Rectal tears Flashcards
what are common causes of rectal tears?
palpation
what are less common causes of rectal tears
enema administration dystocia chronic impaction (dry) and stricture--impaction causes lesions at mucosa of rectum breeding injuries spontaneous rupture
how do you avoid a rectal tear?
do not force against straining or peristaltic wave
what animals do you have to take special precautions with with rectal tears?
arabian horse ponies small breeds fractious horses horses with colic
how can you appropriately restrain horses?/what other precaution to take?
- stocks
- twitch
- sedation
- lubrication
- lidocaine–IV set
What are the grades of rectal tears?
- grade 1
- grade 2
- grade 3a
- grade 3b
- grade 4
What is a grade 1 rectal tear
only mucosa and submucosa are torn
What is a grade 2 rectal tear
only the muscular layer is disrupted and causes mucosa and submucosa to prolapse through defect
what is a consequence of a a grade 2 rectal tear?
creates a site for feces impaction
What is a grade 3A rectal tear?
the serosal area is intact but the tear causes formatino of a serosal diverticulum.
This serosal diverticulum is li kely to be larger than defect cause by grade 2
What is a grade 3B rectal tear?
a tear that enters the mesentery–enters retroperitoneal space. occurs dorsally. That only leaves fat-filled mesocolon as a barrier preventing fecal contamination of abdominal cavity
what is a grade 4 rectal tear?
disrupts all layers of rectum. allows direct palpaton of abdominal organs and gross fecal contamination of abdominal cavity
where do rectal tears usually occur?
dorsal aspect of the rectum. located 15-55cm from anus and parallel to the longitudinal axis
what do you feel with a grade 4 rectal tear?
sudden release pressure
able to directly palpate abdominal organs
what are the clinical signs of a rectal tear?
within 2 hours see signs of peritonitis and endotoxic shock: tachycardia intestinal ileus pyrexia sweating depression
How do you diagnose rectal tears?
- avoid straining–epidural, sedation (xylazine, butorphanol)
- digital palpation
- endoscopy
- abdominocentesis
differentiate feeling of grade 1 vs grade 3 rectal tear
grade 1–feels like a flap of mucosa
grade 3-there are thick rigid and seperated edges that are packed by feces
why would you do abdomiocentesis with a rectal tear?
to rule out septic peritonitis. good diagnostic test
What are the initial treatments for rectal tears?
- reduce activity of rectum–epidural etc
- remove feces from rectum and tear
- treat shock and peritonitis
- rectal packing
- broad spectrum peritonitis
- flunixin meglumine
- mineral oil–lube rectum,
- diet changes–cow pie feces
what antibiotics should be used with a suspected rectal tear
- penicillin, gentamicin, metronidazole
What are the benefits of flunixin meglumine?
antiinflammatory
anti-endotoxin
what is the benefit of mineral oil?
coat feces, don’t break it down so there aren’t small pieces–don’t want small pieces because could go through tear
beyond initial treatment, what steps should be taken with grade 3-4 tears?
- aggressive intravenous fluid therapy, hypertonic saline, isotonic crystalloids
How do you protect tears from conversion to another grade?
- rectal packing (stokinet with cotton, povidone iodine, lubricated gel)
- anus closed using purse-string suture
- epidural anesthesia
what is the surgical treatment for rectal tears?
divert feces away form tear–prevents contamination, impaction, enlargement, progression of peritoniti
What are the general steps of surgical treatment of rectal tears?
- procedure to form stoma
2. procedure to reverse stoma
What is a loop colostomy?
make a loop of small colon–suture together, then make an incision in tenia–large surgery probe, and take loop down to lower incision. Cut and fold back and suture to body wall.
What is the after care for loop colostomy?
broad spectum (pen, gen, metronidazole) laxatives pretrolatum based ointment around stoma!
How do you reverse the stoma? (colostomy)
do anastomosis of the small colon.
What are complications of colostomy?
dehiscence abscessation peristma herniation prolapse rupture colostomy spontaneous closure anastomic impaction dehiscence after reversal
What is an alternative to colostomy?
- incise rectum where tear is, then staple, and oversew mucosa
- suture the defect–deschamps needle
can be used as adjuncts to colostomy
What is the survival rate for grade 1?
93%
What is the survival rate for grade 3 tearA? B?
74%
44%
(60% overall)
What is the prognosis for grade 4 tear?
grave!
