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Alimentary > Large Intestine SA Surgery > Flashcards

Large Intestine SA Surgery Flashcards

1
Q

What defines the colon and rectum?

A

Section of LI in the abdomen (colon) and pelvis (rectum)

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2
Q

Give 3 surgical approaches to the colon

A

Ventral Midline Laparotomy
Pelvic Split
Transanal

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3
Q

What tool is used for a pelvic split? Where is the cut made?

A

Osteotome (small/young animals)
Saw
> cut pubic symphisis

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4
Q

When is colonotomy indicated? How is this carried out?

A

Rarely!
- If full thickness biopsy required
> principles same as enterotomy

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5
Q

Does a FB trapped in the colon require surgery?

A

No, milk FB out of anus

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6
Q

What can removal of the colon cause? How much can be removed before complications arise?

A
  • Decreased colon length -> loss of reservoire and absoprtion capacity, so feaces ^ frequency and ^ wateryness
  • <6cm in a labrador sized dog can be removed without faecal incontinence
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7
Q

What should always be preserved in a colon resection?

A

Ileoceacal junction - preserves ileal function to prevent retrograde flow of colonic bacteria -> SI (could -> bacterial overgrowth and chronic D+)

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8
Q

What is the name of the nerve bundle sitting on the wall of the rectum?

A

Pelvic plexus

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9
Q

What closure materials can be used for a LI anastomosis? What are the pros and cons of each?

A

> Sutures (single layer, simple, interrupted, appositional, PDS 2 monofilament) - optimise would healing, faster gain in tensile strength, minimise v in lumen diameter to v risk of stricture formation, fewer complications.
Staples - rapid and reliable, insert via rectum or incision in ceacum, provide inverted anastomosis, cause post-opbleeding (heals by itself), higher bursting pressures on d7 but no overall difference in healing

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10
Q

Give 7 post-op complications of colorectal surgery

A
  1. Would dehiscence and septic peritonitis
  2. Wound infection
  3. Abscess
  4. Faecal incontinence
  5. Stricture and tenesmus
  6. Rectal prolapse
  7. Haematochezia
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11
Q

How are ABs usually used? How does this differ in colorectal surgery?

A

Therapeutically (culture and sensitivity)

- In colorectal surgery used prophylactically to prevent contamination progressing to a full on infection

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12
Q

What is the most common cause of megacolon? What should first be ruled out?

A 
1* idiopathic megacolon most common
2* causes should be ruled out first (usually problems resulting in constipation for >5m) 
- Pelvic Fx
- Intrapelvic space occupying lesion (neoplasia, lymphadenopathy, abscess) 
- Colorectal neoplasia
- Colorectal abscess
- Perineal hernia (pelvic floor mm) 
- Innapropriate diet
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13
Q

Outline the clinical signs of megacolon

A
  • chronic constipation
  • tenesmus
  • V+ if v long term
  • anorexia
  • weight loss
  • large colon containing faecal material
  • dehydration
  • poor body condition
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14
Q

What should be the first option for megacolon Tx? What are the 2 main Tx options?

A

> Treat underlying 2* disease

  • Medical management (evacuation of colon, laxatives, prokinetics, frequent walks, ^ fibre v residue diet)
  • Surgery (subtotal coloctomy)
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15
Q

What are the post-op complications associated with subtotal colectomy? What is the prognosis?

A
  • recurrent constipation
  • ^ defeacation freqency
  • soft watery feaces
  • tenesmus
  • rectal prolapse
    > prognosis good
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16
Q

What % of colorectal neoplasia is malignant? Give examples of benign and malignant tumours.

A

50%

  • Benign: Adenomatous polyps [~50% show malignant transformation], leiomyomas
  • Malignant: Adenocarcinomas, leimyosarcoma, lymphoma, haemangiosarcoma (endothelial cells of BVs) plasmacytoma
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17
Q

Which artery should NOT be ligated when performing colorectal resection?

A

Caudal mesenteric - may appear small in the cat! Will remove entire blood supply to rectum. Always ligate close to rectum.

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18
Q

What signalment is over-represented for colorectal neoplasia?

