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Small animal surgery I > Surgery of the large intestine, rectum, and anus > Flashcards

Surgery of the large intestine, rectum, and anus Flashcards

1
Q

What is a cecal inversion? What are the typical signs?

A
  • Cecal inversion = cecal intussusception
  • Signs
    • Diarrhea
    • Hematochezia
    • Weight loss
    • Tenesmus
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2
Q

What is the treatment for cecal inversion?

A
  • Manual reduction
  • Colotomy if necessary
  • Typhylectomy
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3
Q

How do you perform a typhylectomy?

A
  • Ligate arterial supply
  • Dissect ileocolic fold
  • Milk out contents
  • Transect and suture
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4
Q

How is blood supply and healing of the large intestine different from the small intestine?

A
  • Higher bacteria count
  • Increased collaginase 1-3 days after sx
  • Segmental blood supply
    • Ileocolic, cranial mesenteric, caudal mesenteric
      • Major: ileocolic, cranial mesenteric
    • If you ligate the segmental blood supply you must remove that section–will get necrosis
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5
Q

What are the most common cecal tumors?

A

Leiomyoma and leiomyosarcoma

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6
Q

What are the causes of megacolon?

A
  • Usually idiopathic (62%)
  • Pelvic obstruction (23%)
  • Neurologic (6%)
  • Endocrine
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7
Q

What are the treatment options for megacolon? What are the specifics for medical management?

A
  • Medical management
    • Correct dehydration
    • Deopstipate
    • Inc. fiber diet
    • Stool softeners
    • Osmotic laxatives (lactulose)
    • Prokinetic agents (cisapride)
  • Subtotal colectomy
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8
Q

What are the goals of subtotal colectomy in the treatment of megacolon?

A

Goal is to remove as much colon as possible

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9
Q

What are the advantages/disadvantages of ileocolostomy and colocolostomy when performing a subtotal colectomy?

A
  • Colocolostomy
    • Remove entire colon and reattach it, leaving ileocolic valve intact
      • Preferable
    • Tension free apposition more difficult (impossible in some patients)
  • Ileocolostomy
    • Tension-free closure
    • Exposes patient to bacteria
    • Increased incidence of severe diarrhea
    • Tend to do worse than colocolostomy patients
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10
Q

What is the typical post-operative course after subtotal colectomy? Prognosis?

A
  • Fluids 1-3days
  • Analgesics
  • Continue antibiotics if gross contamination
  • Feed w/in 24hrs
  • Diarrhea should improve in 2-8wks
  • Good prognosis
    • Dogs–fair to guarded
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11
Q

What is the incidence of dehiscence after intestinal surgery? What is the prognosis?

A

Occurs at about the same rate as with the SI, but can be much worse due to high amounts of bacteria

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12
Q

What is atresia ani (tell me all the things)?

A
  • Stenosis or persistent membrane of the anus or rectum
  • Most commonly reported anomaly
  • Increased incidence in toy poodles and Boston terriers
  • Signs occur at a few wks of age
  • Clinical signs
    • Straining
    • Anal dimple
    • Perineal swelling
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13
Q

Tell me everything about rectovaginal fistulas

A
  • Often associted w/ atresia ani
  • Vulvar irritation, cystitis
  • Passage of urine through rectum or feces through vula
  • Diagnose with positive contrast
  • Treat by transecting and closing defect
  • Treat underlying UTI
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14
Q

3 facts of anogenital clefts?

A
  • Common opening for anus and genital tract-cloaca
  • Leads to ascending UTI
  • Treat with plasty procedure
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15
Q

Differentiate between anal and rectal prolapse

A
  • Anal prolapse
    • Incomplete prolapse
    • Anal mucosa protrudes from orifice
    • Determine underlying cause and treat
    • Manually reduce and place purse string
  • Rectal prolapse
    • Complete–all layers of rectum protrude through anal orifice
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16
Q

What are the predisposing factors for rectal prolapse?

