Rectal And Anal Surgery Flashcards
Rectal prolapse is secondary to ________ which an indicate rectal, anal, or urogenital disease
Tenesmus
DDX for rectal prolapse
Prolapsed intussusception
How can you test for rectal prolapse vs intussusception ?
Probe test
- passed between the border of the anus and protruding mass
- if probe can be passed = intussusception (Surgical emergency)
Treatment for rectal prolapse?
Identify underlying cause
Reduce and place purse-string suture if viable — maintain for 3 days
Amputate if non viable
Colopexy if recurrent
What complications can result after a rectal prolapse amputation?
Infection
Dehiscence
Stricture
Recurrence
What are the indications and techniques used for colopexy?
Recurrent rectal prolapse
Perineal hernia
Suture technique - absorbable/nonabsorbable suture material
Incisional colopexy - absorbable suture material
How is an incisional colopexy preformed?
Descending colon - apply traction
Incision through seromuscular layer of colon and transversus abdominus of body wall
Can perform in more than one spot on descending colon
What are the benign colorectal tumors ?
Adenomatous polyp
Leiomyoma
Fibroma
What are the malignant colorectal tumors?
Adenocarcinoma
Leiomyosarcoma
Lymphosarcoma
Clinical signs of rectal adenoma?
Hematochezia
Tenesmus/dyschezia
Visible mass —> Polyploid/sessile/ multiple
How can you diagnose rectal neoplasia?
Observe/palpate mass
Proctoscopy/colonoscopy
Biopsy - incisional vs excisional
What are the possible approaches for surgical excision of colorectal neoplasia?
Transanal —> lesions involving caudal rectum or anal canal
Dorsal —> lesions involving midrectal but NOT anal canal
Rectal pull through —> distal colonic or midrectal leions not approachable through abdomen
Mucosal resection
T/F: about 50% of colorectal adenocarcinomas are abdominal
True
Mets to regional lymph node and liver
The transanal approach is limited to the caudal ______cm of the rectum. What type of analgesic can you do
4-6
Complications from rectal surgery?
Dehiscence
Infection
Stricture
Incontinence — sphincteric or sensory
What are disease of the anal sacs?
Anal sac impaction
Anal sacculitis
Anal sac abscess
How are infected/accessed anal sacs managed ?
Anal sacculectomy (open or closed technique)
How is a closed anal sacculectomy done? When would you use this technique ?
Blunt probe or instrument
Paraffin injection
Catheter
Use for tumors, infected glands
How is an open anal sacculectomy done? When is this indicated?
Insert one blade of scissors into sac
Apply upward pressure to tops to miniseries tissue cut
OR
Insert groove director/probe through duct into anal sac
Incise over instrument with caudal tension on instrument to minimize damage to sphincter
Dissect anal sac from anal sphincter
Complications to anal sacculectomy?
Infection
Draining tracts
- incomplete removal of anal sac (must excise to resolve)
Fecal incontinence
What are the perineal tumors?
Persian a gland tumor —>adenoma/adenocarcinoma
Adenoma are common in male intact dogs.. how would you treat and what is the prognosis?
Castration and resection
Good prognosis
Guarded to poor for malignant
What is the tumor of the anal sac and what paraneoplasic syndromes are associated?
Apocrine gland adenocarcinoma
Paraneoplasic hyperCa
PU/PD
Renal failure
Perianal fistulas are most common in what breed and what is the most likely EDX?
GSD
Immune mediated
How are perianal fistulas managed?
Diet: IBD can predisposed
Cyclosporine
+/- ketoconazole, glucocorticoids, tacrolimus, azathioprine, metronidazole
Surgical interventions ONLY if un responsive to medical management
