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SAM > Colon > Flashcards

Colon Flashcards

1
Q

LARGE INTESTINE LAYERS

A

Mucosa NO VILLI

Simple columnar epithelium Mucous secreting cells Absorptive epithelial cells

Immune system
SUBMUCOSA
Blood vessels, lymph, nerves, connective tissue, white blood cells MUSCULARIS
• Muscles
•Nervous system
SEROSA
•Comprised of mesothelial cells in cecum and colon

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2
Q

MUCOSAL STRUCTURE

A

Colon lacks large villi

Invaginations of surface epithelium form intestinal crypts

‘Crypts of Lieberkuhn’
Tubular crypts which extend entire thickness of mucosa

Epithelial cells with high mitotic index – quickly move up crypt Absorb vitamins and minerals

Mucous producing cells = Goblet Cells – MANY MORE THAN SI Endocrine cells

Cell turnover slower than small intestine 4-7 days

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3
Q

Mucous producing cell

A

goblet cells- why large instesintal diarrhea has mucous

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4
Q

What kind of laxative is oral polethylene and when do you use it?

A

osmotic laxative; oral enema

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5
Q

What are the main antibiotics for large intestine?

A

Tylosin and Metro

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6
Q

HISTIOCYTIC ULCERATIVE COLITIS

A

BREEDS
 #1 Boxers
 French Bull Dogs, Mastiffs, Malamutes, English Bulldogs

Described in one cat

Usually young animals

CLINICAL SIGNS  Tenesmus
 Mucoid diarrhea
 Hematochezia

 Weight loss
 Decrease appetite

ULTRASOUND
 Diffusely or segmentally thickened colonic wall  Can be normal

HISTOPATHOLOGY

 Multiple inflammatory cells including macrophages = GRANULOMATOUS INFLAMMATION

_ * PAS positive macrophages *_
 PAS stains intracytoplasmic phagocytized bacteria

Biopsy AND culture
 FISH = Fluorescent in situ hybridization
 FISH is a technique used in molecular microbiology to identify bacteria within formalin fixed tissues

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7
Q

What do you treat Histocystic Ulcerative Colitis?

A

Baytril for at leat 8 weeks

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8
Q

What are causes of intususeption?

A

CAUSES
Parasitism, viral enteritis, FB, masses, idiopathic

Neoplasia cause in older animals Postparturient bitches

CLINICAL SIGNS AND PHYSICAL EXAM – as for small intestinal

** If protruding through rectum – must differentiate from a rectal prolapse:

An examining finger can be passed between the prolapse and the anus in patients with intussusception but not in patients with rectal prolapse.

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9
Q

Would you do a bx on a mega colon cat?

A

No- generally normal

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10
Q

When do you consider megacolon for surgery?

A

CAN CONSIDER MEGACOLON

SEVERE

DO NOT CONSIDER SURGERY until NON-RESPONSIVE TO DIET & MEDICAL THERAPY

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11
Q

LAXATIVES MOA

A

MOA: Stimulate fluid and electrolyte transport and can increase propulsive motility

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12
Q

EMOLLIENT LAXATIVES

A

 Increases lipid absorption and impairs water absorption

 Dicotyl sodium sulfosuccinate  Docusate 50 mg PO SID

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13
Q

BULK FORMING

A

BULK FORMING
 Psyllium, wheat bran, pumpkin

 Psyllium 1-4 tsp per meal
 Pumpkin 1-4 TBSP per meal

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14
Q

LUBRICANTS

A

LUBRICANTS
 Mineral oil or White Petroleum
 Prevent water reabsorption
 Useful in mild cases
 Not good for depressed cats d/t aspirate risk

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15
Q

HYPEROSMOTIC

A

HYPEROSMOTIC
 Poorly absorbed polysaccharides

 Lactulose  2-3 mls PO TID = 0.5 ml/kg PO TID
 Stimulates colonic secretion and propulsive motility  Magnesium Salts

 Polyethylene Glycol
 Miralaxx – 1⁄4 tsp BID mixed in food or water  Can titrate up

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16
Q

STIMULANT LAXATIVE

A

STIMULANT LAXATIVE

 Propulsive motility
 Bisacodyl 5 mg PO SID

17
Q

PROKINETIC

A

Cisapride
Stimulates colonic smooth muscle Compounded

Off market for people due to cardiac side effects DOSE

Initially: 2.5 mg per cat PO BID
Dosages may be titrated upwards to as high as 7.5 mg PO TID

