Large intestinal surgery Flashcards
What are the three approaches you can do for large intestine surgery?
ventral midline
pelvic split
transanal
What part of the intestine is it very important to preserve?
ielocaecocolic junction
What kind of suture material should you use?
absorbable monofilament e.g. PDS
removal of over ___ cm of bowel consistently –> incontinence
6cm
WHat species has idiopathic/primary megacolon?
cats
What sort of things can lead to megacolon?
pelvic fractures intrapelvic space occupying lesions colorectal neoplasia colorectal abscess perineal hernia inappropriate diet
What are the clinical signs associated with megacolon?
constipation, tenesmus, vomiting, anorexia, weight loss.
Dehydration, poor BCS
What can you do medically to manage megacolon?
manual evacuation laxatives prokinetics frequent walks high fibre low residue diet
What is the surgical treatment for megacolon?
subtotal colectomy
What are the possible complication following subtotal colectomy?
Constipation increased defecatory frequency soft to watery species tenesmus rectal prolapse
What 2 benign tumour types might you find in colorectal neoplasia?
polyps
leiomyomas
What malignant tumours arise in the colorectal area?
adenocarcinoma, leimyosarcoma, lymphoma, haemangiosarcoma, plasmacytoma
What clinical signs might you see in colorectal neoplasia?
Tenesmus haematochezia incerased defecatory frequency ribbon like faeces rectal prolapse weight loss
What are the 2 resection options for colorectal neoplasia?
submucosal resection
wide surgical excision with resection and anastomosis
WHat resection technique might you be able to use for masses in the caudal third of the rectum?
Rectal pull through
What is the prognosis for adenomatous polyps?
Can be curative with excision but will recur in about 17% of dogs within a year. about 25% have malignant transformation
Median survival >2 years
What is the prognosis for adenocarcinomas?
Cure possible with complete resection as low rate metastasis but often difficult to completely excise. Median survival about 2 years.
Conservative management with faecal softeners can give about 15 months
What are the 3 main causes of rectal prolapses?
GI parasites
Rectal neoplasia
Perineal hernias
What 3 things should you give medically after replacing a rectal prolapse?
Faecal softeners
Anthelmintics
Low residue diet
How should you treat anal sacculitis?
Sedate
Cathetereise duct opening with lacrimal cannula
collect sample for culture
lavage with saline
instil dex and Abs
Systemic Abs if systemic disease or abscess
topical Tx if yeast
What is an open sacculectomy?
Incise through the sphincter muscle and cut out the gland
What is a closed sacculectomy?
incise outside sphincter muscle and remove without going through the muscle
What are the potential complications of anal sacculectomy?
rare to get complications
faecal incontinence
persistent infection if fail to remove all tissue
Is anal sac apcrine gland adenocarcinoma malignant?
Yep. About 50% metastasised at the time of diagnosis
