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Small Animal Final Year > Anal and Rectal Conditions > Flashcards

Anal and Rectal Conditions Flashcards

1
Q

Name some common diseases of the rectum and anus

A
  • Anal sac disease
  • Anal furnculosis
  • Anal adenomas
  • Other peri-anal neoplasia
  • Rectal prolapse
  • Rectal stricture
  • Rectal neoplasia
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2
Q

What is the normal perineum of a dog like?
Where do the anal sacs sit?

A

Perineum of dog:

  • Anal sacs sit at 4 and 8 o’clock to anal sphincter
  • Musculature that supports it all consists of 3 main muscle bundles below – these are important as when we are looking at defects of anatomy, we need to know which muscles we need to put back together again
  • Perineal girdle: supporting structure; muscles that suspends anus in the middle. Levator ani Sphincter (external and internal and anus in middle and anal sac sits between external and internal) Coccygeus Becomes relevant is when dogs develop perineal hernia these 3 muscle groups atrophy under testosterone and you have to be able to put structure back together
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3
Q

What are some general considerations to think of when operating on the rectal/anal area with regards to infection risk?

A
  • Infection risk
    • bacteria & faeces
    • large clip
    • evacuate rectum and place
      • Used to do an enema but this just makes the faecal matter wet and makes all things worse! So best to manually evacuate it!
    • purse string or pack with swabs
    • don’t use enemas
    • pre-op i.v. antibiotics; e.g., cephalexin/metronidazole
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4
Q

What are some pre-op antibiotics you could use when operating at the anal/rectal area?

A

Cephalexin/metronidazole

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5
Q

What are some general considerations to think of when operating on the rectal/anal area with regards to haemorrhage?

A
  • Haemorrhage is an issue
    • very vascular area! Lots of BV and lots of muscles
    • lots of perineal branches of major vessels
    • electrocautery/vessel sealing/harmonic scalpel useful if you have access to them. Just learning how to tie off is equally useful
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6
Q

What are some general considerations to think of when operating on the rectal/anal area with regards to faecal incontinence?

What causes it?

A
  • Faecal incontinence (risk) – always mention this to owners!
    • external anal sphincter is important in faecal continence
    • disruption by excision/damage to nerve supply
    • 50% of sphincter can be safely resected ??
    • If you damage some of the nerves that supply this area, they will be faecally incontinent – its not the cutting of the muscle, it’s the NERVE DAMAGE. If you preserve the nerves, the muscle will heal and should function okay afterwards
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7
Q

What are anal sacs and where are they located?

What is the point of anal sacs?

A
  • Anal sacs are scent glands
  • Located at 4 and 8 o’clock in between external and internal anal sphincters
  • Point of them is to discharge through ducts at defaecation – MARKING TERRITORY
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8
Q

What is anal sac disease and what can cause it?

A
  • Impaction or abscessation
  • Due to a change in consistency of secretion or interference with normal duct emptying; e.g., diarrhoea, diet, tapeworm, seborrhoea, oestrus, scar tissue
  • Remember neoplasia and bites in cats
    • Cats good at biting each other in this area!
  • Narrow duct where it exits into anus and rectum
  • Should express quite easily if you press them, but all sorts of material can be in there
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9
Q

What are some symptoms of anal sac disease?

A
  • Clinically, perineal irritation “scooting”
  • Chewing at tail head
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10
Q

How can you diagnose/treat anal sac disease?

A
  • Impaction/infection very readily diagnosed on palpation
  • Manual expression of the gland
  • Inspissated content may need irrigation
  • Blood tinged material/pus requires lavage and packing with local antibiotic – cow mastitis tubes/ear drops normally under GA
    • Flush and pack with antiobiotic suspension if infected
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11
Q

What are some indications for anal sacculectomy?

A
  • Indications
    • Recurrent impaction and tried other methods of trying to resolve, but still having problems. Esp if there is one abscess scenario after another – best just to remove the anal sacs in this case!
    • Neoplasia
    • On occasion, an additional component of the treatment for to perianal fistula (anal furunculosis)
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12
Q

What should you if you have a rupturd abscess of the anal sac but need to do surgery?

A

Delay surgery if recently ruptured abscess – wait until healed up

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13
Q

What are the 2 versions of an anal sacculectomy?

What is the difference between them?

