gastric dailetteshan volvulus

gastric dilation, twisted aamashayam allengil gastric tortion ennum ariyappedunna gastric dilation volvulus (gdv), amithamaya vaathakathinte alavu moolam wier amithamaayi neengukayum karangukayum cheiyunna naaykkale badhikkunna oru medical avasthayaanu. vayaruvedanayillaatha vaathakathinte neelam (bhakshanathinu sheshamulla oru saadhaarana maattam) allengil jii. dii. vii. ennathine soochippikkaan bload enna vaakk palappozhum oru pothu padamaayi upayogikkunnu.
naayakalil jeevan apakadappeduthunna oru avasthayaanu jii. dii. vii. ithinu pettennulla chikitsa aavasyamaanu. chila enangalil ithu saadhaaranamaanu; aazhathilulla nench ulla enangal prathyekichum apakadasaadyathayilaanu. chikilsayiloode polum naaykkalude marananirakk 10 muthal 60 sathamaanam vareyaanu. shasthrakriyayiloode marananirakk 15 muthal 33 sathamaanamaanu.
lakshanagal.
rogalakshanangal mattu tharatthilulla durithangalil ninnu verthirichariyaan kazhiyilla. oru naaya aswasthathayode nilkkukayum vyakthamaaya kaaranamonnumillathe angeyattam aswasthathayilaayirikkuyam cheythekkaam. vayarinte dridamaaya neelam, balaheenata, vishaadam, shwasikkaan budhimuttu, hypersalivation, chharddi undakkaathe veendum elakal (ulppaadanakshamamallaatha chharddi) ennivayaanu mattu saadhyamaaya lakshanagal. jii. dii. vii ulla pala naaykkalkkum cardiac aritmiyas undu (oru padanatthil 40 sathamaanam). naaykkalile vittumaaraatha jii. dii. vii. yill vishapp kurayuka, chharddi, sareerabhaaram kurayuka thudangiya lakshanagal ulppedunnu.
kaaranagal.
naaykkalile gastric dailetteshan volvulus niravadhi gadakangal moolamaanu undaakunnath, ennaal ellah saahacharyangalilum annanaalathinum vayarinum edayilulla spinktarinte pravarthanarahithathayum pailorasiloodeyulla puranthallalinu thadassamumaanu adiyanthira munvyavastha. gdv vikasippikkunnathinulla kooduthal vyaapakamaayi amgeekarikkappetta chila gadakangalil vardhicha praayam, breed, aazhathilullathum idungiyathumaaya nench, vayattil vyaapikkunna kibble polulla bhakshanagal kazhikkuka, amithamaayi bhakshanam kazhikkuka, vyaayaamathin munbo sheshamo cheria kaalayalavil valareyadhikam vellam kudikkuka, dahananaala rogathinum budhimuttinum mattu kaaranagal enniva ulppedunnu. udamakal santhushtaraanennu karuthunna naaykkalil veekkam varaanulla saadhyatha kurayukayum bhayamullathayi karuthunna naaykkalil vardhikkukayum cheiyunnu. dahananaalavyavasthayude pravartthanatthilum chalanathilum naayayude vyakthithvathinte shaareerika phalangal moolamaakaam ithu. pakaramaayi, veekkam kaanikkunnathilekku nayikkunna avasthakalude falamaayi naaykkal asanthushtaro aswastharo aakam. koshajwalana malavisarjanamulla naaykkalkku veekkam varaanulla saadhyatha kooduthalaanu.
bhakshana gadakangal.
munkaalangalil oru saadhaarana shupaarsha naaykkal bhakshanam kazhikkumbol avarude bhakshana paathram uyarthuka ennathaayirunnu, ennaal ithu yadhaarthathil jii. dii. vii. yude apakadasaadhyatha vardhippichekkaam. divasathil oru thavana maathram kazhikkunnathum valippathil thaazheyulla kanikakal adangiya bhakshanam kazhikkunnathum jii. dii. vii. yude saadhyatha vardhippikkum. dry dogg bhakshanathile cheruvakal nokkunna oru padanatthil daanyangalo soyayo mrugangalude proteinukaloo veekkam varaanulla saadhyatha vardhippikkunnillenle, adhika ennakaloo kozhuppukalo adangiya bhakshanagal wier kaalathamasam moolam apakadasaadhyatha vardhippikkunnu.
