From: Dr. Russell Kalis
Sent: Tuesday, September 01, 2009 16:42
Subject: Lilly’s Post-Operative Status
surgery and general anesthesia went very well.
Gastric Dilatation-Volvulus (GDV), often referred to as
"bloat" or gastric torsion, is a serious condition caused by abnormal
dilatation and twisting of the stomach. The condition is initiated by abnormal accumulation
of air, fluid or foam in the stomach (gastric dilatation). Bloating of the
stomach is often related to swallowed air, although food and fluid also can be
present. Bloat can occur with or without volvulus, or twisting, such is the
case with Lilly. As the stomach enlarges, it may rotate 90 degrees to 360
degrees, twisting between its fixed attachments at the esophagus (food tube)
and at the duodenum in the upper intestine.
Volvulus completely obstructed Lilly’s ability to empty her stomach. The twist
also prevented belching/vomiting which prevented her from being able to relieve
the air and other stomach contents. In fact, a hallmark symptom of torsion is
nonproductive attempts at vomiting. The bloated stomach obstructs the return of
blood from the veins in the abdomen which can lead to low blood pressure,
obstructive shock and associated complications.
The combination of bloating and torsion greatly reduces the blood supply to the
stomach (gastric ischemia) and this can lead to necrosis (death) of the stomach
wall. Shock and lack of blood supply to abdominal organs break down the
integrity of the gastrointestinal tract lining and permit toxins and bacteria
to enter the blood stream. Abnormal blood clotting – disseminated
intravascular coagulation (DIC) – may develop. The spleen can be damaged
or begin to bleed because it is attached to the stomach by a membrane, and it
becomes twisted and rotated abnormally as the stomach turns. Heart function is
compromised due to lack of venous blood return. Irregular heart rhythms often
develop such as ventricular tachycardia.
cardiac arrhythmias were noted at any point prior to or during the surgery. Due
to decreased perfusion and viability of the spleen, Dr. Liska removed the
sleen. In addition, the stomach was derotated and sutured to the abdominal wall
in order to help prevent the stomach from rotating on itself in the future. We
will continue to monitor Lilly throughout the night and will give another
update tomorrow late morning/early afternoon.
noted that Lilly is currently taking thyroid medications. Please let us know
what which medication (Soloxine?) dose (?) and frequency (twice daily?) she has
been receiving in order for us to continue that medication tomorrow morning.