A

open and closed

  • Closed – don’t want to cut wall of sac
  • Open – do cut wall of sac
  • Fill or pack with various different agents – resin put in that nicely highlights the anal sec.
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14
Q

What is the brief way you perform a CLOSED anal sacculectomy?

A
  • Fiddly surgery!
  • Once you have duct highlighted, then literally just make incision straight over, dissect through muscles, tie duct off and remove
  • Foley catheter – can inflate the gland, highlighting margins of anal sac
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15
Q

What is the brief way you perform an OPEN anal sacculectomy?

A
  • Open procedure – sac has been cut into,
  • More difficult surgery as once you cut into it, it tends to fall apart and then its more difficult to follow it around.
  • Also the added that the material inside it will come out and contaminate surgical site
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16
Q

Should you do one anal sac at a time during an anal sacculectomy or both?

A

Either

Bilateral surgery perfectly acceptable as one procedure – okay to remove both sides at the same side

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17
Q

What are some complications of an anal sacculectomy?

A

Complications

  • draining sinus (some gland left)
    • If you leave a bit behind, can lead persistent discharging fistula -
  • Infection
    • Dirty site!
    • Wound infections
  • dehiscence
  • tenesmus
  • faecal incontinence
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18
Q

What is anal furunculosis?

A
  • Suppurative, progressive, deep ulcerating tracts in the perianal tissues
  • Can be very difficult to manage
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19
Q

What breed is anal furunculosis common in?

Why does it happen?

A
  • GSD, but any breed inc. crossbreeds
  • Low tail carriage and often hairy around the back end
  • +++ density of apocrine glands in perineum – no one really knows proper reasons why these develop perianal fistulae at this site
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20
Q

What is the problem here?

Aetiology?

A

Anal furunculosis

  • Hard to see where anus is and where all these tracts start and finish
  • Will be sore and uncomfortable and reluctant to go to the toilet as will hurt
  • One theory it happens – immune mediated component, they attack their own tissues at this site
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21
Q

What is the treatment of anal furunculosis?

A
  • Cyclosporin (“Atopica”) for 12 weeks will resolve 60% but 70% of these will recur in 4 to 17 months
    • As there is a theory its an immune mediated condition
  • Very expensive, many £100’s
  • Can have multiple adverse effects; e.g., v+/d+, coat changes, nephrotoxicity or hepatotoxicity, gingivial hyperplasi
    • Some dogs just don’t tolerate it very well
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22
Q

If you decide to treat anal furuncolosis medically, what can you do?

A

If you do decide to treat this medically:

  • Hypoallergenic diet and immunosuppressive doses of prednisolone is worth a try
  • Only helped in 1/3 of very mild cases
  • Based on theory that there is an association between IBD and fistulae
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23
Q

If you have anal furunculosis, and it isn’t getting better. What can you do?

A
  • If a failure to respond to cyclosporin then check no anal sac involvement
  • If there is, then the dog will require an anal sacculectomy
  • Have to take the tracts out, can cortorise, she likes to just cut them out and leave them open to granulate – keep dog in with buster collar and pack with gel etc.
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24
Q

What is a perianal adenoma?

A

Perianal sebaceous gland adenoma

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25
Q

Which gender is perianal adeomas common in?

Why?

What must you differentiate it from?

A
  • Third most common tumour in male dog
  • Testosterone dependant benign masses
  • Hairless area of anal ring most common location, can see at tail base, prepuce and ventrum
  • Must differentiate from malignant adenocarcinomas
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26
Q

What kinda of perianal glands do cats have?

A

Cats have no perianal glands

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27
Q

What is wrong here?

A

Perianal adenoma

28
Q

What do perianal adeomas look like?

How fast do they grow and to what size?

A
  • Slow growing
  • Rare in castrated dogs and should resolve with castration
  • 0.5 to 3cm diameter – rarely get beyond this
  • Can ulcerate
  • Rarely adherent to surrounding structures
  • Small raised red areas that will go on to ulcerate
  • If you didn’t touch the lumps themselves, but just castrated the dog, these tumours would resolve
29
Q

How can you treat perianal adenomas?

A

If you didn’t touch the lumps themselves, but just castrated the dog, these tumours would resolve

30
Q

What is an anal adenocarcinoma?

A

Malignant lesion of perianal sebaceous glands

31
Q

What are some features of an anal adenocarcinoma?

A
  • Occur in same areas as adenomas
  • Can diffusely infiltrate anal areas
  • Often adherent to deeper tissues
  • Rapidly growing
32
Q

What are some clinical signs of anal adenocarcinoma?

Do they metastasise? If so, where to?

A
  • Clinical signs of dyschezia (constipation) and pain
  • 13% have signs of sublumbar ln enlargement on presentation
  • Rare to metastasize to other organs
33
Q

What is wrong here?

A

Anal adenocarcinoma

34
Q

Anal adenocarcinoma or perianal adenomas -

Which is malignant and which is benign?

A

Anal adenocarcinoma - malignant

Perianal adenomas - benign

35
Q

Anal adenocarcinoma or perianal adenomas -

Which responds to castration?

A

Perianal adenomas

36
Q

How do you treat anal adenocarcinomas?

A
  • Do not respond to castration
  • Aggressive surgical removal with adequate margins is indicated
  • Adjunctive radiotherapy but rarely curative
  • Regional lymph node excision
  • Poor prognosis due to local recurrence and metastasis
  • Distant metastasis can take many years to develop, repeat palliative local surgeries justified
  • Ensure sufficient margins to remove the mass
  • Often when they present surgery alone is rarely curative
37
Q

What is the prognosis of anal adenocarcinomas?

A

Poor prognosis due to local recurrence and metastasis

38
Q

Which age and gender of dogs do you commonly see anal sac adenocarcinoma in?

A

Generally older female dogs (over 10 yr)

39
Q

What is often the first clinical sign of an anal sac adenocarcinoma and why?

A
  • First present sign – PD! If blood profile showed up a high calcium, that should ring alarm bells for paraneoplastic syndrome.
  • Some hormones produce parathyroid like hormone, causes more calcium to be metabolised – makes them thirsty, causes depression and weight loss
  • This tumour is one of the list for causing hypercalcaemia
  • Should also look for lymphoma and mammary carcinoma
40
Q

What are some clinical signs of anal sac adenocarcinoma?

How aggressive are they?

A
  • Small discrete nodules in wall of either sac
  • Paraneoplastic syndrome often accompanies
  • Tumour secretes PTH-like substance
  • Hypercalcaemia causes PUPD, depression, weakness, weight loss
  • Aggressive masses, 50% metastasised at presentation
41
Q

How can you diagnose anal sac adenocarcinoma?

A

Diagnosis based

  • Palpation – first thing
  • biochemical findings
  • Abdominal/thoracic radiographs
  • abdominal/thoracic CT scans – helpful for checking LNs and lymphatic system in general
  • ultrasound of sublumbar lymph nodes
42
Q

Before surgery on a dog with anal sac adenocarcinoma, what should you do?

A

Paraneoplastic syndrome often accompanies this tumour - secretes PTH-like substance - so causes high calcium.

Treat hypercalaemia prior to surgery – don’t want to GA a patient with high calc

43
Q

What is the treatment for an anal sac adenocarcinoma?

A

Treatment

  • excision of primary mass
  • Metastectomy
  • adjunctive chemotherapy
44
Q

What is a rectal prolapse associated with in young animals and then older animals?

A

Associated with endoparasites/enteritis in young animals and tumours or perineal hernias in middle aged/older animals

45
Q

What is the difference between an incomplete prolapse and a complete prolapse?

A
  • Incomplete prolapse - mucosa only has come out
  • Complete prolapse - all layers of rectal wall in entire circumference
46
Q

What is wrong here?

A

Rectal prolapse

47
Q

What breed of cat more commonly gets rectal prolapse?

A

Manx cat

48
Q

What is usually in the history in an animal with a rectal prolapse?

How do you diagnose it?

A
  • Normally some history of recent straining; e.g., perineal surgery, constipation, urinary tract infection, dystocia, etc.
  • No specific lab tests or diagnostics needed other than for underlying condition
    • can see whats going on!
49
Q

What should you differentiate a rectal prolapse from?

How can you tell the difference?

A
  • Ensure not intussusception
    • If try rectal prolapse – can insert something into everted tissue and will concertina back into itself
    • If intussusception that has exteriorised – wont be able to do this! Will be no hole to put something into
50
Q

When you get an acute presentation of a rectal prolapse, how should you manage it?

A

Acute presentation

  • Lavage – first thing to do is to clean it before putting it back in! it is contaminated
  • Lubricate – swollen and difficult to get in
  • Its swollen and need to get it back in – cold saline, sugar are some good ways
  • reduce and place purse string suture once back in, can leave in place for 2-3 days
51
Q

What is a colopexy and what is it used for?

A

Holds colon against the body wall internally

Used if you get recurrent retal prolapse

52
Q

If you need to resect any part of a rectal prolapse, how should you do it?

What should you warn owners of?

A
  • If you have to resect any damaged part – use fulcrum inside, gives something to cut down onto as difficult to cut mobile tissue!
  • Do it in sections
  • Cut one piece and suture, then cut the next piece and suture
  • Hold everted prolapse with stay sutures
  • Nice blood supply, can heal quite quickly
  • Needs antibiotics
  • Warn O of stricture afterwards
53
Q

What is a rectal stricture usually secondary to?

What does it cause clinically?

A
  • Normally occur secondary to proctatitis chronic anal sacculitis, penetrating FB’s or as complication of anorectal sx
    • (Usually 2ry to ongoing problem)
  • Clinically cause dyschezia, constipation and tenesmus
54
Q

How is a rectal stricture diagnosed?

A
  • Diagnosed by digital rectal exam
  • Contrast radiography/colonoscopy are difficult as superficially located
  • Deep biopsy differentiates from neoplasia – bear in mind a stricture can be because of a tumour! Might be useful to get a section for biopsy
55
Q

What is the treatment for a rectal stricture?

A
  • Superficial strictures treated by bougienage (well lubricated finger/blunt instrument)
    • Just stretched! Stretches it open
  • This may need to be repeated at regular intervals for many days
  • Corticosteroids then for 2-3 weeks
  • But if Extensive strictures, may require resection by, for example, rectal pull-through
56
Q

What are rectal polyps?

What gender is mostly affected?

What is the cause?

A
  • Benign, adenomatous polyps
  • Male and female equally affected
  • Mean age 7 yr
  • Sessile, raised or pedunculated
  • Single or multiple
  • Cause unknown
57
Q

What are the clinical signs of rectal polyps?

A
  • blood/mucus in faeces
  • tenesmus can occur
  • polyp can occasionally prolapse from anus
  • secondary rectal prolapse can occur
58
Q

What is the treatment for a rectal polyp(s)?

A
  • small pedunculated masses can be removed from distal rectum with electrocautery, or excision and suture placement – quite easy but if larger:
  • larger polyps may need intestinal resection in order to remove it
59
Q

What is a rectal adenocarcinoma?

What are the clinical signs?

How do you diagnose?

A
  • Infiltrative, ulcerative or proliferative
  • Invades rectal wall causing fibrosis and stricture
  • Clinically cause tenesmus, dyschezia, weight loss and lethargy with advanced malignancy
  • Diagnose on palpation, radiography, ultrasound, endoscopy/proctoscopy, contrast radiography
  • Sick patients, losing weight, signs of malignancies
60
Q

Where do rectal adenocarcinomas generally occur?

A
  • Generally occur in three rectal sites
    • colorectal junction and cranial 1/3 rectum
    • middle 1/3 rectum
    • caudal 1/3 rectum and anal canal
61
Q

What is the surgery for rectal adenocarcinoma?

A

Surgery

  • colorectal resection and anastomosis +/- ischial pubic flap osteotomy
  • dorsal perineal approach
  • rectal pull-through
  • consider and discuss continence with owners!
62
Q

What are some preoperative considerations for rectal surgery?

A
  • Same as for anal surgery
  • Care with enemas – liquifies rectal contents!
  • Evacuate distal rectum
  • Large clip
  • Antibiotics effective against gram-ve aerobes and anaerobes
63
Q

What is atresia ani?

What clinical signs do you see?

A
  • Uncommon, can be associated with recto-vaginal or recto-urethral fistulae
  • Secondary megacolon
  • Neonate with absent anus
  • Tenesmus and bulging of perineum
64
Q

How do you diagnose atresia ani?

A

clinical signs

radiography

65
Q

What is the treatment for atresia ani?

A

Treatment involves creation of an anus by excision of skin and terminal rectal mucosa and careful suturing

Subtotal colectomy (?) – if been present for a while, colon may not be functioning well as a result of beign stretched for so long – may need to take colon out as well

66
Q

What is atresia ani usually associated with?

A

Usually associated with megacolon

Small Animal Final Year (317 decks)

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