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SAM II > Dz's of the Donk: Rectum & Anus > Flashcards

Dz's of the Donk: Rectum & Anus Flashcards

1
Q

Blue box: The following describes what

Columnar epithelium
Lymphoid follicles
Many mucous secreting goblet cells

A

Rectal mucosa

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2
Q

Blue box: Stratified squamous epithelium can be found where?

A

At rectal: anal jxns

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3
Q

There are 3 glands within the anal canal. What are they and do they do?

A
  1. Anal glands: sweat glands; secrete lipids into canl
  2. Circumanal glands (hepatoid): non secretory
  3. Glands of the anal sac: contain protein, bacteria, sebaceous fluid, desquamated cells; scent gland; anal sac sits btwn inner and external m layers around 3 and 9:00 just inside anal sphincter
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4
Q

The PNS supply comes from S1 - S3 –> pelvic nerve. What is its job?

A

Relaxes internal sphincter

Allows defection when patient is relaxed

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5
Q

The SNS supply –> hypogastric n from lunar spine. What’s its job?

A

Contraction of internal sphincter

Patient doesn’t poop when they run

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6
Q

Striated m and pelvic canals = skeletal m –> pudendal n. What is their job?

A

Allows maximum distension of rectum for fecal storage and anal control

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7
Q

In diseases affecting hypogastric and pudendal n, what else can be seen?

A

Dysuria bc these nn also innervate the bladder

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8
Q

What are some clinical signs of disease?

A

Licking at hind end, fecal incontinence, discharge or smell from anal region, some overlap w colonic dz (tenesmus, dyschezia, hematochezia, constipation); NOT involved in assimilation of nutrients or water so clinical signs like wt loss, anorexia, V & D are uncommon

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9
Q

Blue box: What diagnostic method should we not forget with anal diseases if there is concern for ongoing or severe bleeding?

A

Don’t forget coagulation testing!

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10
Q

T/F Rads and US might be limited in dx of rectal dz.

A

True; limited d/t location

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11
Q

What is the empiric tx for acute disease?

A

Deworming
Change in dietary fiber–> addition of fiber such as psyllium
Diet change –> low residue or high fiber

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12
Q

Inflammation of rectal mucosa is called _____.

A

Proctitis

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13
Q

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

A

Perineal hernia

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14
Q

What is the common signalment for perineal hernias?

A

Middle aged, INTACT male dogs –> likely hormone induced

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15
Q

A “small, red rosette” is often the way what is described?

A

Rectal prolapse

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16
Q

How do we diagnose rectal prolapses?

A

Differentiate from intussusception!! By passing probe or lubed finger. Cannot pass finger btwn rectal wall and prolapsed tissue = rectal prolapse

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17
Q

How do we tx rectal prolapses?

A

Small = gentle manual replacement w lube, deworm, low residue diet, stool softeners, treat underlying disease

Large= gentle manual replacement, purse string suture to tighten anal sphincter; if prolapses again then colopexy

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18
Q

Rectal stricture is a narrowing of rectal or anal lumen. The signalment is in older animals as a consequence of neoplasia, severe inflammation (fistulas) etc What is the major, noticeably clinical sign we see?

A

RIBBON STOOLS!!!! Comes out in ribbons bc of narrow diameter !

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19
Q

What can we expect to see on PE of rectal stricture ?

A

Palpate –> narrow, firm lumen
May be painful
May feel impacted stool proximally

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20
Q

How do we dx rectal strictures?

A

“oscopy”- rigid protoscopy OR flexible endoscopy to directly visualize and biopsy abnormal tissue

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21
Q

How do we tx rectal stricture?

A

Balloon dilation of stricture- like w esophageal stricture

Medical: diet, fiber, stool softeners, laxatives, Abs

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22
Q

Rectal neoplasia has similar differentials to colon neoplasia. Having said that, which 2 neoplasias are overrepresented in cats and dogs?

A

Adenocarcinoma and lymphosarcoma

23
Q

Atresia ani is a congenital defect in puppies and kittens. It’s notable within a few weeks of birth or after weaning.

What breed and sex is this condition common in?

A

Males > females

Poodles and Boston Terriers over represented

24
Q

What clinical signs do we see in Types 1, 2 and 3 of atresia ani vs type 4?

A

Types 1, 2 and 3: tenesmus, absence of feces, no visible anal opening, perineal swelling or anal membrane protrusion d/t accumulated feces

Type 4: watery, small amounts of stool, perivalvular erythema; bacterial cystitis and vaginitis

25
Q

What type of atresia ahi has the best prognosis?