A
  • Parasites
  • Colitis
  • Urogenital disease
  • Younger patients
  • Tumors
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17
Q

How do you differentiate between rectal prolapse and prolapsed intussusception?

A

If actual prolapse, blunt probe/finger cannot be inserted

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18
Q

How do you treat a rectal prolapse if the tissue is still viable?

A
  • Manually reduce
  • Facilitate reduction with saline, lubricants, or mannitol
  • Place purse string to keep reduced but allow soft feces
  • Leave for several days
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19
Q

How do you treat a rectal prolapse with non-viable tissue?

A
  • Surgically prep area
  • Place 4 full-thickness stay sutures
  • Use test tube to minimize contamination
  • Resect 1-2cm from anus
  • Simple interrupted
  • Reduce prolapse
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20
Q

What are the treatment options for a recurrent rectal prolapse?

A

Incisional colopexy

Non-incisional colopexy

21
Q

Describe the procedure of a non-incisional colopexy for treatment of recurrent rectal prolapse

A
  • Ventral celiotomy
  • Cranial traction on colon
  • Reduce prolapse
  • Engage submucosa
  • Antimesenteric border
  • Left abdominal wall
  • 2 rows of 5-6 non-absorbable sutures
22
Q

Describe the procedure for an incisional colopexy

A
  • Similar to gastropexy
  • > 3cm incision through serosa and muscular layers
  • Incision through transverse abdominus muscle
  • Can perform in more than one area
23
Q

What is the most common malignant rectal tumor in dogs? What is the signalment?

A
  • Most common: adenocarcinoma
    • German shepherds and poodles predisposed
    • Older dogs
    • Increased incidence in males
    • Not quite as aggressive as SI
24
Q

What is the most common tumor in the rectum? What is the signalment?

A

Adenomatous polyp

  • Most commonly found in distal rectum
  • Collies predisposed
  • Can undergo malignant transformation
  • Single or multiple lesions (higher incidence of transformation in multiple lesions)
25
Q

What are the clinical signs of rectal tumors?

A
  • Tenesmus
  • Dyschezia
  • Painful defecation
  • Rectal prolapse
  • Protrusion of polyp
26
Q

How do you diagnose rectal tumors?

A
  • Direct observation
  • Digital rectal palpation
  • Colonoscopy/proctoscopy
    • May help determine extent
  • Biopsy
    • Helps determine type, stage, and sx indication
    • Always submit excised mass
  • Thoracic and abdominal rads
27
Q

What is the pre-operative treatment for rectal tumors?

A
  • Withhold food 24-48hrs prior
  • Consider multiple warm water enemas up to 12hrs prior
    • If given w/in 12hrs of sx, fluid can be retained –> can lead to more difficult sx or contamination
  • Enemas contraindicated with obstructive lesions
  • Consider prophylactic antibiotics
    • Aerobic and anaerobic activity
28
Q

What are the indications for the trans-anal approach when removing rectal tumors?

A
  • Excision of small, non-invasive pedunculated polyps
  • Lesions in the caudal 4-6cm of rectum
29
Q

What are the indications/procedure for using the dorsal approach when removing rectal tumors?

A
  • Used for tumors in the mid-rectum
  • Place purse string
  • Make inverted U incision between tail and anus and tubur ischium laterally
  • Transect rectococcygeus muscles
  • Bluntly dissect between levator ani and external anal sphincter muscles
  • Place stay sutures proximally and distally
30
Q

What is the modified rectal pull through approach for removing rectal tumors used for? Describe the procedure

A
  • Used for approach to the mid/caudal rectum
  • Evert rectal wall through the anus
  • Place multiple stay sutures
  • Make incision proximal to anocutaneous junction leaving a 1.5cm cuff of rectum
  • Bluntly dissect rectum from external anal sphincter
  • Mobilize rectum caudally and resect
31
Q

What is the Swanson’s rectal pull through approach for rectal tumor removal? When is it used?

