In this BoardsCast deep dive, we continue Tobias Chapter 91 — Stomach  by reframing GDV in the way surgeons must understand it for boards, for practice, and for saving lives.

GDV is not a stomach problem.
GDV is a cardiovascular collapse event disguised as a stomach twist.

For decades, surgeons have been trained to “fix the twist” — untwist the organ, check viability, remove the spleen if it looks ugly.
 But the lethal physiology of GDV occurs long before the stomach ever becomes necrotic.

This episode dismantles the classic “anatomy-first” mindset and replaces it with the hemodynamic mental model that actually saves patients.

You’ll learn:

• Why the stomach’s appearance is a distraction from the true killer
• How vena cava compression, preload loss, and cardiac output failure unfold within minutes
• Why splenectomy rarely solves the real problem
• How myocardial depressant factor and ischemia trigger deadly arrhythmias
• Why lactate trends matter more than lactate values
• The physiologic priority stack that prevents arrest before the abdomen is even opened
• Why decompression is more important than derotation
• Which access points actually deliver fluids to the heart (and which don’t)

If GDV is treated like a gastric surgery instead of a circulatory crisis, the patient dies before the stomach ever does.
 When you shift your focus to restoring venous return, preload, and oxygen delivery, survival changes dramatically.

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