Lecture 19: Sx of the Perineum, Rectum, & Anus 1 (Exam 3) Flashcards
Define:
Rectal Resection
removal of a portion of the terminal large intestine
Define:
Rectal Pull-Through
Resection of the terminal colon or midrectum (or both) using an anal approach w/ or w/out an abdominal pouch
Define
anal saculectomy
removal of one or both anal sacs
Fill in the ?s
list possible indications for recta, anal, or perineal sx:
* dx w/ ?
* anal ? disease
* colonic ?
* perineal ?
* ? perforation
* perianal ?
* ? ischemia
* ? prolapse
* neoplasia
* fecal ?
- Dx W/ biopsy
- anal sac disease
- colonic obstruction
- perineal hernia
- rectal perforation
- perianal fistulae
- **rectal ** ischemia
- rectal prolapse
- fecal** incontinence**
clinical signs of rectal, anal, & perineal dx:
- anal biting or scooting
- anal licking
- tenesmus
- thickening or swelling
- constipation or obstipation
- diarrhea
- hemorrhage or hematochezia
- mass
What referral procedures are required when impaired anorectal innervation (neurologic) is suspected?
- myelographic evaluation
- manometric evaluation
- Electrodiagnostics
What laboratory tests are used for general nonspecific in diseases of the rectum, anal, or perineum
- CBC
- Biochemistry
What laboratory abnormalities would you see in paraneoplastic syndrome?
- hypercalcemia
- anemia
- Hypoglycemia
- Alopecia
- Gastric & intestinal ulcers
What laboratory abnormalities suggest bladder entrapment in perineal hernia?
- azotemia
- +/- hyperkalemia
Which diseases of the rectum, anus, or perineum require radiography to confirm diagnosis?
- sublumbar lymphadenomegaly
- prostatomegaly
- abnormal bladder position with perineal hernia
- free gas in perineal
- intrapelvic, or caudal retroperitoneal space with rectal perforationanus
List some special diagnostic studies that can be used to diagnose disease of the rectum, perineum, or anus?
- Urethrograms
- Cystograms
- GI barium studies
List diagnostic imagine modalities used to diagnose disease of the perineum, rectum or anus?
- ultrasonography
- colonoscopy
- proctoscopy
Fill in the ?s
What preoperative management tools can be used in surgery of the perineum, rectum & anus:
* warm compress if ?
* stool softener
* fistula & tumor ?
* mechanical empty & cleansing (if no ?)
* correct for pre-existing deficits
* blood transfusion if PCV ? or anemic
* treat clotting factor deficiencies with fresh ? or fresh ?
- warm compress if inflamed
- stool softener
- fistula & tumor mapping
- mechanical empty & cleansing (if no perforation)
- correct for pre-existing deficits
- blood transfusion if PCV < 20% or anemic
- treat clotting factor deficiencies with fresh whole blood or fresh frozen plasma
What should be done to the terminal rectum, just before surgery, in all patients?
digitally evacuated after induction
When should rectal perforations be corrected?
as soon as diagnosed
What should you place after induction to facilitate identification of the urethra?
urinary catheter
What can you introduce into the rectum to facilitate identification of the rectal walls?
syringe case
What can you pack into the anal sacs to ID them during dissection?
umbilical tape
(T/F) The small intestine contains more bacteria that the colon.
FALSE (colon contains more bacteria than the ENTIRE of the GI tract)
What is indicated to reduce bacterial load, unless perforation or obstruction expected?
pre-operative colonic emptying & cleansing
What feed regime can help decrease bacterial loads in colon before surgery?
feed elemental diet or low residue diet 2- 3 days before sx
How long should you withhold food for adult patients to decrease bacterial load in colon?
24 hours
How long should you withhold food for pediatric patients to decrease bacterial load in colon?
8 hours
What cleanses the colon better than enemas but is contraindicated with obstruction?
colon electrolyte solutions
What is the best cleansing method for the colon?
electrolyte solution + enema
What should be given 3 hours prior to surgery?
10% Povidone-Iodine should be given 3 hours prior to surgery
What time within surgery will an enema liquefy intestinal content and add to the dissemination of contaminated material during surgery?
less than 3 hours of surgery
What patients can be further deteriorated with use of an enema?
debilitated anorectic patients
What is the major risk of preoperative enemas?
colonic perforation
What type of enemas should you avoid with small or constipated patients?
hypertonic phosphate
What is the high risk of colorectal surgery?
infection!!!
What type of antibiotics should be given prior to surgery?
abx effective against anaerobes and gram (-) aerobes
What artery is the landmark for the colorectal junction
Cranial rectal artery
Fill out the ?s
What surgical circumstances does fecal incontinence usually occur:
* more than ? of terminal rectum resected
* final 1.5 cm of the ? resected
- perineal nerves are ?
- more than half of the ? is damaged
- more than 4cm of terminal rectum resected
- final 1.5 cm of the ** terminal rectum** resected
- perineal nerves are damaged
- more than half of the** external anal sphincter** is damaged
List the surgical approaches to the rectum
- ventral
- dorsal
- lateral
- anal
- rectal-pull through
When is the ventral approach to the rectum utilized?
to resect lesions at the colorectal junction
What procedures are required in a ventral approach to the rectum?
pubic osteotomy or pubic symphysiotomy
What is a pubic osteotomy?
- removal of pubis from coxae to gain ventral access to colon
- then wire the pubis back in when finished
What is a pubic symphysiotomy?
divide the pubis symphysis and flay it open
Does a pubic symphysiotomy or a pubic osteotomy grant you greater access to the colon?
pubic osteotomy
What surgical procedure is shown with the red lines on the os coxae?
pubic osteotomy
What surgical procedure is shown with the green lines on the os coxae?
pubic symphysiotomy
When do you utilize a dorsal approach to the rectum?
if lesion involved the caudal or middle rectum & NOT the anal canal
What approach to rectal surgery is presented here?
dorsal approach
Should you place a drain next to an anastomotic site?
**NO, BAD! **(may cause dehiscence)
When do you utilize a lateral surgical approach to the rectum?
- repairing lacerations
- resecting a diverticulum
What surgical approach to the rectum is shown here?
lateral approach
When do you utilize an anal surgical approach to the rectum?
- resect: small noninvasive pedunculated polyps, broad based rectal masses that can be exteriorized, lesions involving the caudal rectum or anal canal
- appose perforations of the terminal rectum
What is a common problem that can occur when the mucocutaneous junction & skin being resected?
fecal incontinence
What surgical approach to the rectum is shown here?
Anal approach
When do you utilize the rectal pull-through surgical approach to the rectum?
When there is a need to resect a distal colonic or midrectal lesion not approachable through the abdomen and too large or cranial for anal approach
What is a major concern when a circumferential or near-circumferential lesion is resected?
post-operative stricture
What surgical approach to the rectum is shown here?
rectal pull-through
When do you utilize a Swenson’s Pull-Through surgical approach to the rectum?
When disease extends all the way into the colon
What are the main warnings to give owners about rectal surgery?
- incontinence is always a possibility
- hematochezia & tenesmus for 2 weeks is possible
