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Small Animal Surgery > 7 - Large Intestines > Flashcards

7 - Large Intestines Flashcards

1
Q

What are 6 indications for surgery of the large intestines?

A
  1. Obstruction
  2. Perforation
  3. Torsion/entrapment
  4. Colonic inertia (megacolon)
  5. Chronic inflammation
  6. Rectal prolapse
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2
Q

What is NOT an indication for surgery of the large intestine?

A

routine biopsy

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3
Q

What is a colotomy?

A

Incision into the colonic lumen

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4
Q

What is a colectomy?

A

Partial or complete resection of the colon

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5
Q

What is a colopexy?

A

Surgical fixation of the colon

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6
Q

What is a colostomy?

A

Creation of an artificial opening into the colonic lumen

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7
Q

What is the most common reason for R&A of the colon?

A

tumor

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8
Q

What is megacolon?

A

Increased colon diameter and hypomitility associated with severe constipation

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9
Q

What species most commonly gets idiopathic megacolon?

A

cats

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10
Q

What are the 4 steps for medical treatment of megacolon?

A
  1. Evacuate colon
  2. Antibiotics
  3. Osmotic laxatives (lactulose)
  4. Prokinetic drugs (cisapride)
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11
Q

What is the approach to surgical treatment of megacolon?

A
  1. Removal of entire colon except a short segment needed to re-establish intestinal continuity
  2. Subtotal colectomy
  3. +/- address pelvic stenosis
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12
Q

What are 2 ways by which we can do a subtotal colectomy?

A

Ileocolic anastomosis or colocolic anastomosis

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13
Q

What is typhlectomy?

A

Removal of the cecum

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14
Q

What are 5 indications for a typhlectomy?

A
  1. Impaction
  2. Perforation
  3. Inversion
  4. Severe inflammation
  5. Neoplasia
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15
Q

What are 2 indications for a colopexy?

A
  1. Chronic rectal prolapse
  2. Recurrent perineal hernia
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16
Q

What side should a colopexy be done on?

A

left

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17
Q

Why is a colostomy rarely performed?

A

Animals don’t do well with it -

Fecal incontinence occurs and there are very high management requirements

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18
Q

What are the 2 main approaches to the rectum?

A
  1. Ventral midline celiotomy
  2. Caudal/transanal approach
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19
Q

What 2 procedures/techniques can be done at the rectum with a caudal/transanal approach?

A
  1. Mucosal eversion
  2. Rectal pull-through
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20
Q

What part of the GIT has the most bacteria?

A

GIT

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21
Q

T/F: Empty and cleanse after large intestine surgery is no longer recommended.

A

True

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22
Q

Why should perioperative antibiotics be given with large intestine surgery?

A

There is a high risk of infection with coliforms and anaerobes

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23
Q

What perioperative antibiotics should be given with large intestine surgery?

A

2nd or 3rd generation cephalosporins, cefazolin, metronidazole

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24
Q

Why does the large intestine take longer to heal?

A

Collagen lysis, poor collateral, # bacteria, pressure

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25
Q

What are medical treatments for rectal prolapse?

A
  1. Treat underlying disease
  2. Reduce (lavage and lube)
  3. Purse string around anus
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26
Q

What types of lesions would be considered for surgical treatment of a rectal prolapse?

A

Chronic, traumatized, non-reducible lesions

27
Q

What is used as a guide in surgical treatment of rectal prolapse?

A

rectal probe

28
Q

In surgical treatment of rectal prolapse, _____ should be placed cranial to the transection site.

A

stay sutures

29
Q

Rectal prolapses should be transected in _____.

A

stages

30
Q

What type of closure is used for a rectal prolapse transection and what are the margins?

A

Appositional closure, 2 mm from edge and 2 mm apart

31
Q

What should be done after closing the transection of a rectal prolapse?

A

Reduce anastomosis into pelvic/anal canal

32
Q

What muscles support the caudal rectum?

