Lecture 20: Sx of the Perineum, Rectum, & Anus 2 (Exam 3) Flashcards
Define
Inflammation of the anal sacs
Anal saculitis
Define
infection of the anal sacs
anal sac abscess
Define
obstruction of the anal sac ducts
impaction
Where are the anal sacs located in the rectum?
4:30 and 7:30 “o’ clock” positions
What percent of dogs have anal saculitis?
10%
Fill in the ?s
What clinical signs are associated with anal saculitis?
* ?secretion
* sac is ? expressed
* liquid secretions with ? granules
* can have duct obstruction or no duct obstruction
- hypersecretion
- sac is easily expressed
- liquid secretions with yellowish-white granules
- can have duct obstruction or no duct obstruction
What can lead to anal sacculitis?
- diarrhea
- obesity
- in general decreased bowel movements
What breeds of dogs are most likely to develop anal saculitis?
small and toy breeds
Is anal saculitis common in cats?
no
What physical exam findings usually indicated anal saculitis?
- swelling
- draining leasion at 4 or 7 o’clock positions
- +/- fever
- palpate enlarged
- firm and sometimes painful sac
How do you describe normal anal gland secretions?
- serous
- slightly viscid
- granular
- pale-yellow liquid
How do you describe abnormal anal gland secretions?
- whitish gray
- brown
- yellow
- green
- blood
- purulent
- gritty
- turbid
- opaque
When should you check the anal glands of your patient?
every PHYSICAL EXAM that you do (externally)
What diagnostic imagine is recommended for neoplasia of the anal sacs?
- survey radiographs
- CT
- MRI
What is the typical presentation of anal sac impaction?
- sac is distended
- mildly painful
- cannot be readily expressed
What is the typical presentation of anal saculitis?
- moderate to severe pain is elicited on palpation
- secretions are liquid, yellowish, blood-tinged or purulent
What is the typical presentation of anal sac abscessation?
- distention of sac with purulent exudate
- cellulitis of surrounding tissues
- erythema of overlying skin
- pain and fever
When do you use a culture & sensitivity in an anal gland infection?
if first Abx used aren’t responding
What should you consider doing before performing anal saculectomy?
- manual expression
- lavage
- topical antibiotics
- dietary change
What form of treatment is NOT recommended for anal sacculitis?
chemical cauterization
What situations is an anal saculectomy indicated for?
- chronic infected sacs
- anal sac fistulae
- neoplasia
What structures must be meticulously preserved to prevent fecal incontinence during an anal saculectomy?
anal sphincter muscle & nerves
(True/False) If you damage one nerve on one side of the rectum, fecal incontinence with occur.
false (fecal incontinence is the result of damage to the nerves on BOTH sides)
What does the anal sac look like externally?
grayish and glistening
What can you pack the anal sac with to better visualize it?
iodoform umbilical tape
What should you always do with tissues removed from anal sac tumors?
histopathologic examination
What anal saculectomy technique is preferred?
Closed
Describe the closed anal saculectomy technique.
- external anal sphincter muscle is not transected
- lumen of the anal sac remains closed
What procedure is shown here?
Anal saculectomy - closed technique
What procedure is shown here?
Anal saculectomy - open technique
When do perineal hernias occur?
perineal muscles separate, allowing rectum, pelvic and or abdominal contents to displace perineal skin
Where is a caudal perineal hernia located?
between levator ani, external anal sphincter, and internal obturator muscles
Where is a sciatic perineal hernia located?
between sacrotuberous ligament and coccygeus muscles
Where is a dorsal perineal hernia located?
between levator ani and coccygeus muscles
Where is a ventral perineal hernia located?
between the ischiourethralis, bulbocavernosus, and ischiocavernosus muscles
What causes perineal hernias?
- We don’t know for sure.
- hormones may be involved
Why do we see perineal hernias more often in males?
pelvic diaphragm is stronger in female dogs than in males
What can predispose a patient to developing a perineal hernia?
straining when defecating
What is usually within a feline perineal hernia?
rectum
What forms the buldge of the hernia?
perineal fascia (hernial sac)
If you see a perineal hernia with postrenal uremia, what is mostly likely true?
The bladder is entrapped (life threatening)
What percent of perineal hernias occur in male dogs?
93%
When does the risk of perineal hernia occurence increase until?
14 years
What side does a perineal hernia tend to form on?
right
(True/false) not all dogs with perineal hernias have perineal swelling.
true
What is used to determine if fluid is present in an bladder entrapment?
- ultrasound
- perineal centesis
What is the treatment for perineal hernias?
herniorrhaphy
What is the downside of performing a bilateral herniorrhaphy repair?
postoperative discomfort and tenesmus may be greater than after unilateral procedures
What do some surgeons do to avoid performing a bilateral herniorrhaphy?
wait 4 to 6 weeks before performing second herniorrhaphy
What important structures may be displaced from their normal anatomy location by the hernial contents?
perineal vessels and nerves
What do you have to be care not to mistake for a mass in a perineal hernia repair?
prostate
What perineal herniorrhaphy technique is shown here?
traditional technique
What perineal herniorrhaphy technique is shown here?
internal obturator transposition technique
What can most postoperative complications be prevented by in a perineal herniorrhaphy?
meticulous surgical technique
What surgery is often done the same time as a herniorrhaphy to reduce hernia recurrence or contralateral herniation?
castration
What is recurrence of perineal hernia correlate to?
expertise of the surgeon
How can you prevent infection and dehiscence in a perineal hernoirrhaphy?
appropriate antibiotic prophylaxis and surgical technique
What post-op herniorrhaphy complication is associated with pain, non-weight-baring lameness and knuckling?
sciatic nerve entrapment
How do you fix sciatic nerve entrapment as a complication of herniorrhaphy?
remove offending suture from caudolateral approach
What is the prognosis of a perineal herniorrhaphy?
fair to good (when an experienced surgeon performs surgery)
Which perineal hernia patients have the poorest prognosis?
patients with bladder retroflexion
Can you repair preexisting neurologic abnormalities (i.e. anal sphincter incompetence or compromised urinary bladder innervation) with a herniorrhaphy?
nope!
