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6th MELEAH Surgery test 2 (gonna make it my bitch) > 5. Surgery of the Rectum and Anus > Flashcards

5. Surgery of the Rectum and Anus Flashcards

1
Q

What are the different types of rectal prolapse?

A

-Complete which includes all the layers -Incomplete just the mucosa

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2
Q

A rectal prolapse is usually secondary to _______

A

tenesmus

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3
Q

Really important to differentiate rectal prolapse from this other prolapse issue (name it) because they are treated entirely differently? How do we do differentiate and if you can say it’s the un-named issue what does that indicate?

A

Prolapsed intussusception use a probe test to ddx (finger) Use your finger to probe between the border of the prolapse tissue and the anus if that probe(finger) can pass on the sides of the prolapsed tissue that’s a intussusception and it’s a surgical emergency abdominal surgery (r and A, manual reduction) if the probe can’t be passed it’s a rectal prolapse

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4
Q

Rectal prolapse can be caused by these 3 things and you need to treat the underlying cause

A

-megacolon, prostatic disease, parasites treat these first or it will reoccur

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5
Q

If the rectal prolapse still has viable tissue and looks healthy what can you do and how long does this need to be maintained for? What if reoccurance occurs what can you do?

A

Reduce and place a purse string suture is viable dont make so tight that it cant shit!!!! maintain this for 3 days, if reoccurance colopexy

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6
Q

If the rectal prolapse still has nonviable tissue or covered in dirt what can you do?

A

Amputate is non viable

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7
Q

What are some complications for rectal prolapse amputation (4)

A
  • Infection (lots of bacterial)
  • Dehiscence
  • Stricture
  • Reoccurance (even if amputation and they continue to strain)
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8
Q

What are 2 indications for colopexy?

A
  • Recurrent rectal prolapse
  • Perineal hernia
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9
Q

What are some different suturing techniqes for colopexy? What is incisional colopexy

A
  • Absorbable or nonabsorbable as long as you arent using full thickness bites for backteria to take up and cause infection for (NA)
  • Incisional colpexy- absorbable suture material
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10
Q

DO we enter the mucosa in an incisional colopexy?

A

NO we don’t enter the lumen!!! Incision through seromuscular layers of the colon and transversus abdominus of the body wall on the LEFT SIDE

similar to incisional gastropexy

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11
Q

We perform incisional colopexy’s on whichcolonic segment and apply this to help keep it in?

A

descending colon and apply cranial traction to make sure its not going out prolapsing keeping it internal

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12
Q

When we perform a gastropexy it’s sutured in ____ place versus a incisional colopexy?

A

gastropexy one place, incisional colopexy can perform in more than one spot on descending colon

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13
Q

What are the benign and malignant tumors for colorectal neoplasia

A

Benign

  • Adenomatous polyps can transform into malignant forms
  • Leiomyoma
  • Fibroma

Malignant

  • Adenocarcinoma
  • Leiyomyosarcoma
  • Lymphosarcoma
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14
Q

Rectal adenomas are benign or malignant? What are the CS and where do most occur in the body?

A
  • Benign!
  • MOST OCCUR in distal rectum

CS

  • Hematochezia (blood in feces streaks of blood on top surf)
  • Tenesmes(sensation that you constantly have to defecate)/dyschezia(constip) (straining from presence of the tumor stimulating
  • Visible mass (may be intermittent)
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15
Q

What are the different morphological presentations of rectal adenomas and where do they most commonly occur?

A
  • Polypoid-pedunculated or polyp like
  • Sessile-broad based
  • Multiple-more than one
  • Most commonly occur in the DISTAL RECTUM
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16
Q

What are some different ways to diagnose rectal adenoma?

A
  • Direct obs
  • Rectal palpation
  • Proctoscopy(rectum) all the way up to colon with a colonoscopy because there can be multiple
  • Biopsy through colonoscopy taking small mucosal biopsies
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17
Q

When taking biopsies for rectal adenoma, Biopsy through colonoscopy and take small mucosal biopsies for predx, what should you always do even when preop biopsy is performed and why?

A

ALWAYS submit excised masses full thickness even when preop biopsy is performed because up to 25% will come back as a more aggressive tumor (carcinoma in situ, invasive adenocarcinoma)

18
Q

What approaches can you take for rectal adenoma?What is the limiting factor for one of these types of treatment

A
  • Surgical excision
    • Transanal
    • Dorsal approach
    • Mucosal resection only versus full thickness
  • Cryosurgery
    • Can’t evaluate the margins make sure you dont leave tumor cells behind especially if changed from adenoma or carcinoma insitu (locally aggressive) and adenocarcinoma which is more aggressive in multiple locations
    • Can’t confirm dx
19
Q

With colorectal adenocarcinoma, approximately 50% are _______ and have a napkin ring affect which means?

A

abdominal, the adenocarcinoma come and stricutre around that portion of colon.