pathophysiology.
volvulus ennum ariyappedunna dahananaalathinte rekhamsha achuthandinu chuttum wier valayunnu. wier valarunnathinu munbo sheshamo vathaka vyaapanam sambhavikkam. bhramanathinulla ettavum saadhaaranamaaya disha gadikaaradishayil mrugathe pinnil ninnu kaanuka ennathaanu. vayarin eee dishayil 360° vareyum 90° ethir gadikaaradishayilum karangaan kazhiyum. volvulus 180°-ll kooduthalaanengil, annanaalathe adaykkunnu, athuvazhi belching allengil chharddi vazhi mrugathe eee avasthayil ninnu mochanam nalkunnathil ninnu thadayunnu. saadhaarana shareeraghadanayudeyum vathaka vipuleekaranathinteyum eee valachodichathinte phalangalil hypotension (kuranja rakthasammardham), hridayathilekkulla rakthathinte madangivaravu kurayal, aamaashayathile ischemia (raktha vitharanam nashtappedal), shock enniva ulppedunnu. portal sirayile sammarddam karalilekkulla rakthayottam kuraykkukayum rakthathil ninnu vishavasthukkalum agiranam cheyyappedunna baakteeriyakalum neekkam cheyyaanulla aaa avayavathinte kazhivu kuraykkukayum cheiyunnu. valayal raktha vitharanam thadassappeduthukayaanenkil vayarinte maruvashathu pleahike kedupaadukal sambhavikkam. vegathil chikilsichillenkil, veekkam rakthavishabadha, perittonitis, visha shock moolam maranam ennivayilekku nayichekkaam.
roganirnayam.
jii. dii. vii. yude roganirnayam nadathunnathu niravadhi gadakangal kondaanu. eee inavum charithravum palappozhum eee avasthayekkurichu kaaryamaaya samshayam nalkunnu, koodaathe oru shaareerika parisodhana palappozhum vayarile timpaniyulla vayarinte soochana velippeduthunnu. mosham capillary reefil, vardhicha hridayamidippu, mosham pulse gunanilavaaram ennivayulla ilam mucus membranukalude saannidyamaanu shock nirnnayikkunnath. naaya asthiramaanengil wier adichamarthiya sesham saadhaaranayaayi edukkunna radiographukal (ex-reey), vayattil vaathakam vyaapichukidakkunnathayi kaanikkunnu. saadhaaranayaayi vayarinte shareerathinte valathuvasathum ventralilum aaya pilorus, vayarinte shareerathinum madhyarekhayude idathuvashathum thalayottiyullathaanu, palappozhum ex-reyil mriduvaaya tissue upayogichu verthirikkukayum oru prathyeka gyaas niracha pokkattinte (eratta-bubble adayaalam) roopam nalkukayum cheiyunnu.
chikitsa.
gastric dailetteshan volvulus oru adiyanthira medical avasthayaanu; mrugathe oru mrugadoktar parishodhikkendathu anivaaryamaan. minitukalkkullil jii. dii. vii maarakamaayekkaam.
saadhaaranayaayi isotonic draavakangaludeyum hypertonic lavanangaludeyum samyojanam allengil hetaastaarkk polulla colloydal layani, adiyanthara sasthrakriya ennivayulla intravinus fluid therapy upayogichu punarujeevippikkal chikilsayil ulppedunnu. oru vayarile tube kadannupokunnathiloode wier thudakkathil vighadippikkappedunnu, allengil athu saadhyamallengil, vaathakam neekkam cheiyunnathinaayi trokkaarukal charmmatthiloode vayarilekk kadakkaam, pakaramaayi anastheshyaykku sesham trokkaarukal nerittu vayarilekk cherkkaam. shasthrakriyaykkide, wier athinte sariyaaya sthaanathekku thirike vaykkukayum eathenkilum vyathichalicha tissue (prathyekichu wire pleeha) undoyennu vayattil parisodhikkukayum cheiyunnu. vayarile chuvaril enthengilum necrosis undaayal bhagika gastroctomy aavashyamaayi vannekkaam.
prathirodham.
