Dz's of the Donk: Rectum & Anus Flashcards
Blue box: The following describes what
Columnar epithelium
Lymphoid follicles
Many mucous secreting goblet cells
Rectal mucosa
Blue box: Stratified squamous epithelium can be found where?
At rectal: anal jxns
There are 3 glands within the anal canal. What are they and do they do?
- Anal glands: sweat glands; secrete lipids into canl
- Circumanal glands (hepatoid): non secretory
- 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
The PNS supply comes from S1 - S3 –> pelvic nerve. What is its job?
Relaxes internal sphincter
Allows defection when patient is relaxed
The SNS supply –> hypogastric n from lunar spine. What’s its job?
Contraction of internal sphincter
Patient doesn’t poop when they run
Striated m and pelvic canals = skeletal m –> pudendal n. What is their job?
Allows maximum distension of rectum for fecal storage and anal control
In diseases affecting hypogastric and pudendal n, what else can be seen?
Dysuria bc these nn also innervate the bladder
What are some clinical signs of disease?
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
Blue box: What diagnostic method should we not forget with anal diseases if there is concern for ongoing or severe bleeding?
Don’t forget coagulation testing!
T/F Rads and US might be limited in dx of rectal dz.
True; limited d/t location
What is the empiric tx for acute disease?
Deworming
Change in dietary fiber–> addition of fiber such as psyllium
Diet change –> low residue or high fiber
Inflammation of rectal mucosa is called _____.
Proctitis
Protrusion of rectal wall and/or other pelvic and abdominal organs through weakened portion of pelvic diaphragm into ischiorectal fossa is called what?
Perineal hernia
What is the common signalment for perineal hernias?
Middle aged, INTACT male dogs –> likely hormone induced
A “small, red rosette” is often the way what is described?
Rectal prolapse
How do we diagnose rectal prolapses?
Differentiate from intussusception!! By passing probe or lubed finger. Cannot pass finger btwn rectal wall and prolapsed tissue = rectal prolapse
How do we tx rectal prolapses?
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
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?
RIBBON STOOLS!!!! Comes out in ribbons bc of narrow diameter !
What can we expect to see on PE of rectal stricture ?
Palpate –> narrow, firm lumen
May be painful
May feel impacted stool proximally
How do we dx rectal strictures?
“oscopy”- rigid protoscopy OR flexible endoscopy to directly visualize and biopsy abnormal tissue
How do we tx rectal stricture?
Balloon dilation of stricture- like w esophageal stricture
Medical: diet, fiber, stool softeners, laxatives, Abs
Rectal neoplasia has similar differentials to colon neoplasia. Having said that, which 2 neoplasias are overrepresented in cats and dogs?
Adenocarcinoma and lymphosarcoma
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?
Males > females
Poodles and Boston Terriers over represented
What clinical signs do we see in Types 1, 2 and 3 of atresia ani vs type 4?
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
What type of atresia ahi has the best prognosis?
Type 1
Perianal fistulas are chronic, progressive, inflammatory disease. What is the common signalment?
Middle aged to older dogs
German shepherds, Irish setter, Labs
What clinical signs do we see with perianal fistulas?
PAINFUL!, dyschezia, fetal incontinence, over grooming, self mutilation
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
Perianal fistulas
Perianal fistulas has a complex disease etiology. What does dat mean?
Overriding immune dysfunction = main player as responds to immune modulation medication so we tx w an immune suppressor
T/F The treatment of choice for perianal fistulas is surgery.
Nahhhh.
medical mgmt»_space;»» sx
Sx may be indicated if anal gland involvement is also present
***What drug does HP lady loooove for perianal fistulas?
Cyclosporine! 60-100% remission. Oral DOC!!!
What is the prognosis for perianal fistulas?
Guarded for cure but can be managed longterm
Fecal incontinence, stricture, fistula, and recurrence associated with euthanasia decision
What clinical signs do we see with anal sac impaction?
Excessive grooming, malodor, **scooting and dragging dat ass on the ground
T/F Rectal exam may be the only way to detect anal sac impaction.
True
Thin, easily expressed, pal to dark brown liquid describes what we would see in what?
Normal anal gland secretions
Pain, granular, greenish-yellow, also hemorrhage; bacterial infection describes what we would see in what?
Sacculitis
Thick, gray brown paste describes what we would see in what?
Impaction
How do we tx an impaction?
Gentle expression of impaction
How do we tx a sacculitis?
Expresion, flush w saline or 0.5% chlorhexidine solution
Instill w topical antibiotic –> CURVED TIP SYRINGES
How do we tx abscesses?
Lance if not ruptured
Clean area and keep clean
Systemic antibiotics 10-14 days
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
Anal sac apocrine gland adenocarcinoma
This is why we do recitals on every visit !
What would our clin path and imaging tell us that would suggest it’s anal sac apocrine gland adenocarcinoma?
Clin path: HYPERCa: up to 51% !!
Imaging: look for metastasis in chest, bone and abdomen
What is the best way to tx anal sac apocrine gland adenocarcinoma?
Surgical resection + radiation + therapy: combo of all 3 is the best!
What signalment do we expect to see in perianal adenomas?
Little breeds! Cocker spaniel, English Bulldog, Samoyeds, Beagles
INTACT male dogs: 85%!!
What is the best way to tx perianal adenomas?
Surgical excision with castration to limit recurrence
The following describes what?
Inability to retain feces
The involuntary passage of fecal material
Fecal incontinence
Blue box: What age does fecal incontinence frequently affect?
Senior pets!
Incontinence is seen in what 2 diseases?
Reservoir dz and sphincter dz
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?!
Frequent small fecal balls but can signal need to defecate
Sphincter dz is denervation or structural damage of rectum or anus. What is a major giveaway of sphincter dz?
More severe of a disease bc they are not aware that they need to poop
Involuntary expulsion so it just slips out :(
What would we see on a PE of reservoir exam that we wouldn’t see on a PE of sphincter dz?
Neuro exam- everything normal in reservoir dz
Anal sphincter tone diminished in sphincter dz
What is our tx for incontinence?
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
Clicker question: T/F The BEST immune suppressant medication for perianal fistulas is prednisone.
False- it’s cyclosporine!
