of different presentations, for abdominal emergency in the dog that you might see.
And I want to be able to give you some tips about different aspects of diagnosis, about different aspects of management, and some, surgical tips for optimising surgery, and I'm going to cover. A range of, abdominal emergencies, and, focus, in particular on GDB because I think that's one, that fills us all, with a bit, of trepidation. And it's also, such a fantastic, surgery to be able to do.
It's a dreadful disease and it really, is life threatening, but as a vet, you can make such an incredible difference because you take a dog, from a situation where it's almost certainly fatal to a situation. You can have a really good outcome. And it's something that I dreaded but have learned, to actually relish the opportunity to help a patient, suffering, with, with that awful distress.
It's obviously still very upsetting that they experienced that. I also want to touch a bit on a couple of other common abdominal emergencies. Hemoabdomen, where you have a patient who comes in collapsed and free to kneel, which is blood.
And then also, patients who present with protracted, vomiting, from, small intestinal obstruction. And so here I've presented 3 cases, each, with slightly different clinical signs because the pathogenesis of each of these conditions is, is quite different. But what they all share is the fact that emergency abdominal surgery is required.
When we first see them, we might have a suspicion as to what the underlying. Disease process is, even when the client phones, particularly, with the GDB for example, we, are sort of attuned to the client saying, no, that there's unproductive wretching. They wouldn't tend to use that word.
They may say they're trying to be sick, trying to bring something up, and they may, . Be aware of the sort of risk of bloat may use the word bloat and we may be anticipating before the patient even comes through the door into our practise and the patient may have a gastric dilatation and involved. And this is the range of typical presenting signs for patients with gastric dilatation.
Then, this dog, actually has a hemoabdomen, and it's collapsed and, and is hypovolemic, and has mucosal pallor. Hemoabdomen can be, painful to, to some extent. Peritoneal inflammation from, from blood can cause some pain, but it would tend to not be sort of as painful as, for example, gastric dilatation volulus or a patient that had small intestinal obstruction.
So at this stage, we don't know what the diagnosis is, but in all of these patients, the fact that there's abdominal distension, pain, and the fact that they is restlessness, and that, there have been other significant clinical signs suggest that at this stage we know that this is a patient we need to be admitting for further investigations, rather than symptomatic, management, and we'll take, I'll take you through the sort of steps in terms of our diagnosis, diagnostic workup and what we want to look at. First of all, of course, we want to assess the patient and assess where they are with regards to their volume status. This table is really helpful to get a sort of categorization of which point.
Are we in terms of the patient's compensation to a degree of mild hypovolemic shock, to be very severe hypovolemic shock. And I first expected when I graduated to see all patients that had gastric dilatation and obviously collapsed. In severe decompensatory shock.
And it's occurred to me that I, I, I sort of almost got caught out with one of the early patients that did have a gastrodation involved because they came in, early in the disease process and just mild compensatory shock. And actually walked in, wagged their tail, and, and it, I was sort of really second guessing, does this patient actually have gastric dilatation and vaulus, because I'd expected them to be so profoundly sick. And this was because the owners had been really prompt.
Recognising the, the problem, and they had presented the, the dog really promptly. And, and the diagnosis was made early. So it's important to sort of consider that patients can also present in a range of stages.
Within the spectrum of shock, depending on the different conditions. This is a a sort of general guideline to management of hypovolemic shock in the dog. And so you want to achieve rapid aggressive blood volume expansion.
It's obviously going to be tailored to each individual and your assessment of their parameters. You want to ensure that you've got good intravenous access, so place too large for intravenous catheters. And then for your Fluid resuscitation, and use crystalline intravenous fluids add up to a maximum of 60 to 90 mL per hour.
For the first quarter of an hour and then this should be evaluated every 15 minutes and that based patients response to the of fluid and this you see meals. Per hour here. And you assess the mucous membrane colour, full time, heart rate, blood pressure, and the in total solids are also useful to reevaluate whilst patients being stabilised and then adjust each subsequent bonus based upon their clinical improvement.
If there is evidence of haemorrhage and blood transfusions are necessary if peoples rapidly below 25% and that may be suitable. It might for, some of the patients in the spectrum of, of dogs presenting with abdominal emergencies. Blood work is really helpful in terms of further evaluating the patient.