20
Q

With colorectal adenocarcinoma, lesions are _____, _____, and _____(napkin ring). There may be multiple so examine the entire colon and metastasis to _____ and _______

A

With colorectal adenocarcinoma, lesions are luminal, intraluminal and annular(napkin ring). There may be multiple so examine the entire colon and metastasis to regional LNs and liver.

21
Q

Describe the anal surgical approach to the rectum and colorectal junction?

A

Lesions involving caudal rectum or anal canal

22
Q

Describe the dorsal surgical approach to the rectum and colorectal junction

A

Lesions involving midrectum but NOT the anal canal perform incision dorsal to anus

23
Q

Describe the rectal pull through surgical approach to the rectum and colorectal junction

A

Distal colonic or midrectal lesion not approachable through abdomen, pull rectum out toward you and be careful not to cut the external anal sphinctor (mild fecal incontinence temporarily)

24
Q

Describe the swensons pull through surgical approach to the rectum and colorectal junction

A

lesions that extend beyond peritoneal reflection into abdominal cavity and combines the anal and ventral approach

25
Q

Describe the transanal approach

A

epidural block limited to lesions in the caudal 4-6 cm of the rectum (often mucosal layer resection)

26
Q

What are the 4 common complications of rectal sx?

A
  • Dehiscence
  • Infection
  • Stricture
  • Incontinence
    • Spincteric
    • Sensory (be careful in dorsal approach or near sphinctor)
27
Q

Anal sac abcesses are usually treated _______

A

medically (surgery to remove them is only with chronic issues)

28
Q

Anal sac disease is a common problem in _____ breed dogs but any dog can have it, name the 2 breeds commonly associated. rare in _____

A
  • Small breed dogs
    • Poodle
    • Chihuahua
  • (rare in cats)
29
Q

Manage infected or abcessed glands medically until inflammation ressolves and then consider doing this Often uni or bilateral removal known as?

A

Anal Sacculectomy

30
Q

Anal sacs lie within the _____ _____ _____

A

external anal sphincter

31
Q

What do you have to be careful with bilateral anal sacculectomy

A

Fecal incontinence stage them before you take out both to make sure you need to

32
Q

Woudl you perform an open anal sacculectomy on a tumor?

A

FUCK NO NO NO NO

33
Q

What time of anal surgery would we do for tumors and infected glands? What do we often inject so we can dissect around the tumor and remove it

A

Closed anal sacculectomy (usue a blunt probe or instrument to isolated affected anal sac) keeps the tumors contained todo closed! Paraffin injection Incision Access through side of perianal region to access anal sac. Folicatheter

34
Q

WHat are we incising through with open anal sacculectomy?

A

Through the duct and dissect through external anal gland sphinctor muscle so its damaging and why its not commonly performed, ruptured sac, remove all portions because can cause draining tracts if infected

35
Q

What are some complications of a open sacculectomy? WHat if they were ruptured and you were about to go into surgery

A
  • Infection
  • Draining tracts
    • Incomplete reoval of anal sac
    • must excise to resolve
    • Surgery done soon after they ruptured their anal sac you will commonly see this or cellulitis
  • Fecal incontinence

If ruptured, wait and medically manage till inflammation goes down

36
Q

What perianal grand tumor is more common in male intact dogs due to testosterone predispostion? What do we do for tx

A

adenomas(often benign masses so neuter them and that most commonly is asc with a good prognosis!!!!) Guarded to poor if malignant

37
Q

What is a common anal sac tumor, is it benign or malignant and what do you commonly see on blood work?

A
  • Apocrine gland adenocarcinoma (implies malignant
  • you often have a paraneoplastic syndrome with hypercalcemia, if you see it on an older animal go on a cancer hunt! (also PUPD, renal failure)
38
Q

Describe the prognosis for metastasis (and where it goes to) versus no metastesis with apocrine gland adenocarcinoma?

A

No metastasis 16-18 month survival

Metastasis often to the sublumbar LN and less than 1 year survival

39
Q

WHat do you do surgically with apocrine gland adenocarcinoma? What is this often paired with in terms of tx and why?

A

Remove the anal sac and cant get full margins bc that tissue is around your anus and rectum and cant remove that all! unfortunately they will come back radiation therapy often recomemnded bc neoplastic cells inevitably left behind

40
Q

Perianal fistulas are often seen in this breed and caused by this most likely?

A

german shepherd, immune mediated cause

41
Q

How are Perianal fistulas managed?

A

Medical management with high fiber IBD diet and cyclosporine which is expensive but 70-100% resolution, surgical intervention is only recommended if non responsive to medical management

42
Q

What do perianal fistulas show as in terms of CS an what does it commonly look like?

A

painful, perianal drianing, fistulous tracts; confuse with ruptured anal sacs actually in a different location but anal sacculectomies dont really work

6th MELEAH Surgery test 2 (gonna make it my bitch) (8 decks)

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