Large intestinal surgery

Question 1

What are the three approaches you can do for large intestine surgery?

Answer 1

ventral midline
pelvic split
transanal

Question 2

What part of the intestine is it very important to preserve?

Answer 2

ielocaecocolic junction

Question 3

What kind of suture material should you use?

Answer 3

absorbable monofilament e.g. PDS

Question 4

removal of over ___ cm of bowel consistently –> incontinence

Answer 4

6cm

Question 5

WHat species has idiopathic/primary megacolon?

Answer 5

cats

Question 6

What sort of things can lead to megacolon?

Answer 6

pelvic fractures
intrapelvic space occupying lesions 
colorectal neoplasia 
colorectal abscess
perineal hernia
inappropriate diet

Question 7

What are the clinical signs associated with megacolon?

Answer 7

constipation, tenesmus, vomiting, anorexia, weight loss.

Dehydration, poor BCS

Question 8

What can you do medically to manage megacolon?

Answer 8

manual evacuation
laxatives 
prokinetics 
frequent walks 
high fibre low residue diet

Question 9

What is the surgical treatment for megacolon?

Answer 9

subtotal colectomy

Question 10

What are the possible complication following subtotal colectomy?

Answer 10

Constipation 
increased defecatory frequency
soft to watery species 
tenesmus 
rectal prolapse

Question 11

What 2 benign tumour types might you find in colorectal neoplasia?

Answer 11

polyps

leiomyomas

Question 12

What malignant tumours arise in the colorectal area?

Answer 12

adenocarcinoma, leimyosarcoma, lymphoma, haemangiosarcoma, plasmacytoma

Question 13

What clinical signs might you see in colorectal neoplasia?

Answer 13

Tenesmus
haematochezia
incerased defecatory frequency
ribbon like faeces 
rectal prolapse 
weight loss

Question 14

What are the 2 resection options for colorectal neoplasia?

Answer 14

submucosal resection

wide surgical excision with resection and anastomosis

Question 15

WHat resection technique might you be able to use for masses in the caudal third of the rectum?

Answer 15

Rectal pull through

Question 16

What is the prognosis for adenomatous polyps?

Answer 16

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

Question 17

What is the prognosis for adenocarcinomas?

Answer 17

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

Question 18

What are the 3 main causes of rectal prolapses?

Answer 18

GI parasites
Rectal neoplasia
Perineal hernias

Question 19

What 3 things should you give medically after replacing a rectal prolapse?

Answer 19

Faecal softeners
Anthelmintics
Low residue diet

Question 20

How should you treat anal sacculitis?

Answer 20

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

Question 21

What is an open sacculectomy?

Answer 21

Incise through the sphincter muscle and cut out the gland

Question 22

What is a closed sacculectomy?

Answer 22

incise outside sphincter muscle and remove without going through the muscle

Question 23

What are the potential complications of anal sacculectomy?

Answer 23

rare to get complications
faecal incontinence
persistent infection if fail to remove all tissue

Question 24

Is anal sac apcrine gland adenocarcinoma malignant?

Answer 24

Yep. About 50% metastasised at the time of diagnosis

Question 25

What are the DDx for anal sac apocrine gland adenocarcinoma?

Answer 25

perianal adneoma

perianal adenocarcinoma

Question 26

How long can ASAGC patients live if they have chemo and radio and surgery?

Answer 26

about 2.5 years

Question 27

What breed does anal furunculosis usually occur in and what is the treatment?

Answer 27

GSDs

immunomodulatory therapy e.g. atopica (cyclosporine)