A

Type 1

26
Q

Perianal fistulas are chronic, progressive, inflammatory disease. What is the common signalment?

A

Middle aged to older dogs

German shepherds, Irish setter, Labs

27
Q

What clinical signs do we see with perianal fistulas?

A

PAINFUL!, dyschezia, fetal incontinence, over grooming, self mutilation

28
Q

The following PE is seen on what condition?

Perianal ulceration: single or multiple ulcerated sinuses, foul smelling discharge, painful, may need sedation or anesthesia to evaluate, rectal exam may show stricture

A

Perianal fistulas

29
Q

Perianal fistulas has a complex disease etiology. What does dat mean?

A

Overriding immune dysfunction = main player as responds to immune modulation medication so we tx w an immune suppressor

30
Q

T/F The treatment of choice for perianal fistulas is surgery.

A

Nahhhh.

medical mgmt&raquo_space;»» sx

Sx may be indicated if anal gland involvement is also present

31
Q

***What drug does HP lady loooove for perianal fistulas?

A

Cyclosporine! 60-100% remission. Oral DOC!!!

32
Q

What is the prognosis for perianal fistulas?

A

Guarded for cure but can be managed longterm

Fecal incontinence, stricture, fistula, and recurrence associated with euthanasia decision

33
Q

What clinical signs do we see with anal sac impaction?

A

Excessive grooming, malodor, **scooting and dragging dat ass on the ground

34
Q

T/F Rectal exam may be the only way to detect anal sac impaction.

A

True

35
Q

Thin, easily expressed, pal to dark brown liquid describes what we would see in what?

A

Normal anal gland secretions

36
Q

Pain, granular, greenish-yellow, also hemorrhage; bacterial infection describes what we would see in what?

A

Sacculitis

37
Q

Thick, gray brown paste describes what we would see in what?

A

Impaction

38
Q

How do we tx an impaction?

A

Gentle expression of impaction

39
Q

How do we tx a sacculitis?

A

Expresion, flush w saline or 0.5% chlorhexidine solution

Instill w topical antibiotic –> CURVED TIP SYRINGES

40
Q

How do we tx abscesses?

A

Lance if not ruptured
Clean area and keep clean
Systemic antibiotics 10-14 days

41
Q

The following describes which neoplasia?

Dogs > Cats
Malignant
Invasive af
Metastasis: 36-96% of cases
Clinical signs: tenesmus, constipation, anorexia, wt loss: incidental!
PE: firm nodule in/encompassing the anal sac; often irregular

A

Anal sac apocrine gland adenocarcinoma

This is why we do recitals on every visit !

42
Q

What would our clin path and imaging tell us that would suggest it’s anal sac apocrine gland adenocarcinoma?

A

Clin path: HYPERCa: up to 51% !!

Imaging: look for metastasis in chest, bone and abdomen

43
Q

What is the best way to tx anal sac apocrine gland adenocarcinoma?

A

Surgical resection + radiation + therapy: combo of all 3 is the best!

44
Q

What signalment do we expect to see in perianal adenomas?

A

Little breeds! Cocker spaniel, English Bulldog, Samoyeds, Beagles

INTACT male dogs: 85%!!

45
Q

What is the best way to tx perianal adenomas?

A

Surgical excision with castration to limit recurrence

46
Q

The following describes what?

Inability to retain feces
The involuntary passage of fecal material

A

Fecal incontinence

47
Q

Blue box: What age does fecal incontinence frequently affect?

A

Senior pets!

48
Q

Incontinence is seen in what 2 diseases?

A

Reservoir dz and sphincter dz

49
Q

Reservoir dz is rectal or colonic dz causes lack of capacity or compliance. Associated with stricture, fibrosis, mural thickening. Post subtotal colectomy. What kinda poop do we see?!

A

Frequent small fecal balls but can signal need to defecate

50
Q

Sphincter dz is denervation or structural damage of rectum or anus. What is a major giveaway of sphincter dz?

A

More severe of a disease bc they are not aware that they need to poop
Involuntary expulsion so it just slips out :(

51
Q

What would we see on a PE of reservoir exam that we wouldn’t see on a PE of sphincter dz?

A

Neuro exam- everything normal in reservoir dz

Anal sphincter tone diminished in sphincter dz

52
Q

What is our tx for incontinence?

A

Tx primary dz
If postop- often just needs time
Diet: low residue for some, high fiber for others
Freuqnet oud oor time and exercise blah blah blah

53
Q

Clicker question: T/F The BEST immune suppressant medication for perianal fistulas is prednisone.

A

False- it’s cyclosporine!

SAM II (20 decks)

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