Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LASx Final > Rectal Tears / Rectal Prolapse > Flashcards

Rectal Tears / Rectal Prolapse Flashcards

1
Q

Rectal tears mostly affect _____, while rectal prolapse is mostly a problem of _____.

A

Rectal tears mostly affect horses, while rectal prolapse is mostly a problem of ruminants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the different causes of rectal tears?

A
  • Iatrogenic
  • Spontaneous (post-foaling)
  • Other (enema, meconium extraction with forceps, etc)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

TRUE/FALSE

Rectal tears post foaling are evidence of dystocia.

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Iatrogenic rectal tears usually occur on the ____ part of the rectum.

A

DORSAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are rectal tears diagnosed?

A
  • Sudden release of pressure
  • Sudden ability to palpate abdominal organs distinctly (rare)
  • Blood on sleeve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What drugs/methods are used to stop rectal contractions while confirming rectal tears with your bare hand (gross)?

A
  • Epidural
  • Xylazine
  • Butorphanol
  • Buscopan
  • Lidocaine Enema or gel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Other than palpating with your poor gloveless hand, what are other ways to confirm rectal tears?

A
  • Speculum examination of rectum to visuaize mucosa
  • CBC or abdominocentesis (changes may not be seen right away)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can you prevent rectal tears?

A
  • Copious lubrication
  • Adequate restraint: Sedation if necessary
  • Muscle relaxant: Buscopan (Small dose ~ 3 mL; 60 mg)
  • Don’t try to palpate beyond your reach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

GRADE IT: Rectal Tears

Tissue Affected:

  • Mucosa
  • Submucosa
A

Grade 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

GRADE IT: Rectal Tears

Tissue Affected:

  • Muscular layer disrupted
  • Mucosa and submucosa may prolapse into defect and provide site for fecal impaction
A

GRADE 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GRADE IT: Rectal Tears

Tissue Affected:

All except serosa

A

GRADE 3A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

GRADE IT: Rectal Tears

Tissue Affected:

  • All except serosa
  • Mesorectum and retroperitoneal tissue
A

GRADE 3B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

GRADE IT: Rectal Tears

Tissue Affected:

  • All layers into abdomen
  • May be associated with prolapse of small colon or small intestine through defect

*Horse can develop sepsis/peritonitis in relation to this tear

A

GRADE 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Location of Rectal Tears:

  • Most tears are ____ & ____.
  • Usually _____cm from anus

*Distance from anus not a good indicator of tear location
relative to retroperitoneal ref lection and abdominal
cavity

A
  • Most tears are dorsal & longitudinal
  • Usually 15 to 55 cm from anus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Idiopathic tears may simply present as ____ and pass
unnoticed for some time because tear is not suspected.

A

Idiopathic tears may simply present as colic and pass
unnoticed for some time because tear is not suspected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs of Rectal Tears:

  • May be ______ in Grade 1
  • ________ and _______within a few hours in more serious cases
  • Feces may be ______ initially
A
  • May be asymptomatic in Grade 1
  • Peritonitis and toxic shock within a few hours in more serious cases
  • Feces may be hemorrhagic initially
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the initial treatment in severe cases showing signs septic shock and peritonitis?

A
  • Flunixin
  • Intravenous fluids
  • Antibiotics (Penicillin, gentamicin, metronidazole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are initial treatment options for rectal tears?

A
  • Treat septic shock and peritonitis
  • Reduction of rectal motility
  • Epidural anesthesia to allow gentle removal of feces
  • Gentle packing of rectum
  • Referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the purpose of gently packing the rectum for initial treatment of rectal tears?

A
  • Protect tear
  • Prevent contamination of abdomen
  • Prevent conversion of Grade III to Grade IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Non-Surgical Treatment: Grade I or II

  • _______ and ______ sufficient for Grade I
  • ______ alone may be sufficient for the smallest lesions
  • Soften feces with______
A
  • Antibiotics and Flunixin sufficient for Grade I
  • Observation alone may be sufficient for the smallest lesions
  • Soften feces with Mineral oil / bran mashes / green grass / moistened pellets - not preferred by Gilbert because increased chance of leaking and more difficult to evacuate than pellets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Non-Surgical Treatment: Grade III
______ & Frequent manual removal of feces via ______.