A minimum database includes packed cell volume and serum total solids, and a blood smear. We want to look for a neutral count in morphology and look for platelets. It would then more comprehensively be useful to have a full haematology, but that may well not be possible setting.
To the same extent as it would be, in, in normal working hours. Serum biochemistry can often get a really useful profile from an in-house analyzer, and coagulation tests may be warranted if we've got evidence of bleeding. And then we're going to think of trying to understand more what is going on, what's causing the signs of abdominal distension, abdominal pain and distress, and radiographs are a really value initial screening tool.
It is commonplace now for practises to have access to a patient sort of. Bedside ultrasound machine to do free fluid checks and assess what's going on and the use of radiography alongside ultrasound is extremely valuable and complementary and to evaluate what's happening. We're focusing first on radiographs.
The important radiographic changes that we're looking for when we're trying to determine whether this patient does require surgical management are loss of serosal detail. Pneumo peritoneum and in an abnormal size, shape, or location of the gastrointestinal, neurogenital or reproductive tracts. For loss of serosal detail, the possible causes may be lack of fat stores in a very emaciated or young animal.
And that, you know, would not be an indication for surgery. What we would be concerned about really is the accumulation of peritoneal fluid. Is it ascites, blood, chile, septic exudate, or urine.
Now for the presence of ascites or Kyle, and then a more comprehensive medical workup would be indicated before abdominal expiration if that is indeed indicated at all. If there's presence of blood of a significant volume and ongoing in production associated with hyperalemic shock, septic state or urine, then there's a clear indications that abdominal expiration is required. Perineal carcinomatos also.
Result in a loss of serosal detail, and this is where there has been a carcinoma present somewhere within the abdomen. It may not have a significant focal mass, but the carcinoma cells have extended throughout the serosal peritoneal surface or created this loss of serosal detail. It may be that exposure laparotomy is warranted to actually Achieve a diagnosis and that this may not be indicated as an emergency.
The use of ultrasound is really valuable to assess for free fluid and to guide sampling, which would then further guide which type of fluid this was and and whether or not this was a situation where we were having to perform emergency abdominal expiration. The image in this photo here is an exploratory laparotomy wound in a dog that has ongoing active septic peritonitis from gastrointestinal wound dehiscans. These images, I've shared as an interesting sort of point in terms of signs that we can see radiographically when we are evaluating the patient.
And we have got the two images at the top. Are patients that have loss of serosal detail due to a, an underlying pathology. So there is some free peritoneal fluid in this patient.
And there is peritoneal carcinomatosis in this patient who's also very thin. You can appreciate here that there's very little soft tissue seen over the dorsal spine. This patient, however, actually has an unremarkable abdomen, but there is loss of serosal detail.
This is actually a very young patient that has not, laid down, significant. Fat stores within the abdomen, and you can appreciate that because there are some open growth plates here in the pelvis, and along the lumbar spine. But what is actually interesting is to look at the fact that in these patients, there is distension, you can see that the abdomen is bulging.
And in this patient where in fact there is not fluid in the abdomen causing loss to the young age of the animal, the contour of the abdomen is much more normal, extending sort of cordially without this bulge, and it's interesting to look at that. You could have, of course, could use ultrasound to confirm, but sometimes there's information on the radiograph that we don't immediate immediately appreciate unless we look. So abdominalcentesis, as I've mentioned, would be indicated and, and if we are suspecting a hemoabdomen, then the PCV of fluid from the abdomen will be similar to or greater than the peripheral PCV because if there's been ongoing bleeding, PCV may actually be higher than the patient's current PCV.
And if you look at and sample that you've taken from the abdomen, it just looks like blood, do remember to actually spin that down and measure what the PCB of that fluid is because hemorrhagic effusion looks like blood, but when you spin it down, it, it may only have a PCB of 5 to 10% and that may change your management plan. And you may need to consider whether there's an alternative cause for the effusion that is not, ongoing haemorrhage requiring surgical intervention. Then again thinking about the different things we see on the radiographs when we're considering whether or not this is a patient that requires emergency intervention.
