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DDX Gastrointestinal system > Consitpation, Tenesmus, Dyschezia, and Fecal incontinence > Flashcards

Consitpation, Tenesmus, Dyschezia, and Fecal incontinence Flashcards

1
Q

Define constipation

A
  • Constipation = infrequent or difficult evacuation of dry, hard feces
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2
Q

Define Obstipation

A

= severe form of constipation where faeces is so hard and dry that the animal is no longer able to defecate. Requires medical intervention

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3
Q

Define Tenesmus

A

= ineffectual and painful straining at defecation or urinations. Results from disease of large intestine or lower urinary tract.

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4
Q

Define Dyschesia

A

difficult or painful evacuation of faeces. Result from disease of anal and perianal tissues

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5
Q

Define Fecal incontinence

A

= defecation without conscious control

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6
Q

What is the function of the LI?

A
  • Function: absorption of water and electrolytes (ascending and transverse colon) and storage of faeces (descending colon)
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7
Q

Describe Haustral contractions

A

= contractions of circular and longitudinal smooth muscle of colon results in accumulation of colonic contents in unstimulated segments.

Mixing increases exposure of contents to colonic mucosa for maximum water and electrolyte absorption while propelling ingesta down the length of the colon

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8
Q

Define Mass Movements

A
  • intense propulsive activity down entire length of colon to propel fecal matter toward anus for defecations.
  • Occur a few times daily most commonly following a meal and stimulated by autonomic nervous system.
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9
Q

Explain the anatomy and nervouse supply to the anal sphincter

A

Anal sphincter – internal sphincter composed of smooth muscle (direct extension of circular smooth muscle of rectum) and external anal sphincter composed of striated muscle

Internal sphincter remains contracted most of the time and is responsible for fecal continence.

Internal sphincter receives its parasympathetic nervous supply from sacral spinal cord segments via pelvic nerves

Sympathetic innervation is from lumbar spinal cord segments via hypogastric nerves.

Sympathetic stimulation = contraction of internal anal sphincter

Parasympathetic stimulation results = relaxation.

External anal sphincter is under conscious control and allows animal to resist and prevent defecation from occurring.

External sphincter is innervated by somatic efferent nerve fibers, originating in the cranial sacral spinal cord segments and coursing through the pudendal nerves.

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10
Q
A
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11
Q

What can be the potential signalment of tenesmus?

A

Signalment

Malformed sacral spinal cord:

  • Bulldogs
  • boston terrier
  • manx cats
  • GSD – perianal fistulas -> dyschezia and constipation
  • Megacolon occurs in middle-aged male cats

Male dogs - prostatomegaly

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12
Q

What are the inflammatory or infectious causes of tenesmus and dyschezia?

A

Inflammatory or infectious

  • IBD
    Dietary indiscretion
  • Intestinal parasitism
  • Idiopathic colitis
  • Pythiosis
  • Bacterial or fungal colitis
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13
Q

What are the obstructive causes of tenesmus?

A

Obstructions

Intraluminal:

  • Colonic neoplasia
  • Foreign body strictures

Extraluminal:

  • Pelvic fractures
  • Masses
  • Organomegaly
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14
Q

What are the causes of dyschezia?

A
  • Perianal fistulas
  • Perineal hernia
  • Anal/rectal neoplasia
  • pseudocoprostasis
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15
Q

What are the physical exam findings of a patient with tenesmus?

A
  • Underlying systemic disease:
  • Weakness
  • Anorexia
  • Increased water loss (polyuria)
  • Abdo palpation -> distended colon with hard faeces
  • Anus- fecal hair mats (pseudocoprostatitis), masses, and perianal fistulas.

Digital palpation of Rectum and distal colon:

  • hard, dry faeces,
  • colonic or rectal masses
  • foreign bodies
  • pelvic fracturs
  • enlarged sublumbar lymph nodes
  • prostatomegaly in male dog
  • perianal hernias
  • evidence of anal sac disease
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16
Q

What are the diagnostic tests used for patients with tenesmus?

A
  • CBC
  • Serum biochemistry
  • Urinalysis

Abdominal rads:

  • colonic distension
  • masses
  • foreign bodies
  • LN enlargement
  • Prostatomegaly
  • pelvic fractures

Abdo US:

  • intraluminal or extraluminal masses
  • prostatomegaly
  • enlarged lymph nodes

Colonoscopy:

  • may reveal colonic neoplasia
  • perineal hernias
  • diverticula
  • strictures.
17
Q

What can be common history findings of patients with tenesmus?