What is a disadvantage to the latter method?

A

Peritoneal lavage & Frequent manual removal of feces via Epidural catheter

Epidural = labor intensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

TRUE / FALSE

Grade III rectal tears must be treated surgically.

A

FALSE

Often respond to non surgical treatment, which is also
cheaper

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the different methods of surgical repair of rectal tears?

A
  • Direct suture repair
  • Temporary indwelling rectal liner
  • Loop colostomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe rectal tear repair using direct suture repair.

A
  • Fresh, clean lesion close to anus
  • Epidural
  • Stay sutures in anus (split anus dorsally if necessary)
  • Prolapse tear: -Hold with multiple Allis tissue forceps, Staple with TA90 & Oversew with simple continuous suture
  • Alternatively, suture blindly
  • (Lesions usually not accessible via midline celiotomy)
  • (Laparoscopic repair has been described)
25
Q

________ repair of rectal tears protects tear and allows it to heal spontaneously. It may also be used with or without direct suture

A

Temporary, indwelling rectal liner

26
Q

Describe the Temporary, indwelling rectal liner technique of rectal repairs.

A
  • Make liner by gluing palpation sleeve or similar to rectal prolapse ring
  • Ring is 5 cm diameter, 7.5 cm long
  • Place dacron loops through holes
  • Caudal midline celiotomy
  • Secure liner oral (“upstream”) to the tear

Anesthetized horse, dorsal recumbency

  • Assistant passes lubricated ring, guided by surgeon to cranial to tear
  • Ring secured with tight circumferential suture
  • Incorporate circumferential suture into individual sutures through all layers of colon and Dacron loops in ring
  • Bury circumferential suture with Lembert pattern
  • Cross tie: Prevent cranial movement of sleeve when horse lies down
  • Circumferential suture cuts through colon and allows passage of ring and liner in 9 – 12 days
  • By then apposed colon edges have healed
27
Q

What approache is taken when repairing rectal tears via indwelling liners?

A

Ventral midline celiotomy

28
Q

When repairing rectal tears with an indwelling liner, circumferential suture is buried with a ______ pattern.

A

Lembert

29
Q

The indwelling liner of rectal tear repair should pass in ____ days.

A

9-12 days

30
Q

What techniques of rectal repair are pictured?

Which is preferred?

A

Loop colostomy is preferred to end-colostomy because it is easier to perform, easier to reverse.

31
Q

The following are indications to repair a rectal tear via _____.

  • Grade IV; +/- Grade III
  • Tear > 25 % of rectal diameter
  • Tear > 50 cm from anus
A

Loop colostomy

32
Q

What approach is used in a loop colostomy?

A

High left flank, low left flank, ventral midline

33
Q

Describe post op care and complications of loop colostomies.

A

Post care: cradle (prevent self-mutiliation)

Complications

  • Dehiscence
  • Infection
34
Q

While palpating a valuable broodmare for diagnosis of pregnancy you feel a slight “give” in the rectum above your hand. There is a small amount of blood on your hand. Careful digital exploration reveals a 2 cm dorsal partial thickness tear. You advise the owner to:

A. Destroy the mare immediately before she suffers.
B. Cross tie the mare; administer banamine and antibiotics; watch carefully.
C. Send the mare immediately for surgery at a referral clinic.
D. Turn mare out in a large pasture.

A

B. Cross tie the mare; administer banamine and antibiotics; watch carefully.

35
Q

What are some sequelae to Grade III/IV rectal tears?

A
  • Cellulitis
  • abscess
  • toxemia
  • laminitis
  • intestinal adhesions
  • stricture
  • diverticulum
  • fistula
36
Q

What is the prognosis / survival rate for rectal tears based on grade?

A
  • Grade I - 93 %
  • Grade II - 80 %
  • Grade III - 70 %
  • Grade IV- 6%
37
Q

What is this?

