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Small Animal Medicine II > Constipation, Tenesmus, & Painful Defecation > Flashcards

Constipation, Tenesmus, & Painful Defecation Flashcards

1
Q

What is the difference between tenesmus and dyschezia?

A

TENESMUS = ineffectual and painful defecation or urination, typically associated with colonic and urogenital disease

DYSCHEZIA = difficult or painful defecation, usually a result of anal and perianal disease

(typically used interchangeably)

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2
Q

What are the 7 major causes of constipation?

A
  1. neuromuscular dysfunction
  2. idiopathic megacolon - cats!
  3. mechanical - colonic or rectal obstruction
  4. inflammation
  5. metabolic or endocrine
  6. drugs - opioids decrease motility
  7. low fiber diet
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3
Q

What are the 2 major categories of colonic/rectal obstructions that can lead to constipation?

A

INTRALUMINAL - FB, masses (colorectal adenocarcinoma), strictures (atresia ani)

EXTRALUMINAL - external mass compressing colon (LN), pelvic fractures, pseudocorpostasis (feces cakes anal opening)

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4
Q

What 4 metabolic/endocrine diseases can cause constipation?

A
  1. hypokalemia, hypercalcemia
  2. obesity
  3. dehydration - CKD
  4. congenital hypothyroidism - dull, depressed, small
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5
Q

What 2 aspects of diet can cause constipation?

A
  1. low in fiber
  2. high in indigestible material - hair (long-haired animals), bones, mulch (dietary indiscretion - dogs)
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6
Q

What is the most common cause of constipation in cats? What are the most common clinical signs?

A

idiopathic megacolon common in middle-aged males - dysfunction of colonic smooth muscle

  • reduced to absent bowel movements
  • weight loss
  • PE - colonic impaction, dehydration, abdominal pain
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7
Q

What are some possible physical exam findings in patients with constipation?

A
  • impacted feces in colon
  • dehydration
  • abdominal pain
  • intraabdominal masses or lymphadenopathy
  • rectal mass, FB, or stricture
  • perineal hernia
  • abnormal pelvic canal
  • neurologic disease
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8
Q

What 2 diagnostics are recommended for cases of constipation?

A
  1. CBC/chem/UA +/- T4 - r/o metabolic/endocrine disease
  2. abdominal radiographs - assess severity and extend of colonic impaction, assses for cause (FB, mass, pelvic fx)
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9
Q

How are radiographs used for assessing megacolon?

A

ratio of maximal diameter of the colon to L5 length

  • <1.28 = normal
  • > 1.48 = megacolon
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10
Q

How are AUS and colonoscopy used for assessing constipation?

A

AUS - intra/extraluminal masses, prostatomegaly

COLONOSCOPY - inflammatory lesions, masses, strictures, diverticula

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11
Q

What 5 treatments are recommended for constipation?

A
  1. rehydration
  2. removal of impacted feces - enema, manual, laxatives
  3. dietary change - fiber!
  4. laxatives + prokinetics - self-evacuation
  5. address underlying cause
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12
Q

What 4 substances can be used in enemas? What is typically avoided?

A
  1. warm water
  2. KY jelly
  3. lactulose
  4. dioctyl sodium sulfosuccinate (DSS) - stimulates movement

sodium phosphate (OTC human-grade) - can result in severe hyperphosphatemia, hypocalcemia, and hypernatremia

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13
Q

What are the 4 common types of laxatives?

A
  1. bulk forming
  2. emollient
  3. lubricant
  4. hyperosmotic
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14
Q

What bulk forming laxatives are recommended? How does it work?

A

FIBER (pumpkin, psyllium) - increases fecal water content and improves colonic motility

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15
Q

What are 3 types of hyperosmotic laxatives?

A
  1. poorly absorbed polysaccharides
  2. lactulose - stimulates colonic secretions and propulsive motility
  3. polyethylene glycols (PEG) - at home, chronic therapy = Miralax powder in food; in-hospital nasogastric tube CRI PEG3350 slow drip for defecation within 8 hours
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16
Q

What 2 diets are recommended in constipated patients?

A
  1. high fiber - bulk forming
  2. low residue - reduces fecal material, recommended for cats with no musculature to their colon where increased mass of feces is not helpful
17
Q

What prokinetic is recommended for cases of constipation? When are they used? What is not used?

A

Cisapride (5HT4 agonist) - works lower in the GIT, enhances colonic motility

megacolon or refractory constipation/obstipation

Metoclopramide

18
Q

What surgical procedure can be performed for refractory cases of constipation?

A

subtotal colectomy

19
Q

What are the main 3 groups of differentials for tenesmus/dyschezia?

A
  1. colorectal disease - neoplasia, inflammation, infections (Histoplasma), obstruction (stricture, FB), rectal prolapse
  2. perianal disease - anal sacculitis, perianal fistula, neoplasia, hernia, atresia ani
  3. urogenital disease - prostatomegaly
20
Q

What history is important to gather in cases of tenesmus/dyschezia?

A
  • presence of GI or urogenital signs - duration and frequency
  • timing - prior to defecation (obstruction), persistence after defecation (inflammation)
  • diet - changes, indiscretion
  • medications - opioids affect motility
  • signalment - GSD and perianal fistulas, intact males and prostatomegaly
21
Q

What is the most important part of the physical exam in cases of tenesmus/dyschezia?

A

careful abdominal, rectal, and perianal evaluation

  • masses
  • inflammation
  • hernia
  • fistulas
  • stricture
  • enlarged/firm bladder or prostate
22
Q

What 4 diagnostics are commonly used for tenesmus/dyschezia?

A
  1. abdominal rads - fecal impation, extraluminal compression from masses, prostate, LNs, or pelvic abnormalities
  2. AUS - LNs, structural prostatic or urethral disease, thickening, mass
  3. FNA/biopsy of masses
  4. colonoscopy - masses, stricture, biopsies at areas of inflammation, neoplasia, or infection
23
Q

What are the 2 most common colorectal neoplasias? How are they diagnosed?

A
  1. adenocarcinoma - dog
  2. lymphoma - cat

palpate rectal mass, thickening, or napkin ring narrowing

24
Q

What benign growth is commonly found in the colorectal region?

A

benign adenomatous polyps - predunculated, focal, sessile tumors

25
Q

How are colorectal neoplasia and polyps treated?

A

surgical removal

26
Q

What is a rectal stricture? What are 3 possible causes of their formation?

A

narrowing of the rectal lumen by fibrous or proliferative tissue

  1. trauma
  2. inflammation
  3. tumors
27
Q

How is rectal stricture diagnosed? Treated?

A

rectal exam or colonoscopy/proctoscopy

balloon dilation or surgery

28
Q

What are perianal fistulas? What breed is most commonly affected?

A

chronic, progressive development of ulcerated draining tract in the perianal skin and associated structures around the anus

GSD –> most likely immune-mediated –> recommend immunotherapy

29
Q

What are 4 parts to medical treatment of perianal fistulas? When is surgical treatment recommended?

A
  1. immunosuppression - Prednisone +/- Azathioprine, Cyclosporine, topical Tacrolimus
  2. antibiotics
  3. dietary change - hypoallergenic
  4. stool softeners - Miralax, lactulose

when medical management fails OR in addition to medical therapy

30
Q

What are the 2 most common perianal tumors? What treatment is recommended for each?

A
  1. anal sac adenocarcinoma - hard, firm mass on anal sac diagnosed with FNA or biopsy, patient commonly presents with hypercalcemia of malignancy or metastasis –> surgical excision, radiation, chemotherapy
  2. perianal adenoma - more common in intact dogs –> surgical removal, castration
31
Q

What are 3 possible infectious causes of colitis and proctitis?

A
  1. Histoplasmosis
  2. Prototheca
  3. bacterial

Small Animal Medicine II (57 decks)

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