A
  • Duration of signs
  • Frequency of attempts
  • Diet – fibre content
  • Anorexia – decreased access to food or water
  • Hx of pelvic trauma or abdominal surgery
  • Dyspnea – reluctance to defecate
18
Q

What are some important questions to ask for patients with tenesmus?

A

Urinate -exclude LUT :

  • Normal stream?
  • Dripping?
  • Appearance:

Faeces:

  • Normal?
  • Thin, ribbonlike or small amounts? -> obstructions
  • Excessive groomins of regions?
  • History of trauma/fractures?

Cats with tenesmus or dyschezia:

  • Vocalise or defecate outside the litter box
  • Timing :
  • Prior to defecations = obstruction

After defecations = irritation/inflammation

19
Q

What are important physical exam features to differentiat tenesmus from lower urinary tract disease or lower GIT problem?

A
  • Palpate bladder to rule out obstruction
  • Inspect anus and perianal region to rulte out perianal fistulas, anal sac rupture, and faecal hair mats causing pseudocoprostasis

Digital rectal palpation:

  • uroliths in urethra
  • Prostatomegaly in male dogs
  • Rectal masses
  • Perineal hernia
  • Anal sacculitis
  • Sublumbar lymph node nelargement
  • Pelvic fractures

Faeces – absent, scant, bloody consistente with inflammatory disease

20
Q

What diagnostic tests can be performed for tenesmus and dyschezia?

A
  • CBC, biochemistry, urinalysis to exclude systemic disease
  • Fecal flotation – GI parasites
  • Radiographs and ultrasound: – rule out extraluminal compression of colon
  • foreign body
  • pelvic fracture
  • olonic masses

Colonoscopy and proctoscopy:

  • identify mases, foreign body strictures
  • Biopsys for inflammation, infection, or neoplasia
21
Q

What are the causes of fecal incontinence due to a damaged anal sphincter?

A

Damaged anal sphincter (non-neurogenic sphincter incompetence):

  • Cauda equina syndrome
  • Damage to pudendal nerve
  • Sacral spinal cord trauma
  • Neoplasia
  • Compressive lesions
  • Degenerative myelopathy
22
Q

What are the causes of fecal incontinence due to disrupted nervous supply to anal sphincter?

A

Disruption of nervous supply to anal sphincter (neurogenic incompetence):

  • Anal trauma or surgery
  • Anal neoplasia
  • Damage to levator ani
  • Coccygeus muscles
23
Q

Explaine reservoir incontinence

A

Reduced capacity or compliance of rectm (reservoir incontinence):

Pet aware of urge to defecate, but conscious control of defecation is overwhelmed by presence of colorectal disease causing irritation, decreased storage capacity of rectum, or overwhelming fecal volume.

24
Q

What are some common history findings and questions to determine in a patient with faecal incontinence?

A
  • Establish is animal is aware of defecation and assuming normal posture to defecate
  • Awareness, diarrhea, increased frequency, and mucus/blood in feaces suggests => colorectal disease and reservoir incontinences
  • Behavioural problems = still normal posturing, frequency, and consistency
  • Reservoir incontinences -> attempt to get outside to defecate but unable to retain faeces, and defecate close to the door outside
  • History of recent trauma/surgery -> anal sphincter damage
  • Neurogenic sphincter incompetence- loss of tail wagging, abnormal tail carriage, hind limb ataxia or weakness, decreased HL spinal reflexes, concurrent urinary incontinence
25
Q

What are important findings to lok for on physical examination in a patient with faecal incontinence?

A
  • Trauma or lesion to anal sphincter
  • Anal tone in response to finger, thermometer to hemostatic forceps
  • Rectal exam -> reveal masses
  • Pain palpating sacrum or lumbosacral space with lumbosacral stenosis
  • Abnormal fecal consistency with mucus or blood indicates colorectal disease and reservoir incontinence
  • Neurologic exam – associated with neurogenic sphincter mechanism incompetences due to spinal cord damage/disease:
    • decreased tail tone, HL ataxia, decreased hopping and wheelbarrowing, decreased HL spinal reflexes, decreased conscious proprioception, lumbosacral pain, loss of bladder tone
26
Q

What are some diagnostic tests that can be performed in a patient with faecal incontinence?

A

CBC, biochem, urinalysis, caudal abdominal rads

Diagnostic imaging: required to characterise nature of disease of spinal cord if neurogenic causes of sphincted incompetences suspected.

  • epidurogram
  • myelogram
  • CT scan
  • MRI
27
Q
A

DDX Gastrointestinal system (9 decks)

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