A

Rectal Tear

38
Q

TRUE/FALSE

Rectal prolapse may affect any breed, sex or age but more commonly affects older feedlot cattle.

A

FALSE

Affects younger feedlot cattle

39
Q

Describe the pathogenesis of rectal prolapse.

A
  • Abdominal/pelvic cavity vs. anus
  • Decreased sphincter tone
  • Constipation, diarrhea, colitis, cystitis, dystocia
  • Excessively short tail cropping of sheep
  • Altered pressure gradient
40
Q

Classify the Rectal Prolapse!

Only mucosa projects through anus

A

TYPE 1

41
Q

Classify the Rectal Prolapse!

Prolapse of all layers of rectum

A

Type II

42
Q

Classify the Rectal Prolapse!

Small colon intussuscepts into rectum

A

Type III

43
Q

Classify the Rectal Prolapse!

Rectum / colon intussusception through anus

A

Type IV

44
Q

What are the most common types of rectal prolapse?

A

Types I & II

45
Q

On palpation of rectal prolapse, ______ are continuous with anus.

_____ has palpable depression (“Trench”) inside rectum.

A

On palpation of rectal prolapse, Types I – III are continuous with anus

Type IV has palpable depression (“Trench”) inside rectum.

46
Q

How can rectal prolapse be managed?

A
  • Eliminate predisposing factors
  • Eliminate straining
  • Soothe mucosa
  • Resolve prolapse
47
Q

What are the benefits of a Caudal epidural anesthesia when managing rectal prolapse?

A

Caudal epidural anesthesia

  • Resolves straining (temporarily)
  • Allows evaluation
  • May facilitate repositioning / replacement
  • May allow surgery
48
Q

What are teh treatment options for rectal prolapse?

A
  • Replacement and purse string suture
  • Perirectal injection of iodine?
  • Submucosal resection
  • Stair step amputation / Amputation after through- and-through sutures
49
Q

Type ___ rectal prolapse must be treated with celiotomy, resection, anastamosis.

A

Type IV

50
Q

Describe the treatment of rectal prolapse via replacement & puse string suture.

A
  • Caudal epidural
  • Clean prolapse: Hypertonic solution, Glycerol
  • Lidocaine jelly
  • Reduce prolapse

Purse string suture:

  • Umbilical tape
  • Tighten to allow 2-3 fingers
  • Remove after 1 week
51
Q

A rectal prolapse that is necrotic, ulcerated, traumatized mucosa, and healthy underlying tissue should be treated with ______.

A

Submucosal resection

52
Q

Describe the surgical technique of submucosal resection treatment of rectal prolapse.

A
  • Epidural and hypertonic solution
  • Insert flexible tubing, fix with needles (cross-pin)
  • Make two circumferential incisions, just through mucosa, at ends of tissue to be removed
  • Connect with longitudinal incision to same depth
  • Remove collar of damaged tissue by blunt dissection (ligate individual vessels)
  • Anchor tissue with 4 simple interrupted sutures (monofilament, absorbable)
  • Complete apposition with continuous suture for each quadrant
53
Q

_____ correction of rectal prolapse causes reduced risk of stricture formation.

A

Stair step amputation

54
Q

Describe the technique of stair step amputation surgical repair of rectal prolapse.

A
  • Circumferential incision: Preserve inner mucosa and submucosa; Create plane toward caudal aspect of prolapse
  • Make incision through inner layer of mucosa
  • Flap inner mucosa over outer and suture as for submucosal resection
55
Q

This is a type _____ rectal prolapse.

A

Type IV

56
Q

TRUE / FALSET

Rectal prolapse in a sheep always requires amputation of at least some portion of rectum.

A

TRUE??

57
Q

Prognosis of rectal prolapse:

  • Types I & II
  • Types III & IV
A
  • I & II: Good
  • III & IV: guarded (vascular damage to small colon)
58
Q

What is an alternative to purse string suture repair of rectal prolapse?

A

Perirectal injection of iodine (causes scar tissue formation and permanent purse string)

LASx Final (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions