Digestion & Metabolism 2: Large Intestinal Sx Flashcards
once the COLON is INSIDE THE PELVIC CANAL, it’s considered the…
RECTUM
clinical signs of COLORECTAL dz? (4)
- TENESMUS
- CONSTIPATION
- D+
- MELENA/FRANK BLOOD
diagnostic TECHNIQUES for LI DZ in SA? (5)
- abdominal PALPATION
- rectal examination
- RADS
- US
- PROCTOSCOPY/COLONOSCOPY
2 indications for COLONOSCOPY?
- animals with CHRONIC D+
- animals with RECTAL/COLONIC TUMORS to see extent of DZ
pre-op steps for COLONOSCOPY vs. COLONIC SX?
- night before COLONOSCOPY = LAXATIVES
- night before COLONIC SX = WANT FECES DRY/FORMED, otherwise cannot clamp colon well
cecal INTUSSUSCEPTION & IMPACTION IS ____
RARE
3 ways CECAL cancers can present?
- COMPLETELY INCIDENTAL FINDING when found on EXPLORE or US, usually asymptomatic
- has NONSPECIFIC GI SIGNS
- ACUTE ABDOMINAL CRISIS/PAIN
usually by the time we find CECAL MASSES, they’re ___ and we’ll need to…
what specific procedure do we need to do to ensure proper anastomosis?
LARGE, we’ll need to RESECT THE WHOLE CECUM & PART OF THE ILEUM
THE BOWEL LUMENS WILL NOT BE THE SAME SIZE BETWEEN ILEUM & COLON, so must OVER-SEW COLON/LARGER PORTION
CECAL NEOPLASIAS are usually these specific types of neoplasms… (2)
- LEIOMYOSARCOMAS/LEIOMYOMAS
- GI STROMAL CELL TUMORS
GI STROMAL CELL TUMORS tend to be responsive to WHAT medication? this includes even if the neoplasm is WHAT?
responsive to TYROSINE KINASE INHIBITORS, even if the cancer is METASTATIC
FELINE MEGACOLON…
cats usually come in with WHAT clinical sign?
if SEVERE, tx….
5 clinical signs? what 2 are almost ALWAYS present?
cats usually come in SEVERELY CONSTIPATED
if SEVERE, then MEDICAL TREATMENT USUALLY DOESN’T WORK
5 clinical signs? what 2 are almost ALWAYS present?
1. CONSTIPATION –> ALMOST ALWAYS PRESENT
2. TENESMUS –> ALMOST ALWAYS PRESENT
3. +/- ANOREXIA
4. +/- VOMITING
5. +/- WEIGHT LOSS
Dx lesion
FELINE MEGACOLON
diagnostic workup for FELINE MEGACOLON? (3)
- PHYSICAL EXAM = THOROUGH bc many cats with this are OLDER & have CONCURRENT DZ
- RECTAL EXAM = usually need SEDATION
- NEUROLOGIC EXAM
if we think a cat has FELINE MEGACOLON & is SEVERELY CONSTIPATED, what other condition should we search for?
PERINEAL HERNIA
4 possible causes of FELINE MEGACOLON?
describe one of the more common ones?
4 causes?
1. IDIOPATHIC (most of the time)
2. PELVIC STENOSIS (also somewhat likely)
3. NERVE INJURY
4. CONGENITAL DEFORMITY in MANX cats
for PELVIC STENOSIS, can occur if FRACTURE IN PELVIS and CAT STARTS TO WEIGHT-BEAR BEFORE FULLY HEALED
what is fractured here? what DISEASE can this secondarily cause in CATS?
PELVIC FRACTURE –> PELVIC STENOSIS
FELINE MEGACOLON/CONSTIPATION
MOST of the time, CHRONIC CONSTIPATION has what kind of cause?
what are the other 2 possibilities?
MOSTLY IDIOPATHIC
2 others?
1. NEUROMUSCULAR DZ
2. MECHANICAL OBSTRUCTION
3 principles of MEDICAL THERAPY for CHRONIC CONSTIPATION?
- removal of IMPACTED FECES
- LAXATIVE therapy
- COLONIC PROKINETIC AGENTS
how can BULK LAXATIVES help with CONSTIPATION? (2)
what are 3 examples of bulk laxatives?
- bulk laxatives BULK UP STOOL/make it SOFTER
- FIBROUS MATERIAL METABOLIZED BY BACTERIA will STIMULATE SMOOTH MSUCLE CONTRACTION
3 examples?
1. PSYLLIUM
2. WHEAT BRAN
3. CANNED PUMPKIN
4 examples of HYPEROSMOTIC LAXATIVES…
which one is safe for cats?
4 examples?
1. LACTULOSE
2. MAGNESIUM SALTS
3. POLYETHYLENE GLYCOLS
4. SODIUM PHOSPHATE
LACTULOSE is safe for CAT USE!
CISAPRIDE…
= what is it?
what does it DO?
when does it NOT WORK?
= COLONIC PROKINETIC AGENT
acts DIRECTLY ON COLONIC SMOOTH MUSCLE & COLONIC INNERVATION, causing SMOOTH MUSCLE CONTRACTION
it WON’T WORK if SMOOTH MUSCLE IS INCAPABLE OF CONTRACTING AT ALL
3 indications for SURGERY secondary to CONSTIPATION?
- CHRONIC CONSTIPATION is NOT RESPONSIVE TO MEDICAL THERAPY
- CONSTIPATION secondary to HEALED PELVIC FRACTURES
- CONSTIPATION associated with PERINEAL HERNIATION
PRE-OP evaluation prior to COLONIC sx? (4)
- do THOROUGH PRE-OP EVALUATION
- NO ENEMA, LEAVE HARD FECES IN COLON
- THOROUGH digital rectal exam UNDER GA
- give PREOP ANTIBIOTICS bc likely to have CONTAMINATION
leaving material in the ____ colon can help you avoid ____ in ANASTOMOSIS, but if there IS ____ (same word as before), then you can see… (3)
ASCENDING, TENSION, TENSION
- STRICTURE
- LEAKAGE
- BOTH
what is the MOST IMPORTANT FACTOR IN A HEALING BOWEL?
what SUTURE PATTERN should be used on bowel surgeries?
A GOOD BLOOD SUPPLY
SINGLE INTERRUPTED APPOSITIONAL SUTURES
PERINEAL HERNIA…
can cause WHAT common clinical sign?
caused by WEAKNESS in WHAT MUSCLES? what 2 specifically?
2 other clinical signs seen?
how can the BLADDER be involved in this?
can cause CONSTIPATION
caused by WEAKNESS IN SUPPORTING MUSCLES OF THE PELVIC DIAPHRAGM that are LATERAL TO THE RECTUM, specifically..
1. COCCIGEUS
2. LEVATOR ANI MUSCLES
2 other clinical signs?
1. TENESMUS
2. URINARY OBSTRUCTION
if animals STRAIN HARD ENOUGH, can GET BLADDER INTO HERNIA
PERINEAL HERNIA…
most common in WHAT animal/age?
often presents as…
RARE in what species?
most common in INTACT MALE DOGS OVER 5 YEARS
often presents as RECTUM BULGING OUT due to SUPPORT OF MUSCLES LOST
RARE IN CATS
Dx lesion
PERINEAL HERNIA
Dx lesion
PERINEAL HERNIA
what LESION is this? what DZ can it occur in?
BLADDER RETROFLEXION
can occur in PERINEAL HERNIA
if we try to do a CYSTOCENTESIS on a dog with a PERINEAL HERNIA but NOT MUCH URINE COMES OUT, what does this mean?
suspect that the BLADDER HAS ALREADY RUPTURED & UROABDOMEN
the ___ ____ muscle sits on the ____ (pelvic bone name)
INTERNAL OBTURATOR, ISCHIUM
PERINEAL HERNIAS in CATS are…
somewhat common
ID Dz
PERINEAL HERNIA causing AIR TO ENTER ABDOMEN
what are 2 COMMON causes of the colon to become DISPLACED?
what ELSE can we see GROSSLY?
- PARASITES
- PROTOZOA
GROSSLY, can see PROLAPSED RECTUM
what SUTURE PATTERN should we use for a COLOPEXY? why?
PURSE-STRING because it’ll PREVENT RECTAL PROLAPSE in the future
RECTAL POLYP definition
= BENIGN RECTAL TUMOR OR ADENOMA
CARCINOMA IN SITU definition
= ATYPICAL cells present but DO NOT EXTEND BEYOND MUSCULARIS MUCOSAE
SOME rectal polyps can undergo ____ ____
usually present with what 2 clinical signs?
MALIGNANT TRANSFORMATION to cancer
2 clinical signs?
1. TENESMUS
2. BLOOD IN FECES
what DIAGNOSTIC gives you the MOST information regarding COLONIC/RECTAL neoplasia?
what OTHER 2 things should you assess?
DIGITAL RECTAL EXAMINATION tells you HOW FAR IT’S EXTENDING
other 2 things?
1. ASSESS LOCAL LNs
2. LOOK FOR DISTANT METASTASIS
