Surgical Approach to the Large Intestine Flashcards
What are the different approaches that can be taken to access the LI?
Ventral Midline Laparotomy
Pelvic Split
Transanal
What should be done if a FB is in the LI?
Milk it out and only enter the LI if absolutely necessary, it shouldn’t be necessary with a LI FB.
What consequences are there of removing:
a) too much of the LI
b) the ileocaecolic junction?
a) Loss of reservoir & absorptive function
Increased faecal frequency
b) Can lead to increased risk of infection of the SI as bacteria can backtrack.
How much LI is removable whilst retaining continence?
6cm (in a Labrador sized dog)
Which suture material should be used for the LI?
PDS II
What common thing might be seen when stapling the LI to anastamose it?
Post op bleeding/blood on the faeces
What are the complications of colorectal surgery?
Dehisence and SP Wound infeciton Abscess formation Faecal incontinence Stricture & Tenesmus Rectal prolapse Heamatochezia
How can megacolon be diagnosed?
Colon full of faecal material with dehydration and lack of BC. Need to rule out other causes of constipation first.
How is megacolon treated?
Underlying disease treatment if secondary Medical: -Enemas -Prokinetics -Laxatives -High Fibre, low residue diet -Increase walks Sugical - subtotal colectomy
What dogs are predisposed to adenocarcinomas of the LI?
Dogs 6-9yo. GSDs, great dane, dobermans, boxers
What historical findings might indicate a LI neoplasia?
weight loss tenesmus heamatochezia increased defecation frequency rectal prolapse ribbon like faeces
How could neoplasia of the LI be diagnosed?
Rectal exam (60-80%)
Radiography
Ultrasound
Colonoscopy
What types of resection of the colon can be performed?
Submucosal resection - good survival times
Wide surgical excision with intestinal resection and anastamoses.
If there is metasteses of LI neoplasia would resection still be considered?
Yes as it may make the patient more comfortable.
What can cause rectal prolapse?
Parasites
Rectal neoplasia
Perineal hernias
What is the treatment for rectal prolapse?
anthelmintics
faecal softeners
low residue diet
sedatives
stitch to body wall if repeats
What are the anal glands?
Invaginations of the skin
What does the normal anal sac fluid look like?
Liquid brown
Outline the treatment for anal sac:
a) Impaction
b) Sacculitis/Abscess
a) manual expression
b)Sedate/aneasthatise
Catheterise the ducts
Collect samples
Lavage
Dexmethasone and antibiotics into the gland
Systemic antibiotics if abscess/systemic disease
Yeast treatment if found on cytology
What are the two types of sacculectomy? When would these be performed?
Perform with repeat cases. Open and closed techniques
What are the complications that may occur with sacculectomy?
Faecal incontinence
-Should be fine if one caudal rectal nerve is preserved
Persistent infection
-Due to failure to remove all of the tissue
What are the treatments for perianal adenoma and adenocarcinoma?
Adenoma - castration may be sufficient.
Carcinoma - combination of surgery, chemotherapy and radiotherapy
What is anal furunculosis?
Immune mediated attack of skin around the anus.
What is the treatment of choice for anal furunculosis?
High dose cyclosportin and then taper. Can also use topical creams but not as effective. Ketoconazole can prolong activity of cyclosporin but does have side effects.
