07 - constipation and anorectal diseases

Question 1

(constipation)

1. 7 causes?

Answer 1

1. foreign material
2. environemntal (unfamiliar surroundings)
3. painful defecation from anorectal dz
4. obstruction
5. neuromuscular dz
6. dehydration
7. drug related

Question 2

(constipation)

1. Cx?

Answer 2

1. reduced/absent defecation, dyschezia, abdominal discomfort, paradoxical diarrhea

Question 3

(constipation)

1. dx?

Answer 3

1. review history, px, rectal exam, abdominal palpation, lab eval, radiographs, ultrasound, other tests for thryoid fx and neuromuscular disorders

Question 4

(constipation)

1. simple constipation withougt systemic signs can be managed using what?

severe may require what?

Answer 4

1. rectal suppositories or oral laxatives combined with dietary modification and ^water intake

removal of impacted feces from colon with correction of dehydration and electrolye imbalances

Question 5

(initial relief of constipation)

Answer 5

Question 6

(constipation)

(oral laxative therapy)

1. fiber
2. lubricant: which is better: petrolatum or mineral oil?
3. example of emollient laxative?
4. example of osmotic laxatives?
5. stimulant laxative example?
6. pro-kinetic?

Answer 6

2. petrolatum (mineral oil may lead to inhalation lipid pneumonia)
3. docusate
4. lactulose
5. bisacodyl (contraindicated in presence of obstructive lesion)
6. cisapride (contraindicated in presence of obstructive lesion)

Question 7

(megacolon in cats)

1. most common cause?
2. most common in what cats?
3. tx?

Answer 7

1. idiopathic (obstructive 25%, neurologic dysfx 5%)
2. middle-aged to older males
3. evacuation of feces, lactulose, cisapride. most cats eventually will need subtotal colectomy

Question 8

(anorectal prolapse)

1. happens most often in what?
2. partial prolapse -> red, swollen, doughnut shaped ring

complete prolapse -> edematous, cylindrical shaped mass

3. need to differentiate from what?
4. tx?

Answer 8

1. kittens and pups with persistent straining to defecate because of parasites
2. intussusception
3. underlying + manually reduce prolapse, may need sx

Question 9

(perianal hernia)

1. weakened perineal muscularture fails to support the rectal wall, resulting in persistent rectal distention
2. occurs mostly in what dogs?
3. path?
4. Cx?
5. dx?
6. tx?

Answer 9

2. middle aged, intact male dogs
3. unknown (straining, neurogenic atrophy, male hormones, megacolon in cats)
4. perineal swelling (uni or bilateral)
5. based on palpation
6. mild: laxative and stool softening

castration of dogs may prevent progression

corrective perineal herniorrhaphy and castration are required in most cases

Question 10

(anorectal stricture - stenosis)

1. result from what?
2. Cx?
3. dx?
4. tx?

Answer 10

1. trauma from FB, anorectal sx, chronic inflammation, adenocarcinoma
2. dyschezia, tenesmus, hematochezia, secondary constipation
3. rectal palpation, contrast radiography
4. conservative, balloon dilation may be successful

Question 11

(anal spasm)

1. idiopathic spasm of the anal sphincter when the animal attempts to defecate
2. occurs most freq in what dogs?
3. tx?

Answer 11

2. german shephards
3. treat conservatively, resection of the pudendal nerve may be required

Question 12

(anal and rectal atresia)

1. atresia ani and rectal atresia are congenital malformations
2. Cx?
3. tx?

Answer 12

2. inability to defecate -> abdominal distension, tenesumus, systemic deterioration, death
3. sx

Question 13

(rectovaginal fistula)

1. a rare congenital malformation of females characterized by passage of fecal material through the vaginal opening
2. can be surgically corrected, but prognosis is guarded

Question 14

(anal sac disease)

1. is impaction usually uni or bilateral?
2. anal sacculitis uni or bi?
3. anal sac abscesses are usually uni or bi?

Answer 14

1. bilateral (anal sac is distended, mildly painful, and not readily expressed)
2. can be either (mod to severe pain and purulent contents)
3. unilateral (marked distension of sac with pus, erythema of the overlying skin, and fever)

Question 15

(anal sac dz)

1. Cx = scooting, tenesumus, licking and biting
2. dx based on exam of anal sacs
3. tx?

Answer 15

3. manually evacuate, irrigate with povidone-iodine solution, and treat with systemic antibiotics based on culture and sens

anal sacculectomy may be required

Question 16

Psuedocoprostasis = ?

Answer 16

anal opening obstructed by surrounding hair

Question 17

(rectal, anal, and perianal tumors)

(benign rectal polyps)

1. common in what dogs?
2. usually solitary, focal, pedunculated, or sessile masses
3. detect with what?
4. tx of choice?

Answer 17

1. middle aged and older dogs
2. rectal palpation, bx for definitive dx
3. surgical excision

Question 18

(rectal, anal, and perianal tumors)

(perianal gland adenoma)

1. tumors dependent on what?
2. most common in what dogs?
3. treatment of choice?

Answer 18

1. androgens
2. older, intact male dogs
3. surgical excision and adjunctive castration

Question 19

(perianal gland adenocarcinoma)

1. occur most often in what?
2. locally invasive? metastasize?
3. dx requires what?
4. do what to check for mets?
5. prog?

Answer 19

1. aged? female dogs
2. yep, eventually
3. biopsy
4. thoracic and abdominal radiography
5. good if no mets, bad if mets

Question 20

(apocrine gland adenocarcinoma)

1. occurs in what dogs?
2. mets?
3. tx of choice?

Answer 20

1. middle aged and older dogs
2. yep - sublumbar LN and distant sites
3. sx excision