Pneumo peritoneum. So causes of pneum peritoneum include prior abdominal surgery. Interestingly, appreciable free peritoneal gas can remain present and be identified on a radiograph for around 3 to 4 weeks and postoperatively.
So if you had a patient who you were evaluating. That had had surgery, recently, even within the last 3 to 4 weeks, then taking a radiograph and seeing some free peritoneal gas doesn't necessarily mean the same as it would if that patient had not had surgery within that last month. When we're looking for free peritoneal gas, what we're really looking for is a sign that there has been gastrointestinal tract rupture, or perhaps rupture of another tract within within the abdomen, such as the your genital tract, but typically because gas is present within the gastro tract gastrointestinal tract, we're suspicious of gastrointestinal tract rupture if we see any free peritoneal gas.
The place that you look is the cranio dorsal abdomen to see this. So gas cordal to the diaphragm actually highlights the diaphragm as a distinct white band with the radiolucent lung fields cranially and then the free peritoneal gas cordially creating radiolucency and cranial to the liver. This is an example of pneumo peritoneum in a cat.
This cat had been on long-term non-steroidal anti-inflammatories, for management. Of osteoarthritis, which is an appropriate management approach, but we know that, that it can come with side effects of gastrointestinal ulceration. Unfortunately, this cat had a perforated gastroduodenal ulcer, and a large volume of free peritoneal gas was produced and we can see here that there is a Highlighted diaphragmatic silhouette, and that's because there is gas free within the abdomen which is cranial to liver causing this to be highlighted.
Another factor that we're looking for when we're trying to consider is this abdomen, a surgical abdomen, is, is there small intestinal obstruction. The diagnosis is made up on the basis of the diameter of the small intestine. The index of suspicion is increased significantly if the distention ends abruptly, which then suggests focal lesions such as a foreign body.
There are various different reference guides to gauge small intestinal distention, and once you have looked at a lot of radiographs over time, you get more of a general. Appreciation as to what looks normal and what doesn't. But I think it's really valuable to have these guides, at any stage in your career to, to sort of have some subjective assessment.
As to the potential for there being distension beyond what should be normal. So not exceeding twice the width of a rib, not exceeding the height of the central part of the body belt to, or, the, the ratio of the maximum small distance diameter, the height of the body belt 5 at its narrowest point is less than 1.6.
And what I tended to do is use a bit of paper and and measure that on the screen of the radiograph to give a sort of an assessment of how extended that. If you are unclear, the best thing to do, is, you know, evaluate the patient overall, but come back and repeat a radiograph in maybe 4 hours or maybe the next morning to assess whether things have changed, or whether they remain the same or have got worse, in terms of your decision as to what to do. This is a puppy with a small intestine obstruction, and you can see here there is marked distension of the small intestine, and there's actually this sort of classic appearance of, the loops of distended bowels of folding up on themselves, and there's even a sort of a ground glass appearance at the sort of cadal abrupt end of this obstructive pattern.
I'm going to mention a couple of tips here about surgical management of small intestinal obstruction. Most small intestinal obstruction. Cases are caused by ingestion of a foreign body.
And in most circumstances, it is feasible for the foreign body to be removed via an enterotomy. So simply making an incision over or just aboral to the site where the foreign body has become obstructed and then gently milking that foreign body out and closing. The gut wall with simple interrupted sutures full thickness and to close that enterotomy.
The incision in the gut wall is performed slightly aboral to the site of obstruction and to ensure that the wound is in a healthy wall of intestine and not within the area that has been most compromised by the site of obstruction. In some circumstances, if there has been perforation of the gut wall, if there has been prolonged obstruction and loss of viability of the gut wall, then it may be necessary to perform an intestinal section on osmosis. This would also be the same if it were an.
A mass, in the intestine that was actually causing the obstruction. It'll be indicated to form an intestinal sectionsmosis actually with a degree, of, margins. And When we are performing.
The intestinal resection and smosis. The most important thing, things that we're guided by in terms of deciding what extent of intestine to resect is, firstly, most importantly, of course, the intestinal viability. We want to make sure that our intestinal wounds are going to be within tissue that is healthy, and has good viability.