A
  1. Levator ani
  2. Coccygeus
  3. External anal sphincter m.
33
Q

What is the role of the internal and external sphincter mm?

A

Control continence

34
Q

What innervates the internal anus/perineum?

A
  1. Parasympathetic branch of pelvic n. (S1-3)
  2. Sympathetic motor from hypogastric n.
35
Q

What innervates the external anus/perineum?

A

Caudal rectal branch of pudendal n.

36
Q

The caudal rectal branch of the pudendal n. is _____ and responsible for _____.

A

voluntary, continence

37
Q

What is the main vascular supply to the anus/perineum?

A
  1. Internal pudendal a.
  2. Caudal rectal a.
  3. Caudal mesenteric a.
  4. Cranial rectal a.
38
Q

Where are the anal sacs located?

A

Between inner smooth and outer striated mm. (between internal and external sphincters)

39
Q

The anal glands line the _____ and open into the _____.

A

wall, sac (intermediate zone)

40
Q

What are the 2 most important diagnostic steps to make a working diagnosis regarding the anus/perineum?

A
  1. Visual inspection
  2. Palpation
41
Q

What are 2 reasons not to do a rectal exam?

A
  1. No finger
  2. No anus
42
Q

Fecal incontinence occurs if more than ___ cm or the final ___ cm of terminal rectum is resected.

A

4cm, 1.5cm

43
Q

Fecal incontinence occurs if _____ or _____ nerves are damaged.

A

perineal, caudal rectal

44
Q

Fecal incontinence occurs if more than half of the _____ is damaged.

A

external anal sphincter

45
Q

What are the 2 most common anal sac diseases?

A

Infection or impaction

46
Q

How should anal sacculitis be medically managed?

A

Expression, lavage, AB’s, dietary change, treat dermatoses

47
Q

What should not be used in medical management of anal sacculitis?

A

chemical cauterization

48
Q

When should anal sacculitis be surgically managed?

A

When there is an abscess or if it is chronic/recurrent

49
Q

What are DDx for a perianal fistula?

A
  1. SCC
  2. Perianal tumors
  3. Anal sac fistula
  4. Pythiosis
  5. Tail fold pyoderma fistula
50
Q

What is the more common treatment for a perianal fistula?

A

Medical - Clyclosporine

51
Q

Which type of anal sacculectomy has less risk of contamination? Which should you never do when there is suspected neoplasia?

A

Closed, Open

52
Q

What 5 diagnostics can help us determine if there is an anal neoplasia?

A
  1. Rectal palpation
  2. Imaging
  3. Cytology
  4. Labwork (look for hypercalcemia)
  5. Histopath
53
Q

80% of anal neoplasias are _____.

A

perianal adenomas

54
Q

What sex is more likely to develop a perianal adenoma?

A

intact male (12x)

55
Q

Perianal adenomas are hormone _____.

A

dependent

56
Q

What is treatment for perianal adenomas?

A

Castration +/- local excision

57
Q

What types of carcinomas can occur as an anal neoplasia?

A

Perianal or apocrine

58
Q

When are anal sac adenocarcinomas common? When are they rare?

A

Common in older dogs;

Rare in cats

59
Q

Anal sac adenocarcinomas have a _____% metastatic rate to local LNs at time of Dx.

A

50-80%

60
Q

What blood work level would be abnormal in an anal sac adenocarcinoma and what mediates this?

A

Hypercalcemia of malignancy;

Mediated by PTHrp

61
Q

What are the treatments for anal sac adenocarcinomas?

A
  1. Primary tumor excision
  2. LN removal if enlarged
  3. Chemo +/- RT
62
Q

What does atresia ani lead to?

A

Inability to defecate normally

63
Q

What does a rectovaginal or rectourethral fistula lead to?

A

Abnormal communication and passage of feces

64
Q

What is the medical treatment for fecal incontinence?

A

Treat causative disease, low residue diet, opioids, enemas, and rectal stimulation

Small Animal Surgery (17 decks)

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