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Medicine II > Colonic and Rectal Disease > Flashcards

Colonic and Rectal Disease Flashcards

1
Q

Obj: Differentiate clinical signs of recto anal diseae from colonic disease and unique clinical signs of specific underlying etiologies

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2
Q

Obj: describe the association between proctitis, colonic disease and possible sequela

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3
Q

Obj: given PE and imaging findings, recommendd the best treatment for an individual patient with rectoanal disease

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4
Q

Obj: list broad differentials for constipation and

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5
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Obj:

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6
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Obj:

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7
Q

What are the clinical signs of Rectoanal disease?

A
  • Often difficult to distinguish from clinical signs of colonic disease
    • Tenesmus
    • Mucoid or hemorrhagic discharge
    • Dyschezia
  • Ribbon-like appearance to stool with masses/stricture formation
  • Location of blood
    • blood coating outside of stool - concern for luminal lesions
    • Intermixed - inflammatory disease
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8
Q

What are the different categories of Rectoanal disease?

A
  • Rectal disease
  • Anal sac disease
  • Perineal disease
  • Diseases of storage/defecation
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9
Q

Define dyschezia

A

difficult/painful defecation

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10
Q

What is Proctitis? etiologies?

A
  • Rectal mucosal inflammation
  • Etiologies:
    • Colonic inflammation
    • Foreign body
    • Rectal prolapse
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11
Q

What are the clinical signs of Proctitis?

A
  • Tenesmus
  • hematochezia
  • dyschezia
  • concurrent diarrhea suggests colonic involvement
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12
Q

How is Proctitis diagnosed?

A
  • Exclusion of other causes
  • Histopathology
    • most common - lymphoplasmacytic inflammation
    • less common - neutrophilic, eosinophilic, granulomatous
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13
Q

What is the treatment for Proctitis?

A
  • Similar to idiopathic IBD/colitis
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14
Q

What is a Rectal-anal stricture? etiologies?

A
  • Narrowing of rectal or anal lumen
    • usually secondary to circumferential disease
  • Etiologies:
    • Circumferential neoplasia
    • Rectoanal foreign body
    • Severe IBD
    • Perianal fistula
    • Complication of rectal resection-anastomosis surgery
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15
Q

What are the clinical signs of Rectal-anal stricture

A
  • Dyschezia
  • Tenesmus w/ narrow ribbon-like stool
  • secondary constipation/obstruction
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16
Q

How are Recto-anal strictures diagnosed?

A
  • Physical exam (rectal)
  • Abdominal ultrasound to ID underlying conditions
  • Proctoscopy or colonoscopy for visualization and biopsy
17
Q

What is the treatment for Recto-anal strictures?

A
  • Endoscopic or fluoroscopic-guided balloon dilation or bougienage
    • for non-infiltrative disease
    • multiple procedures usually needed
    • intralesional triamcinolone can decrease re-stricture rate
  • Surgery - Rectal pull through, resection and anastomosis
  • Peri-procedural antibiotics
  • Easy digestible diet and laxatives
18
Q

What are the possible complications of Rectal pull-through, resection and anastomosis for Rectal-anal strictures?

A
  • Fecal incontinence
  • dehiscence
  • re-stricture
  • infection
19
Q

What is a Perianal Fistula? etiologies?

A
  • Perianal ulceration and formation of one or more ulcerated perianal sinuses
    • secondary to chronic, progressive inflammation
  • Etiology: incompletely understood
    • Immune-mediated inflammation (T-cell)
    • Associated with dietary intolerance in some cases (e.g. idiopathic IBD)
    • +/- bacterial or anatomic factors
20
Q

What are the clinical signs of a Perianal Fistula?

A
  • Severe perianal pain and dyschezia
  • Foul-smelling, mucopurulent discharge from fistulas
  • Self-mutilation, tail chasing
  • +/- history of chronic diarrhea
21
Q

How are Perianal Fistulas diagnosed?

A
  • PE:
    • sedation often required
    • Rectal exam to evaluate for secondary stricture formation, involvement of anal glands, progression into rectal lumen
  • +/- Rectal/colonic biopsies to diagnose underlying GI disease
22
Q

What is the treatment for Perianal Fistulas?

A
  • Immunosuppression
    • Cyclosporine
      • Low-dose ketoconazole may allow dose reduction: Cytocochrom P450 inhibitor
    • Topical Tacrolimus 0.1%
      • similar response as cyclosporine
      • difficult to apply if animal is painful
    • Other drugs: Prednisone, azathioprine
  • Daily topical cleaning
  • Pain management Stool softener
  • Diet trial - novel protein or hydrolyzed
23
Q

What is the prognosis for Perianal Fistulas?