But that's not only determined by the extent of Injury to the gut wall. It's also determined by where the perfusing blood vessels are entering and so to optimise our resection anastomosis, we want to make sure that we do actually have a healthy blood vessel coming in adjacent to where the anastomosis site is performed. So, and we have to look carefully at where the vessels are.
And consider that along with the site of the trauma to the gut wall before placing our clamps, to decide upon the portion to be resected. We ideally use a traumatic bowel clamps, or if we have the luxury of an assistant, assistant's fingers are the best a traumatic occlusion device that that can be used. When we perform endo endostomosis, it's really, really important to make sure that you have got good position of the gut wall and particularly in the mesenteric order.
Where all of this mesenteric fat is present, and it actually can obscure your view for of the gut wall to continue placing sutures and so I always ensure that I place the first suture. In the mesenteric border, the second suture and anti-mecenteric borders so that we've got an idea of how it's all going to come together. But then continue placing a row of suture on both sides around the mesenteric borders so that we can really see that everything is in place, before the fat comes together and and obscures our view.
Full thickness positional sutures are what we need and the recommended suture material would be polydioxinone or comparable suture for its its strength, it's monofilament nature and lack of of wicking. Linear foreign bodies are a particular challenge. Now they're a particular challenge to identify on imaging, and they are then also more of a challenge to manage as well.
And so, it's really important that you look out for them. If you have a patient that has had vomiting, repeated vomiting, has, is depressed, has some signs of abdominal pain. Radiographs may not be as easy to interpret as the case where obstruction is occurring.
What a linear foreign body does is it attaches at a tether point oral within the gas gastrointestinal tract. Typically in the cat this is beneath the tongue and in the dog is at the gastric pylorus. And then a length of foreign material runs.
Through the gastrointestinal tract and because it cannot process that material through because it's tethered further cranially, the gut as it peristalsis, gathers up on the the linearron body and becomes placated and it starts to actually cut through the mesenteric wall, creating injury and creating defects. Now when you're looking at radiographs to assess for in your foreign body, what you're looking for is an abnormal bunching of the intestines. Small intestines should take up any space that is not occupied by dispensable organs, and you must evaluate this.
It's the most common type of foreign body to actually be overlooked. When you're looking for linear foreign bodies, you You may see umlication, which produces eccentrically place teardrop shaped gas bubbles. And it's actually very rare for radiographs to indicate gastrointestinal perforation due to linear body because everything is all held together and even if perforations occurred at several sites.
These are some radiographs of patients with linear thrombodies, and you can see there's no marked accumulation of gas, but the small intestine is quite bunched and isn't following a nice. Loose path as it normally would within the abdomen. And this is another example of a dog again with a new thrombody.
So they are picked up on the basis of physical examination and combined with diagnostic imaging, but also it's really important that you look underneath the tongue to try and identify. This is a dog, with a sort of a tie underneath the tongue, and cats, it can be really difficult to see because it can cut through and leave just an area that just looks inflamed but often it's like a thread that they may have ingested. Now we're going to come on to gastric dilatation of all of this and first the diagnosis.
Gastric dilation involves often presents with an unmistakable clinical sign. However, radiography is required to confirm a diagnosis. The diagnosis can be made on the basis of a single view, however, it's important that a right lateral radiograph is obtained.
A left lateral could produce the false impression that the patient is suffering from gastric dilatation alone because of altered position of gas within the pylorus. So GDV occurs when there is rotation of the pyloris around the long axis of the oesophagus. If you position the patient in.
Left lateral recumbency, what happens is that The area that you can see most clearly on the radiograph just looks like a gastric dilatation because the pylorus and this soft tissue band. May well be occluded or faced and not not seen by fluid pooling most ventrally. That's why it's really important that to assess patient for GDB position them in the right lateral recumbency because.
And you can see this twist of the stomach and this soft tissue band appearing as a double bubble because the fluid falls dependently and the gas is there to outline this abnormality and that's what allows you to get the diagnosis. Here are some examples of patients with GDB. Sometimes you don't have a really clear big double bubble.
You've got a smaller bubble which may also be slightly over sort of shadowed by lots of gas within the intestine. Sometimes you might have a slightly different orientation. Here is the, the band.
This is a more classic sort of cottage loaf type appearance to the bands. And this is slightly more separate double bubble. There are lots of different appearances, they don't all look exactly like the textbook, but you need to be looking for that soft tissue band and compartmentalization of the stomach.
Let's go through GDB in more detail. GDV causes obstruction of the caudal vena cava, and decreased venous return to the heart. Leading to hypovolemic shock.
There is an increased pressure and aul of short gastric vessels, which leads to gastric wall necrosis. You also get cranial pressure in the diaphragm which causes poor ventilation, and you get stretching and vulsion of splenic vessels and splenic torsion, possibly leading splenic necrosis. Together this leads to metabolic derangements, arrhythmias, and inflammation and endotoxemia, which can lead to diffuse intravascular coagulation if things are not addressed.
The sequence of initial management includes placement of IV catheters, analgesia. A pure opioid like methadone would be appropriate and start aggressive fluid resuscitation. Then perform right lateral abdominal radio radiography and achieve gastric decompression once you've got some fluids on board.
This can be achieved by percutaneous gastrocentesis, so you use a large bore IV catheter for trochorization. This means you can withdraw the tect and follow the stomach as it decompresses with the catheter without being concerned about traumatising any of the internal organs. The other option is gastric tube decompression.
You can see here the tube is being pre-measured to the level of around the 11th rib to be able to then pass the stomach tube safely and a bandage is used in the patient's mouth to prevent them from chewing on the tube. There was a publication looking at different methods of gastric decompression, and. What this indicated was that tubing was successful in 75% of patients and trochorization was successful in 86% of patients.
Some patients had both techniques performed, but overall, the most important message was that gastric decompression is a safe technique. And it's really important to remember it, it's very important in terms of improving patients stability in terms of cardiovascular status, but also making sure that we try and avoid injury to the gastric mucosa and gastric wall, and it's safe to perform and should always be performed in stabilising patients with gastric dilation involved with this. It's not uncommon for cardiac arrhythmist to be diagnosed on the basis of thoracic consultation.
Treatment is only instituted if there are indications that it's hemodynamically significant. So what's really important is the patient is properly fluid resuscitated first because that will be causing hemodynamic compromise, and only when they've been adequately volume resuscitated if they're having an arrhythmia that is associated when it occurs. With hypertension, then, it would then be justified to start antiarrhythmic agents as well, potentially.
There's always a lot of discussion about lactate when we're considering patients with gastric dilatation and ovulus. And this is produced by anaerobic, metabolism. And it's been shown in a number of different publications to be really quite useful as a predictor of outcome.
And because these patients are extremely sick on presentation, and it can be a very costly and associated with significant morbidity to go through the surgery and therefore, it can be useful to have a prognostic indicator for clients as to whether or not they wish to proceed. And this slide provides summary. Of the different, findings of different publications and the I think what useful one is that if initial lactates greater than 6 million litre, gastroent necrosis and greater expense is more likely.
What is really important, however, is that on the basis of lactate, we shouldn't have a hard and fast rule not to recommend expo laparotomy because even patients with high lactate can have a successful outcome. So if a client is wishing. And to attempt treatment regardless of the lactate, then exposure laparotomy should always be recommended because, the results do not always indicate what's going on internally.
So how should we actually perform the surgery? The aims of the surgery are to have a look and see what's happening within the abdomen, de rotate the stomach, assess for gastric necrosis, and perform a partial gastrectomy if required, and assess for splenic necrosis and perform a splenectomy if required. And then it's important that we prevent recurrence by performing gastropexpy.
This is a patient with a gastric dilatation of volvulus, as the abdomen is opened, and we can tell this because the omentum has been pulled over the surface of the stomach and that confirms that we've had gastric dilatation and ulus that has occurred. Here is another picture prior to decompression. This is what the stomach should look like when we look in the abdomen.
We should just see the surface with the great momentum coming away cordially, and we should see the rosal surface of the stomach. When gastric dilation of vagus occurs, the pylorus rotates in a clockwise direction and moving from the right side of the abdomen over to the left side, and it can rotate sort of to you know, a range of degrees around that clock face, at 180 to 360 degrees. Here again you can see the omentum drawn over a stomach that has rotated.
And in order to reduce this rotation. You actually reach up with one hand on the left side of the abdomen to feel the pylori and put some gentle sustained pressure on the stomach on the right side and flip the stomach back. And this is achieved more straightforwardly if the stomach has been.
So you may want to stomach tube intraoperatively at the time, or press with a needle, in theatre for further trochorization. Once the stomach has been. And rotated, we then want to look at it really carefully to assess the signs of gastroent necrosis.
So we're looking over the whole area for signs of gastric compromise. In this stomach there is just an area of of sort of some degree of inflammation but no evidence of gastro necrosis and this patient could then go on and have a gastropexxy performed, and is likely to have a very successful outcome. In other circumstances it can be quite difficult to decompress and de-rotate the stomach.
This is intraoperative trochorization being performed. This is the stomach still in the rotator position, it's being decompressed. We may want to form intraoperative gastric decompression with the stomach tube.
If you weren't able to place it preoperatively, you may well be able to place it intraoptively by guiding the stomach tube in with your hand whilst your colleague is passing the tube down the oesophagus. If you do gastric lavage, ensure the endotracheal tube is cuffed to avoid increasing the risk of aspiration pneumonia and kink the tube when withdrawing to reduce leakage into the oesophagus and the oropharynx again, decreasing the risk of aspiration pneumonia. Gastric necrosis occurs in 10 to 35% of GDV patients, and the risk factors are increased duration and severity of clinical signs.
This occurs because of rupture of the short gastric vessels which provide the blood supply to this area of the fundus close to the cardiac, along with the pressure necrosis on on the mucosa as well. And this is a patient with an area of gastric necrosis affecting the fundus, and it's being managed with a surgical stapler. Another picture of patient being managed with a surgical stapler.
If you don't have access to a surgical stapler, then the use of stay sutures and double layer closure is appropriate for management of the receptive portion of tissue. Sometimes gastric necrosis can be very severe. This is a patient with extremely severe gastric necrosis and you can see here it's being managed with placement of a series of stay sutures within the viable portion of tissue, and that then that can be removed and closed.
Gastric invagination is another technique that is described where you actually take the area of abnormal tissue and you fold it in on itself and close the area over. This can be really helpful if you're operating as a sole surgeon a patient that's extremely sick, but unfortunately it can be associated with issues of gastric ulceration that can cause severe haemorrhage within the stomach. And if this is necessary to perform, it's important to follow up with gastroprotectants, monitor for Melina, and ensure that you continue to check PCV postopically and warn the clients that there could be further problems with ongoing haemorrhage internally.
Ideally, the gastric tissue should be receptive necrotic. Sometimes the extent of necrosis is very significant and it can continue to extend and if it involves the cardio where the oesophagus is entering the stomach, then it may be that in this circumstance it is inoperable. This is a patient with very severe gastric dilatation and volvulus, and you can see that there is extensive areas of gastro necrosis in this patient which are extending, throughout, a lot of the body, but most critically.
Down to the cardia. The pyloris can often appear continue to appear viable and and be viable, but you haven't got a viable stomach if you can't get a tube from the oesophagus to that site. It's not uncommon for there to be splenic necrosis concurrently in patients with gastric dilatation and less.
This is a patient, that has got extensive splenic necrosis and this patient requires a splenectomy. And this patient has got a partial area of splenic necrosis. The most straightforward way to manage that would be nevertheless to do a total splenectomy, but that it is possible to manage that with a surgical stapling device.
Splenectomy is a technique that is commonly performed in small animal surgery. One of the common indications is one of the other presenting signs, not the gastric dilatation is that we've just been focusing on, but the patient that presented with a hemoabdomen due to suspected. Splenic mass.
And we, must consider that there are multiple different potential causes for a hemoabdomen, although, problems associated with the spleen, are the most common cause of hemoabdomen. When we're performing a splenectomy, there are a couple of different options of the technique. It's possible to go along the highless and individually ligate and divide every vessel that is providing the blood supply to the highless or and it is.
Quicker and efficient and to actually identify the blood vessels further away from the spleen and ligate and divide them at this point. It's important that you are confident with performing secure ligatures and for the splenic artery vein, you would want to perform a transfixing ligature. It is important that you note where the blood supply to the pancreas is a rising and that you ensure that you don't provide.
You don't compromise the blood supply to the pancreases. One complication is ischemic pancreatitis if you move too distally. I mentioned that because it's important to be aware, but however, if you are mindful and look for where the pancreas is, it's very unlikely that it would cause this problem.
When we're considering patients, this is a little bit of a detour here, and patients that present, with a hemoabdomen, we're most commonly thinking that this patient have a hemangiosarcoma. And the counselling with the client at this point where it is an emergency situation can be really challenging. A splenectomy offers a medium survival time in patients with Maussarcoma of about 19 to 83 days if there's no other therapy.
That has been indicated. If patients have splenectomy and followed up by chemotherapy, this can increase their survival time, but fewer than 10% of dogs survive for more than one year. There are also non .
Neoplastic causes of hematoin, but these, are, less than. So it would be around 2/3 of patients would have a hemangiosarcoma in a patient that's presented with a spontaneous ruptured hemo abdomen around 2/3 to 80% depending upon what studies we look at. And then coming back to gastric dilatation and volvulus, gastropexxy is absolutely mandatory.
The recurrence of gastric dilatation volvulus if it's not performed is around 75%. All gastropexxy procedures reduce the risk of recurrence of GTV to a very low level. There are different merits of each technique, and so therefore it really should be based upon surgeon preference.
I think that the most reliable and straightforward one form is an incisional gastropexxy. So I'm just going to finish up now by saying incisional gastropexxy. So you assess the position on the right body wall.
So you want to take the, an incision is made cordal to the last rib through the transverse abdominal muscle and you oppose. The pyloricant, to the right body wall. This is the incision in the transverse abdominal muscle.
And here is a corresponding incision that's been made in the pyloriantrum of the stomach. This has been made as a seromuscular incision, so this submucosa and mucosa are very importantly, and then these two incisions are opposed together and a a line of simple continuous on each side to achieve subsequently a maturity and this is what is what at the end. It's been shown to have very long term.
What's interesting in one study was that, although it was very effective at preventing repeat gastric dilatation involved with this, 10% of dogs had repeat gastric dilatation. It's important to warn clients that gastric dilatation may still continue that they have a tendency to have this. Post-operatively, it's really important to monitor your patient really carefully and adjust the fluid therapy, as indicated.
Ensure, food and water and, and don't necessarily expect that they will eat within the 1st 24, 48 hours when food is available intermittently. Gastroprotectants are indicated and metoclopramide is a within a few minutes. Official.
Post-operative an analgesia we want to avoid anti-inflammatories and use pure opioid agonists followed by then by partial opioid agonist. There has been some indication. That the use of lidocaine CRI, which can be beneficial for analgesia as well, has also been suggested to have a protective effect with regards to the general inflammation associated with gastro volvulus and the instance of acute kidney injury, and some emergency clinicians advocate this being started early at at at presentation.
The risk factors for death associated with gastric dilation and bolus are increased duration of clinical signs, hypertension at any point during management, and a combined splenectomy and partial gastrectomy. In an emergency clinic population, I'm looking at first is the survival with 80%. There, is higher success rates, in, some referral centre settings, but, in a first opinion practise, there can be survival around 80%, showing that there really can be a very positive outcome.
From your interventions and it can be a really an extremely rewarding condition, to manage. Unfortunately, there are a range of different postoperatives that can be seen, and these can be systemic, thoracic, or abdominal. This flow chart, gives a guide for management of patients, with, failure to do well following gastric dilatation, and involved with the surgery, and the algorithm allows you to look at what information you wish to gain, and what you might see, and what that might mean in terms of your intervention.
So I won't talk through all of it, but hopefully you can use that as a reference to look back at. So how should we cut GDPs? We want to operate on them following a prompt diagnosis, appropriation, and with an appropriate definitive surgical technique and then provision of intensive post-op care.
Following appropriate management, the prognosis can be good with survival rates around 85%. Thank you very much for listening.