A
  • Combines trans and anal abdominal approach
  • Used for more extensive lesions of the rectum
32
Q

Describe the lateral approach to rectal tumor removal

A
  • Limits approach to one side of rectum
  • Used for rectal diverticulum or laceration
  • Approach from base of tail to ischium 1-3cm lateral to anus
  • Separate tissue between levator ani and ext anal sphincter to expose lateral rectum
  • Preserve caudal rectal nerve
  • Procedure rarely used
33
Q

Describe the ventral approach for rectal tumor removal

A
  • Lesions at colorectal junction
  • Pubic osteotomy 1, 2
  • Pubic symphysiotomy 1, 3
34
Q

What is the medical management of anal saculitis?

A
  • Express gland
  • Cannulate and irrigate
  • Infuse abx/steroids
  • +/- systemic abx
  • Drain/flush abscess
  • Treat underlying problem
    • Diarrhea
    • Allergies
35
Q

What is the surgical management for anal saculitis?

When is it indicated?

A
  • Anal sacculectomy
  • Indicated when medical management fails or neoplasia is suspected
36
Q

Surgical management for anal saculitis should be performed after _______.

A

inflammation is controlled

37
Q

Describe a closed anal sacculectomy

A
  • Often performed in ferrets and for neoplasia
  • Blunt probe/instrument
  • Paraffin injection
  • Catheter
38
Q

Describe the technique for an open anal sacculectomy

A
  • Exposes secretory lining
  • Insert 1 blade of scissors into sac
  • Apply upward pressure to tips to minimize tissue cut or insert groove director or 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
39
Q

What are the potential complications of anal sac surgery?

A
  • Infection
  • Draining tracts
    • Incomplete removal of anal sac
    • Must excise to resolve
  • Fecal incontinence
    • Trauma to caudal rectal nerve or external anal sphincter
    • Give 3-4mo for reinnervation
40
Q

What is the most common malignant tumor of the anal sac?

A

Apocrine gland adenocarcinoma

41
Q

What are the characteristics/signalment of apocrine gland adenocarcinomas?

A
  • Highly malignant
  • Regional LN metastasis
  • Older spayed female dogs???
  • Perianal swelling or incidental finding
  • 25-90% have paraneoplastic syndrome
42
Q

What is paraneoplastic syndrome?

A
  • Hypercalcemia and hypophosphatemia
  • PU/PD
  • Muscle weakness
  • Vomiting
43
Q

What is the prognosis of apocrine gland adenocarcinoma?

A
  • Poor
    • 50% have mets on presentation
    • MST < 1yr with metastasis
    • MST 16-18mo with no mets
    • Monitor Ca levels pre- and post-op
44
Q

What is the management of perianal adenomas?

A
  • Regress with castration
  • Castration/surgical excision
45
Q

What are perianal fistulas?

A

Chronic suppurative ulcerative tracts

46
Q

What are the potential etiologies of perianal fistulas?

A
  • Broad base low carried tail
  • Abscessed anal glands
  • Hair follicle infection
  • Immune-mediated
47
Q

What is the signalment of perianal fistulas? Signs/diagnosis?

A
  • Middle-aged German shepherds
  • Diagnosis/signs
    • Presence of fistulous tract
    • Tenesmus
    • Dischezia
    • Licking
    • Malodorous perianal discharge
    • Pain
48
Q

What is the medical management for perianal fistulas?

A
  • Perianal cleansing
  • Antibiotics
  • Immunosuppressive therapy
    • Prednisolone
    • Cyclosporine
    • Azathioprine
49
Q

What are the surgical managements available for perianal fistulas?

A
  • Surgical excision
  • Concurrent anal sacculectomy
  • Cryosurgery
  • Fulguration
  • Tail amputation
  • Laser excision
  • Anoplasty

Small animal surgery I (25 decks)

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