Abdominal free fluid- minimal cellularity, some neutrophils, no organisms. Compensated PCO2 should be 32.2
rDVM radiographs- get rads typical case
Expected effect of FFP on albumin- increase by 4.
Significant drop in iCa- dilution vs citration vs intracellular shift in face of GI necrosis- iCa 1.2 to 0.65. Glucose decreased and K increased as reduced catecholamine surge and glucose moved into cells and K out. TS declined
Anion gap reduced by 3 for every 10g/L drop in albumin
Managed to get across the red line about 1 hour after admission.
Bowel loops less than ideal, 360 degree twist to mesentery
Post intestinal shuffling- mesenteric thrombosis
In 2 case series with a total of 15 dogs, one survived where torsion was an incidental finding during celiotomy for something else. 2 isolated case reports of survival.
Many associations suggested- deworming, trauma, EPI, IBD, vigorous activity.
Typical age of diagnosis 1.5, range foetal to 84 years old.
Ligament of treitz well described in dog- contains smooth muscle, physiologic sphincter controlling rate of duodenal emptying.
Bacterial translocation and bacteremia, endotoxin uptake, protease uptake
During hypoxia, intracellular ATP is converted to hypoxanthine. Normally oxidised by xanthine dehydrogenase XDH. Hypoxanthine increases 10 fold in hypoxia as increased intracellular Ca inactivates XDH to xanthine oxidase, resulting in hyoxanthine accumulation. When oxygen reintroduced, XO reacts with hypoxanthine and results in oxygen free radical generation. This in turn results in cell membrane dysfuction and DNA damage.
Best if drugs in tissue at time of reperfusion. N acetylcysteine is a glutathione precursor, which then scavenges free radicals. Drug to block ischemiz/ reperfusion holy grail. Ischemic pre-conditioning.
Surgical time- 90 min. Comatose with heavy pharyngeal secretions, not swallowing. Pentastarch COP=32mmHg. PCO2 52.8 post op.
Responded well to norepinephrine and a further 8 litres fluids (plasma, pentastarch, crystalloids) over the next 12 hours. Biggest concern CNS dysfunction
Turns out resistant enterococcus cultured from abd fluid- by the time culture result available, clinical status much improved.
Ventilated for 35 hours without sedation/ anesthesia. Good tolerance trickle feeding, decline in PCV not accompanied by worsening GI hemorrhage, off pressors
switch cefoxitin to enro/ metronidazole, off fentanyl, pulled central line, gave diphenhydramine
Circumstances in which they occurr depends on inciting antigen.
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