jii. dii. vii aakramanangalude aavarthanam oru prasnamaakaam, ithu 80 sathamaanam naaykkalil (shasthrakriyayillaathe) vaidyashaasthraparamaayi maathram chikilsikkappedunnu. aavarthanam thadayunnathinaayi, veekkam shasthrakriyayiloode chikilsikkumbol, palappozhum oru valathuvashathe gastropexy nadathunnu, ithu bhaviyil vayarinullile araykkullil valayunnathu thadayunnathinaayi vividha reethikaliloode vayarinte mathiline shareerathinte mathilumayi urachucherkkunnu. gastropexical ulla naaykkalkku ippozhum vayarile vathaka vyaapanam undakamenkilum, gastric volvulasinte aavarthanathil ganyamaaya kuravu kaanapedunnu. gastric dailetteshan-volvulasinu sasthrakriya nadatthiya 136 naaykkalil, gastropexicallu aarr naaykkalkku aavarthanavum adhika shasthrakriyayillaatha 74 (54.5%) naaykkalkku aavarthanavum undaayi. jii. dii. vii. yude uyarnna apakadasaadhyathayullathaayi kanakkaakkappedunna naaykkalil, muun episodukalulla allengil jii. dii. vii. yilek munkootty kaanapedunna dahananaala rogamulla naaykkal, aadya-oordar bandhuvaya (maathaapithaakkal allengil sahodarangal) naaykkal ennivayulppede, gastropexical prathirodhaathmakamaayi nadathunnu.
gastric dailetteshan-volvulus thadayaan sahayikkunna munkaruthalukalil oru valia bhakshanathinu pakaram divasam muzhuvan cheria bhakshanam kazhikkuka, bhakshanathinu munbo sheshamo udan vyayaamam cheyyaathirikkuka enniva ulppedunnu.
pravachanam.
anukoolamaaya roganirnayathil ettavum pradhanappetta gadakamaanu udanadi chikitsa. 6 manikkooril kooduthal chikitsa vaikukayo perittonitis, sepsis, hypotension allengil pracharippicha intravascular koguleshan ennivayude saannidhyam negatteevu pravachana soochakangalaanu.
charitraparamaayi, jii. dii. vii. oru surakshithamaaya pravachanam nadathiyittundu. aadyakaala padanangal jii. dii. vii ulla naaykkalude marananirakk 33 muthal 68 sathamaanam vare kaanikkunnundengilum, 2007 muthal 2012 vareyulla padanangal" 10 muthal <aii. dii. 1> vareyulla marananirakk report cheythu. chikilsayiloode polum marananirakk 10 muthal 40 sathamaanam vare athunnu. rogiyude vegathilulla chikitsa nalla shasthrakriyaykk munbulla sthirathayum moolam marananirakk mothatthil 10 shathamaanamaayi ganyamaayi kuranju (oru referral krameekaranatthil). shasthrakriyaykk sheshamulla negatteevu roganirnaya soochakangalil poost operative cardiac aritmiya, splenectomy allengil bhagika gastric vichedanam upayogichu splenectomy enniva ulppedunnu. avatharanam muthal sasthrakriya vareyulla kooduthal samayam kuranja marananirakkumayi bandhappettirikkunnu, orupakshe eee naaykkalkku kooduthal poornnamaaya preopparetteevu draavaka punarujjeevanam labhichathinaal, nadapadikramatthinu munbu hridayasambandhamaaya sthiratha mechappettu.
epidemiology.
pothuvaayi paranjaal, aazhathilulla nench ulla naaykkalkku jii. dii. vii ettavum apakadakaramaanu. grettu danes, veymaaranezhsu, sent ennivayaanu ettavum apakadasaadyathayulla anchu enangal. bernardukal, gorden settarukal, airish settarukal. vaasthavathil, oru grettu daninu gdv vikasippikkanulla jeevitakaala apakadasaadhyatha 37 shathamaanathinaduthaanennu kanakkaakkappedunnu. airish wolfhounds, jarmman shorthair pooyintarukal, jarmman sheppereds, rodatian ridjbaakkukal enniva pole staanderd poodles eee aarogya prashnathinu apakadasaadhyathayund. baasett houndukalkkum daashandukalkkum naaykkalekkaal kuranja apakadasaadhyathayund.