18
Q

RECTAL MUCOSA

A

Columnar epithelium Lymphoid follicles

Many mucous secreting goblet cells

19
Q

AT RECTAL:ANAL JUNCTIONS

A

Stratified squamous epithelium

20
Q

Internal sphincter

A

Internal – smooth muscle – involuntary

21
Q

External sphincter

A

External – skeletal – voluntary

22
Q

pelvic nerve

A

Parasympathetic supply from S1-S3 pelvic nerve

 Stimulate rectal motility and relaxes internal sphincter
 i.e. allows defection when patient is relaxed

23
Q

Hypogastric nerve

A

Sympathetic supply Hypogastric nerve from lumbar spine  Inhibits rectal motility and causes contraction of internal sphincter
 i.e the patient doesn’t poop when they run

24
Q

pudendal nerve

A

Striated muscle and pelvic canals = skeletal musclepudendal nerve  Allows maximum distension of rectum for fecal storage and anal control

25
Q

PROCTITIS

A

Inflammation of rectal mucosa

Secondary to foreign bodies, prolapse, or extension of colitis

CLINCIAL SIGNS
 Tenesmus, dyschezia, hematochezia

Concurrent diarrhea  Colonic disease

Exclude FB, infection, neoplasia

If not other disease/as above and biopsy shows inflammatory infiltrates  Same treatments as describe for colonic inflammatory disease

26
Q

PERINEAL HERNIA

A

Protrusion of rectal wall and/or other pelvic and abdominal organs through weakened portion of pelvic diaphragm into ischiorectal fossa

 Bladder, prostate, omentum, SI, descending colon  Herniations of organs less common in cats

Unilateral or Bilateral disease

Failure of some part of the pelvic diaphragm  Levator ani muscle
 Coccygeal muscle
 Internal and external anal sphincter muscle

 Fascia

27
Q

Who are perianal hernias very common in?

A

Intact male dogs

28
Q

How can you tell a rectal prolapse from a intussupection?

A

Differentiate from intussusception by passing probe or lubed finger

 Cannot pass finger between rectal wall and prolapsed tissue due to the continuity with prolapse tissue and junction of anus

29
Q

Ribbon stools make you think of…

A

RECTAL STRICTURE

30
Q

ATRESIA ANI

A

Congenital defect in puppies and kittens
Notable within few weeks of birth or after weaning Males > females

BREEDS:
 Poodles and Boston Terriers overrepresented

31
Q

What are the 4 types of atresia ani?

A

4 types:

  1. Imperforate anus
     Rectum ends at anus but impeded by membrane  Constipation and tenesmus soon after weaning
  2. Rectum ends in blind sac around cranial aspect of pelvis & imperforate anus
  3. Rectal atresia
     Cranial rectum ends in cranial pelvic canal  Terminal rectum and anus are normal
  4. Rectovaginal and/or rectourethral fistula with patent anus
32
Q

Which type of atresia ani has the best prog?

A

Type 1

33
Q

Who are anal fistulas in?

A

ANAL FARUNCULOSIS

Chronic, progressive, inflammatory disease

Middle aged to older dogs German Shepherds
Irish Setter
Labrador

34
Q

What is the etiology of perianal fistulas?

A

Overriding immune dysfunction = main player as responds to immune modulation medication

35
Q

how do you treat perianal fistulas?

A

Medical Management >> Surgical

Topical
 Hair clipping
 Daily cleaning
 Topical hydrotherapy  Antimicrobial cleanser  Topical medications

Surgery may be indicated if also anal gland involvement

PAIN MANAGEMENT

DIET
 Hydrolyzed or novel antigen

Prednisone
Less expensive
Remission rates around 30% Improvement 30%

Cyclosporine 60-100 % remission

Oral drug of choice Azathioprine can also used

Topical Tacrolimus 2% Full healing in 50%

Improvement in 90% PROGNOSIS

Guarded for cure but can be managed longterm

Fecal incontinence, stricture, fistula, & recurrence associated with euthanasia decision

36
Q

ANAL SAC APOCRINE GLAND ADENOCARCINOMA

A

Hypercalcemia

37
Q

PERIANAL ADENOMAS

A

Arise from circumanal glands Breeds

Cocker Spaniel English Bulldog  Samoyeds,
 Beagles

Intact male dogs – 85%

CLINICAL SIGNS

None or associated with pain, obstruction, secondary infection, pruritis

TREATMENT

Surgical excision with castration to limit recurrence

PROGNOSIS

 GOOD

Other benign and malignant neoplasia possible so always BIOPSY

Usually solitary in perineal region but can be multiple

Can be in other anatomic locations like prepuce, thigh, inguinal, tail root

38
Q
A

SAM (13 decks)

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