E2- Surgical diseases of rectum and anus

Question 1

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

Answer 1

aboral- healthy tissue

Question 2

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

Answer 2

antimesenteric border- mesentery has vessels

Question 3

Rectal prolapse- complete vs incomplete

Answer 3

complete involves all layers

incomplete- mucosa

Question 4

Rectal prolapse can be secondary to?

Answer 4

tenesmus

rectal/anal dz

urogenital dz- straining to urinate

Question 5

Differential dx of prolapsed rectum

Answer 5

prolapsed intussesception

Question 6

Probe test for prolapse

Answer 6

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

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

Question 7

Probe test pos or neg?

Answer 7

finger can be passed so intussusception

Question 8

Treatment of rectal prolapse

Answer 8

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

Question 9

Complications after rectal prolapse amputation

Answer 9

infection

dehiscence

stricture

recurrence

Question 10

Colopexy indications

Answer 10

recurrent rectal prolapse

perineal hernia

Question 11

Suture technique used for colopexy

Answer 11

absorbable/nonabsorbable suture material

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

Question 12

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

Answer 12

seromuscular layers of colon

transversus abdominus of body wall

Question 13

Incisional colopexy: descending colon- apply ____ traction

Answer 13

cranial

Question 14

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

Answer 14

true

Question 15

Benign tumors of colorectal neoplasia

Answer 15

adenomatous polyps

leiomyoma, fibroma

Question 16

Malignant tumors of colorectal neoplasia

Answer 16

adenocarcinoma

leiomyosarcoma

lymphosarcoma

Question 17

Clinical signs of rectal adenomas

Answer 17

hematochezia

tenesmus/dyschezia

visible mass (may be intermittent)

Question 18

Presentation of rectal adenomas

Answer 18

most occur in distal rectum

polypoid

sessile

multiple

Question 19

How do we diagnose colorectal neoplasia

Answer 19

direct observation

rectal palpation

proctoscopy/colonoscopy

biopsy

Question 20

Colorectal biopsy

Answer 20

incisional vs excisional

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

Question 21

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

Answer 21

25%

Question 22

Treatment of colorectal neoplasa

Answer 22

surgical excision: transanal, doral, mucosal approach

cryosurgery: cant evaluate margins, cant confirm dx

Question 23

Colorectal adenocarcinoma: approximately 50% are _____

Answer 23

abdominal

Question 24

Colorectal adenocarcinoma: lesions?

Answer 24

luminal, intramural, annular (napkin ring)

Question 25

Why must we examine the entire colon for colorectal adenocarcinoma?

Answer 25

may be multiple

Question 26

Where do we check for metastasis for colorectal adenocarcinoma?

Answer 26

lymph nodes and liver -can also go to the lungs

Question 27

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

Answer 27

anal, dorsal approach, rectal pull-through

Question 28

\_\_\_\_\_ approach for lesions involving caudal rectum or anal canal

Answer 28

anal

Question 29

\_\_\_\_\_ approach for lesions involving midrectum but **NOT anal canal**

Answer 29

dorsal approach

Question 30

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

Answer 30

rectal pull through swenson's pull-through- lesions that extend beyond peritoneal reflection into abdominal cavity combines the anal and ventral approach

Question 31

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

Answer 31

4-6cm not a full thickness cut epidural block

Question 32

Name the surgical technique

Answer 32

Dorsal approach to the rectum

Question 33

Name the surgical approach

Answer 33

rectal pull through

Question 34

Complications of rectal surgery

Answer 34

dehiscence infection stricture incontinence- sphincteric, sensory

Question 35

Anal sac disease is a common problem in \_\_\_\_

Answer 35

small dogs- poodle, chihuahua rare in cats

Question 36

3 types of anal sac dz

Answer 36

anal sac impaction anal sacculitis (infections) anal sac abscess

Question 37

Describe the location of the anal sacs

Answer 37

anal sacs lie within external anal sphincter

Question 38

Manage infected or abscessed glands medically until \_\_\_\_

Answer 38

inflammation resolves

Question 39

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

Answer 39

disease process determines it

Question 40

Closed anal sacculectomy

Answer 40

blunt probe or instrument paraffin injection catheter use for tumors, infected glands

Question 41

Open anal sacculectomy

Answer 41

* 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

Question 42

Complications with anal sacculectomy

Answer 42

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

Question 43

Perianal gland adenomas/adenocarcinomas are more common in?

Answer 43

male intact dogs bc of increased testosterone

Question 44

Perianal gland adenomas/adenocarcinomas: good prognosis factors?

Answer 44

benign masses castration and resection

Question 45

Perianal gland adenomas/adenocarcinomas poor prognosis?

Answer 45

if its malignant

Question 46

Anal sac tumors: apocrine gland adenocarcinomas

Answer 46

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

Question 47

Periaal fistulas breed disposition?

Answer 47

german shepards

Question 48

Most likely cause of perianal fistulas?

Answer 48

immune mediated

Question 49

Signs of perianal fistula

Answer 49

painful perianal draining fistulous tracts

Question 50

Medical management of perianal fistulas

Answer 50

diet: IBD may predispose/potentiate signs cyclosporine: 70-100% resolution +/- keroconazole, glucocorticoids, tacrolimus, azothioprine, metronidazole

Question 51

When do perianal fistulas require surgery?

Answer 51

if they are non responsive to medical management