Exam 2: Rectal Tears and Rectal Prolapse Flashcards
A rectal tear is a potentially catastrophic event
in this species
HORSES
Most rectal tears in horses occur
on the _______ aspect
dorsal
This muscle relaxant is used in horses
in order to prevent rectal tears
BUSCOPAN
A spontaneous rectal tear can occur post-foaling
in horses due to
pressure necrosis at the ____________.
Pelvic inlet
- squeezes foal against pelvic inlet and squeezes rectum*
- against rim of pelvis = crush necrosis and hole in rectum*
How is a rectal tear diagnosed and confirmed?
Sudden release of pressure felt on palpation
Sudden ability to palpate abdominal organs
Blood on sleeve
Confirmed via speculum exam of rectum or careful palpation
BARE HANDED with lube
Rectal tears in mares are usually dorsal
and ____________
longitudinal
When confirming rectal tear by bare hand palpation,
what meds can be used to stop rectal contractions?
Epidural
Xylazine/Butorphanol/Buscopan
Lidocaine enema or gel
The most common rectal tear classification is
Grade 1, which involves these layers of tissue
mucosa and submucosa
What tissue layers are involved in a Grade 2 rectal tear?
mucosa, submucosa, and MUSCULAR LAYER
may feel like a thin wall/diverticulum- feces impacted here
Grade 3A rectal tear involves
all layers except the ________
serosa
Grade 3b involves
mucosa, submucosa, muscular layer, serosa,
___________ and ____________
MESORECTUM and RETROPERITONEAL TISSUE
Grade 4 rectal tear extends into the ________
abdomen
A colicking horse is seen after palpation.
What are you concerned about?
Rectal tear
Septic shock and peritonitis are potential
sequela of rectal tears in horses.
Which antibiotics are used to treat this?
Penicillin
Gentamicin
Metronidazole
Flunixin
How is a rectal tear initially treated?
Given Antibiotics
Buscopan to reduce rectal motility
Epidural anesthesia
Gentle packing of rectum with gauze soaked in iodine
the REFER OUT!
Which grades of rectal tears can be treated
non-surgically and how are they treated?
Grade 1, 2, or 3:
Grade 1 and 2: Antibiotics + Flunixin
Grade 3: Frequent manual removal of feces + epidural anesthesia
+ peritoneal lavage
Grade _____ rectal tears must always be treated surgically
Grade 4
What surgical methods can be used
to fix a rectal tear?
Direct suture repair
Temporary indwelling rectal liner
Loop colostomy
What are the indications for a loop colostomy (LOW LEFT FLANK)
in the treatment of rectal tears in horses?
Grade 4, maybe Grade 3
Tear > 25% of rectal diameter
Tear > 50 cm from anus
What is the prognosis for rectal tears?
Grade 1: 93%
Grade 2: 80%
Grade 3: 70%
Grade 4: 6% only
What complications are associated with Grade 3 and 4
rectal tears?
Cellulitis, Abscess
Toxemia, Laminitis
Intestinal adhesions
Stricture
Diverticulum
Fistula
In regards to rectal prolapse:
is most common in younger _______ cattle
feedlot
Describe the pathogenesis of
rectal prolapse in sheep
due to excessively short tail cropping
If cut the tail too short, you cut the coccygeus muscle,
which causes decreased support around the anus
predisposing to rectal prolapse
Classify the rectal prolapse:
only mucosa projects through the anus
Type 1
Classify the rectal prolapse:
prolapse of all layers of the rectum
Type 2
Classify the rectal prolapse:
Small colon intussuscepts into rectum
Type 3
Classify the rectal prolapse:
Rectum/colon intussusception through the anus
Type 4
What are the most common types of rectal prolapse?
Types 1 and 2
Classify this rectal prolapse:
Type 2:
Prolapse of all layers of the rectum
On palpation of rectal prolapse,
a palpable trench is felt inside the rectum.
What classification does this correspond to?
Type 4 rectal prolapse
How would you treat a Type 1 or 2 rectal prolapse?
Replacement and purse string sutures
+
Perirectal injection of iodine
(causes scar tissue formation, like a permanent purse string suture and keeps condition from recurring)
What is the treatment of choice for rectal prolapse
that has necrotic, ulcerated, or traumatized mucosa, but
healthy underlying tissue?
Submucosal resection
(tissue anchored every 90 degrees- 4 simple interrupted sutures)
What are the 2 methods of amputation that
can be used to treat rectal prolapse?
Overlapping mattress suture amputation
Stair Step amputation (reduced risk of stricture formation!)
How is a Type 4 rectal prolapse treated surgically?
Celiotomy, Resection, and Anastomosis
(must open up cavity to make sure mesentery has not torn
and lost blood supply to GI)
