Digestion & Metabolism 2: Large Intestinal Sx

Question 1

once the COLON is INSIDE THE PELVIC CANAL, it’s considered the…

Answer 1

RECTUM

Question 2

clinical signs of COLORECTAL dz? (4)

Answer 2

1. TENESMUS
2. CONSTIPATION
3. D+
4. MELENA/FRANK BLOOD

Question 3

diagnostic TECHNIQUES for LI DZ in SA? (5)

Answer 3

1. abdominal PALPATION
2. rectal examination
3. RADS
4. US
5. PROCTOSCOPY/COLONOSCOPY

Question 4

2 indications for COLONOSCOPY?

Answer 4

1. animals with CHRONIC D+
2. animals with RECTAL/COLONIC TUMORS to see extent of DZ

Question 5

pre-op steps for COLONOSCOPY vs. COLONIC SX?

Answer 5

1. night before COLONOSCOPY = LAXATIVES
2. night before COLONIC SX = WANT FECES DRY/FORMED, otherwise cannot clamp colon well

Question 6

cecal INTUSSUSCEPTION & IMPACTION IS ____

Answer 6

RARE

Question 7

3 ways CECAL cancers can present?

Answer 7

1. COMPLETELY INCIDENTAL FINDING when found on EXPLORE or US, usually asymptomatic
2. has NONSPECIFIC GI SIGNS
3. ACUTE ABDOMINAL CRISIS/PAIN

Question 8

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?

Answer 8

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

Question 9

CECAL NEOPLASIAS are usually these specific types of neoplasms… (2)

Answer 9

1. LEIOMYOSARCOMAS/LEIOMYOMAS
2. GI STROMAL CELL TUMORS

Question 10

GI STROMAL CELL TUMORS tend to be responsive to WHAT medication? this includes even if the neoplasm is WHAT?

Answer 10

responsive to TYROSINE KINASE INHIBITORS, even if the cancer is METASTATIC

Question 11

FELINE MEGACOLON…

cats usually come in with WHAT clinical sign?

if SEVERE, tx….

5 clinical signs? what 2 are almost ALWAYS present?

Answer 11

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

Question 12

Dx lesion

Answer 12

FELINE MEGACOLON

Question 13

diagnostic workup for FELINE MEGACOLON? (3)

Answer 13

1. PHYSICAL EXAM = THOROUGH bc many cats with this are OLDER & have CONCURRENT DZ
2. RECTAL EXAM = usually need SEDATION
3. NEUROLOGIC EXAM

Question 14

if we think a cat has FELINE MEGACOLON & is SEVERELY CONSTIPATED, what other condition should we search for?

Answer 14

PERINEAL HERNIA

Question 15

4 possible causes of FELINE MEGACOLON?

describe one of the more common ones?

Answer 15

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

Question 16

what is fractured here? what DISEASE can this secondarily cause in CATS?

Answer 16

PELVIC FRACTURE –> PELVIC STENOSIS

FELINE MEGACOLON/CONSTIPATION

Question 17

MOST of the time, CHRONIC CONSTIPATION has what kind of cause?

what are the other 2 possibilities?

Answer 17

MOSTLY IDIOPATHIC

2 others?
1. NEUROMUSCULAR DZ
2. MECHANICAL OBSTRUCTION

Question 18

3 principles of MEDICAL THERAPY for CHRONIC CONSTIPATION?

Answer 18

1. removal of IMPACTED FECES
2. LAXATIVE therapy
3. COLONIC PROKINETIC AGENTS

Question 19

how can BULK LAXATIVES help with CONSTIPATION? (2)

what are 3 examples of bulk laxatives?

Answer 19

1. bulk laxatives BULK UP STOOL/make it SOFTER
2. FIBROUS MATERIAL METABOLIZED BY BACTERIA will STIMULATE SMOOTH MSUCLE CONTRACTION

3 examples?
1. PSYLLIUM
2. WHEAT BRAN
3. CANNED PUMPKIN

Question 20

4 examples of HYPEROSMOTIC LAXATIVES…

which one is safe for cats?

Answer 20

4 examples?
1. LACTULOSE
2. MAGNESIUM SALTS
3. POLYETHYLENE GLYCOLS
4. SODIUM PHOSPHATE

LACTULOSE is safe for CAT USE!

Question 21

CISAPRIDE…
= what is it?
what does it DO?
when does it NOT WORK?

Answer 21

= 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

Question 22

3 indications for SURGERY secondary to CONSTIPATION?

Answer 22

1. CHRONIC CONSTIPATION is NOT RESPONSIVE TO MEDICAL THERAPY
2. CONSTIPATION secondary to HEALED PELVIC FRACTURES
3. CONSTIPATION associated with PERINEAL HERNIATION

Question 23

PRE-OP evaluation prior to COLONIC sx? (4)

Answer 23

1. do THOROUGH PRE-OP EVALUATION
2. NO ENEMA, LEAVE HARD FECES IN COLON
3. THOROUGH digital rectal exam UNDER GA
4. give PREOP ANTIBIOTICS bc likely to have CONTAMINATION

Question 24

leaving material in the ____ colon can help you avoid ____ in ANASTOMOSIS, but if there IS ____ (same word as before), then you can see… (3)

Answer 24

ASCENDING, TENSION, TENSION

1. STRICTURE
2. LEAKAGE
3. BOTH

Question 25

what is the MOST IMPORTANT FACTOR IN A HEALING BOWEL? what SUTURE PATTERN should be used on bowel surgeries?

Answer 25

A GOOD BLOOD SUPPLY SINGLE INTERRUPTED APPOSITIONAL SUTURES

Question 26

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?

Answer 26

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

Question 27

PERINEAL HERNIA... most common in WHAT animal/age? often presents as... RARE in what species?

Answer 27

most common in INTACT MALE DOGS OVER 5 YEARS often presents as RECTUM BULGING OUT due to SUPPORT OF MUSCLES LOST RARE IN CATS

Question 28

Dx lesion

Answer 28

PERINEAL HERNIA

Question 29

Dx lesion

Answer 29

PERINEAL HERNIA

Question 30

what LESION is this? what DZ can it occur in?

Answer 30

BLADDER RETROFLEXION can occur in PERINEAL HERNIA

Question 31

if we try to do a CYSTOCENTESIS on a dog with a PERINEAL HERNIA but NOT MUCH URINE COMES OUT, what does this mean?

Answer 31

suspect that the BLADDER HAS ALREADY RUPTURED & UROABDOMEN

Question 32

the ___ ____ muscle sits on the ____ (pelvic bone name)

Answer 32

INTERNAL OBTURATOR, ISCHIUM

Question 33

PERINEAL HERNIAS in CATS are...

Answer 33

somewhat common

Question 34

ID Dz

Answer 34

PERINEAL HERNIA causing AIR TO ENTER ABDOMEN

Question 35

what are 2 COMMON causes of the colon to become DISPLACED? what ELSE can we see GROSSLY?

Answer 35

1. PARASITES 2. PROTOZOA GROSSLY, can see PROLAPSED RECTUM

Question 36

what SUTURE PATTERN should we use for a COLOPEXY? why?

Answer 36

PURSE-STRING because it'll PREVENT RECTAL PROLAPSE in the future

Question 37

RECTAL POLYP definition

Answer 37

= BENIGN RECTAL TUMOR OR ADENOMA

Question 38

CARCINOMA IN SITU definition

Answer 38

= ATYPICAL cells present but DO NOT EXTEND BEYOND MUSCULARIS MUCOSAE

Question 39

SOME rectal polyps can undergo ____ ____ usually present with what 2 clinical signs?

Answer 39

MALIGNANT TRANSFORMATION to cancer 2 clinical signs? 1. TENESMUS 2. BLOOD IN FECES

Question 40

what DIAGNOSTIC gives you the MOST information regarding COLONIC/RECTAL neoplasia? what OTHER 2 things should you assess?

Answer 40

DIGITAL RECTAL EXAMINATION tells you HOW FAR IT'S EXTENDING other 2 things? 1. ASSESS LOCAL LNs 2. LOOK FOR DISTANT METASTASIS