A
  • 60-80% improvement after 4wks cyclosporine
    • avg complete resolution time of 10-16 in 70-90% of dogs
  • Guarded for complete resolution: relapse common
24
Q

What are the possible complications of Perianal Fistula treatment?

A
  • Fecal incontinence
  • anal stricture
25
Q

What is Fecal incontinence? Etiologies?

A
  • Inability to retain feces, resulting in involuntary leakage of fecal material
  • Etiologies:
    • Reservoir incontinence
      • disease-related decreased rectal capacity to hold fecal material or decreased compliance
        • subtotal colectomy
        • Colonic/rectal fibrosis or severe thickening due to severe IBD
    • Sphincter Incontinence
      • disease-related denervation
      • damage to external anal sphincter
26
Q

What are the clinical signs of Fecal incontinence?

A
  • Usually more severe with sphincter incontinence vs reservoir incontinence
  • Reservoir:
    • frequent, voluntary defecation of small fecal balls due to intact external anal sphinter
    • awareness of fecal material presence
  • Sphincter:
    • involuntary expulsion of fecal material
27
Q

How is Fecal Incontinence diagnosed?

A
  • Physical Examination
    • Reservoir:
      • frequent posturing to defecate with urgency
      • +/- concurrent signs of colonic disease
        • hematochezia, dyschezia
      • Specific disease processes
        • Colorectal: neoplasia, constipation, proctitis, colitis
    • Sphincter: Neurologic
      • Dribbling of feces from anus, especially with conditions resulting in increased pressure
        • e.g. coughing, excitement, barking
      • Decreased anal tone
      • Specific disease processes:
        • Cauda equina
          • Congenital vertebral malformation, meningomyelocele, sacrococcygeal hypoplasia (Manx), vertebral fracture, lumbosacral instability or compression, vascular insult, neoplasia, diskospondylitis
        • CNS
          • Infectious (Distemper, FIP) Degenerative myelopathy, neoplasia, vascular insult, trauma
        • Peripheral neuromuscular Disease
          • Polyneuropathies, dysautonomia, myasthenia gravis, +.- hypothyroidism
  • Complete Neurologic Exam:
    • Bladder size, ease of expression, colonic distention, gait, postural reactions, tail tone/anal tone, perineal reflexes, lumbosacral pain, other signs of autonomic nervous system disease
      • distended, flaccid, easily expressed bladder suggest lesion of the sacral spinal cord, sacral or pudendal nerves, or generalized LMN disease
      • Usually Normal w/ reservoir incontinence
  • Rule-out behavioral/altered mentation/lack of house-training
28
Q

What is the treatment for fecal incontinence

A

treatment of underlying disease

29
Q

What is Constipation? Etiologies?

A
  • Prolongation of GI transit, typically associated with hardened feces +/- difficult defecation
  • Etiologies:
    • Dehydration from systemic disease
    • Electorlyte abnormalities: hypokalemia, hypo-/hypercalcemia
    • Endocrine disease: hypothyroidism
    • Neurologic disease: Breed/anatomic related or acquired (dysautonomia)
    • Orthopedic or obstructive disease
    • Prostatomegaly
    • Lack of exercise
    • Obesity
    • Drugs: Opioids
    • Idiopathic constipation (cats)
30
Q

What is Feline Idiopathic constipation? etiologies?

A
  • Impaired colonic smooth muscle function
    • abnormalities in colonic motility pacemaker cells
    • Decreased response to neurotransmitters, membrane depolarization, and electrical field stimulation
    • No histopathologic lesions of muscle cells/myenteric neurons
31
Q

How does Feline Idiopathic constipation progress?

A
  1. Constipation: prolonged GI transit +/- difficult defecation
  2. Obstipation: dilation + loss of function
  3. Megacolon: End-stage
32
Q

What are the clinical signs of Feline Idiopathic Constipation?

A
  • Days to months of reduced to absent or painful defecation
  • Dry, hard feces
  • +/- Tenesmus
33
Q

How is Feline Idiopathic Constipation diagnosed?

A
  • Rule-out local or systemic predisposing causes
  • Abdominal Radiographs
    • Radiographic obstipation: colonic distention 1.5x the length of L7 vertebrae
    • Clinical obstipation: degree of loss of function
34
Q

What is the treatment for Feline Idiopathic Constipation?

A
  • Hydration
  • Diet
    • High fiber if no persistent colonic dilation/loss of function
    • easily digestible/low residue if persistent colonic dilation
  • Promotility medication
    • Cisapride 0.1-0.5 mg/kg q8-12h,
      • given 30min prior to feeding
  • Laxatives

Medicine II (46 decks)

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