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Surgery > E2- Surgical diseases of rectum and anus > Flashcards

E2- Surgical diseases of rectum and anus Flashcards

1
Q

Do we go oral or aboral for an enterotomy on intestinal foreign body?

A

aboral- healthy tissue

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2
Q

For an enterotomy, we cut on the mesenteric or antimesenteric border?

A

antimesenteric border- mesentery has vessels

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3
Q

Rectal prolapse- complete vs incomplete

A

complete involves all layers

incomplete- mucosa

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4
Q

Rectal prolapse can be secondary to?

A

tenesmus

rectal/anal dz

urogenital dz- straining to urinate

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5
Q

Differential dx of prolapsed rectum

A

prolapsed intussesception

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6
Q

Probe test for prolapse

A

pass finger b/t border of the anus and protruding mass

if probe can be passed, intussusception is the dx = surgical emergency

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7
Q

Probe test pos or neg?

A

finger can be passed so intussusception

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8
Q

Treatment of rectal prolapse

A

indentify and treat the underlying cause

reduce and place purse-string suture if viable- maintain for 3 days (tx underlying cause and give stool softeners)

amputate if nonviable

colopexy if recurrent- keeps it from coming back out

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9
Q

Complications after rectal prolapse amputation

A

infection

dehiscence

stricture

recurrence

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10
Q

Colopexy indications

A

recurrent rectal prolapse

perineal hernia

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11
Q

Suture technique used for colopexy

A

absorbable/nonabsorbable suture material

dont let needle go into lumen (dont go through mucosa)

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12
Q

Incisional colopexy: incision through ______ layers of cokon and ____ abdominus of body wall

A

seromuscular layers of colon

transversus abdominus of body wall

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13
Q

Incisional colopexy: descending colon- apply ____ traction

A

cranial

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14
Q

T/F you can perform an incisional colopexy in more than one spot on descending colon

A

true

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15
Q

Benign tumors of colorectal neoplasia

A

adenomatous polyps

leiomyoma, fibroma

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16
Q

Malignant tumors of colorectal neoplasia

A

adenocarcinoma

leiomyosarcoma

lymphosarcoma

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17
Q

Clinical signs of rectal adenomas

A

hematochezia

tenesmus/dyschezia

visible mass (may be intermittent)

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18
Q

Presentation of rectal adenomas

A

most occur in distal rectum

polypoid

sessile

multiple

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19
Q

How do we diagnose colorectal neoplasia

A

direct observation

rectal palpation

proctoscopy/colonoscopy

biopsy

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20
Q

Colorectal biopsy

A

incisional vs excisional

ALWAYS submit excised masses even when pre-op biopsy is performed- more difinitive dx

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21
Q

Up to ____% of colorectal neoplasia will come back as a more aggressive tumor (carcinoma in situ, invasive adenocarcinoma)

A

25%

22
Q

Treatment of colorectal neoplasa

A

surgical excision: transanal, doral, mucosal approach

cryosurgery: cant evaluate margins, cant confirm dx

23
Q

Colorectal adenocarcinoma: approximately 50% are _____

A

abdominal

24
Q

Colorectal adenocarcinoma: lesions?

A

luminal, intramural, annular (napkin ring)

25
Q

Why must we examine the entire colon for colorectal adenocarcinoma?

A

may be multiple

26
Q

Where do we check for metastasis for colorectal adenocarcinoma?

A

lymph nodes and liver -can also go to the lungs

27
Q

What are the surgical approaches to the rectum and colorectal junction?

A

anal, dorsal approach, rectal pull-through

28
Q

_____ approach for lesions involving caudal rectum or anal canal

A

anal

29
Q

_____ approach for lesions involving midrectum but NOT anal canal

A

dorsal approach

30
Q

______ approach for lesions in distal colonic or midrectal lesion not approachable through abdomen

A

rectal pull through

swenson’s pull-through- lesions that extend beyond peritoneal reflection into abdominal cavity

combines the anal and ventral approach

31
Q

Transanal approach is limited to lesions in the caudal ____ cm of the rectum

A

4-6cm

not a full thickness cut

epidural block

32
Q

Name the surgical technique

A

Dorsal approach to the rectum

33
Q

Name the surgical approach

A

rectal pull through

34
Q

Complications of rectal surgery

A

dehiscence

infection

stricture

incontinence- sphincteric, sensory

35
Q

Anal sac disease is a common problem in ____

A

small dogs- poodle, chihuahua

rare in cats

36
Q

3 types of anal sac dz

A

anal sac impaction

anal sacculitis (infections)

anal sac abscess

37
Q

Describe the location of the anal sacs

A

anal sacs lie within external anal sphincter

38
Q

Manage infected or abscessed glands medically until ____

A

inflammation resolves

39
Q

Anal sacculectomy: open vs closed techniques -how do we choose which to use?

A

disease process determines it

40
Q

Closed anal sacculectomy

A

blunt probe or instrument

paraffin injection

catheter

use for tumors, infected glands

41
Q

Open anal sacculectomy

A
  • insert one blade of scissors into sac
  • apply upward pressure to tips to minimize tissue cut OR insert groove director or probe through duct into anal sac
  • incise over instrument w/ caudal tension on instrument to minimize damage to sphincter
  • dissect anal sac from anal sphincter
  • not commonly performed, ruptured anal sac
42
Q

Complications with anal sacculectomy

A

infection

draining tracts- incomplete removal of anal sac, must excise to resolve

fecal incontinence

43
Q

Perianal gland adenomas/adenocarcinomas are more common in?

A

male intact dogs bc of increased testosterone

44
Q

Perianal gland adenomas/adenocarcinomas: good prognosis factors?

A

benign masses

castration and resection

45
Q

Perianal gland adenomas/adenocarcinomas poor prognosis?

A

if its malignant

46
Q

Anal sac tumors: apocrine gland adenocarcinomas

A

express sac and repalpate for tumor- do a good rectal

paraneoplastic hypercalcemia, PU/PD, renal failure

no metastasis- 16-18m survival

metastasis present <1yr -LNs, lungs

47
Q

Periaal fistulas breed disposition?

A

german shepards

48
Q

Most likely cause of perianal fistulas?

A

immune mediated

49
Q

Signs of perianal fistula

A

painful

perianal draining

fistulous tracts

50
Q

Medical management of perianal fistulas

A

diet: IBD may predispose/potentiate signs
cyclosporine: 70-100% resolution

+/- keroconazole, glucocorticoids, tacrolimus, azothioprine, metronidazole

51
Q

When do perianal fistulas require surgery?

A

if they are non responsive to medical management

Surgery (15 decks)

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