A
  • older dogs 6-9yo

- adenocarcinomas in GSD, Great Dane, Boxer, Doberman

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19
Q

What are the clinical signs of colorectal neoplasia?

A
  • tenesmus
  • haematochezia
  • ^ defaeatory frequency
  • Ribbon-like feaces
  • Rectal prolapse
  • weight loss
20
Q

Where are 60-80% colorectal adenocarcinomas? What would be felt on rectal exam?

A
  • Mid-caudal rectum, palpable on rectal exam

- Polypoid mass, irregular mucosal surface, annular stricture

21
Q

What diagnostics may be used to diagnose colorectal neoplasia?

A

Radiography (abdo and thorax)
Ultrasound guiding FNA
Colonoscopy and grab biopsy

22
Q

What are the 2 types of surgical treatments of colorectal neoplasia? Are these curative?

A
  • Submucosal resection
  • Wide surgical excision [3cm] with intestinal resection and anastomosis
    > treatment but not cure
23
Q

How can relaxation of the anus for transanal surgery be acheived?

A

Epidural

24
Q

When is rectal pull-through for surgery advocated?

A

Lesion in caudal 1/3 to 1/2 of rectum

25
Q

What is the prognosis for adenomatous polyps?

A
  • surgical resection can -> cure
  • 17% dogs recurrence at ~12months
  • 25% dogs malignany transformation at 9-17months
  • median survival >2years [GOOD!]
26
Q

What is the prognosis for adenocarcinomas?

A
  • cure possible with complete resection (low rate of distal metastasis)
  • complete resection often difficult due to location
  • median survival 22 months
27
Q

What is the median survival time for treatment of colorectal tumours with fecal softeners alone?

A

15 moths

28
Q

What is the 1st choice for treatment of colorectal tumours?

A

Submucosal section alone - Mean disease free interval: 36.8months
Complications all resolved within 1 week

29
Q

Give 3 main causes of rectal prolapse. What age group are most commonly seen?

A
  • GI parasites
  • Rectal neoplasia
  • Perineal hernias
    > young animals
30
Q

Give 4 conservative treatments of rectal prolapse

A
  • Anthelmintics
  • Feacal softeners
  • Low residue diet
  • Sedatives
31
Q

Give 2 surgical treatments of rectal prolapse

A
  • Purse string suture around anus (leave 1-2.5mm gap) cut and stitch simultaneously so free end of rectum not lost. Remove ~ 1 week
  • if repeat prolapse suture colon wall to transversus abdominis (submucosa so almost full thickness)
32
Q

What are anal sacs formed from?

A

Invaginations of skin

33
Q

What clinical signs are associated with anal sac impaction, inflammation and infection?

A
  • perineal irritation (scooting, licking, discomfort on defaecation)
  • enlarged, potentially painful anal sacs
  • abnormal secretions (should be watery brown, may become thick and pasty white/yellow/green)
  • reddened inflamed skin or draining tract suggestive of infection or ruptured abscess
34
Q

What is the treatment for anal sac impaction?

A

Manual expression

35
Q

What is the treatment for anal sacculitis/abscess?

A
  • sedate/anaesthesia
  • catheterise duct opening (lacrimal cannulae) lavage sacs with 0.9% saline
  • Collect sample for culture and cytology
  • Instill dexamethasone and ABs
  • Systemic ABs if evidence of abscess or systemic disease
  • Topical treatment of yeast overgrowth if indicated on cytoloty
36
Q

What are the 2 types of anal sac surgery? What should be done prior to this?

A
  • Anal sacculotomy - open or closed

> treat inflammation/infection before surgery

37
Q

What are the complications associated with anal sacculotomy? Are these common?

A

> uncommon

  • fecal incontinence (if dissection was traumatic/aggressive)
  • usually temporary unless BOTH caudal rectal nerves cut (if only one the other can compensate)
  • persistent infection with draining tracts if failure to remove all anal sac tissue
38
Q

Give a highly malignant anal sac tumour. What differential diagnoses should be considered?

A

Apocrine gland adenocarcinoma (50% metastasis at diagnosis)
DDx
- perianal adenoma (circumanal, hepatoid) - benign, common, testosterone driven, intact males and spayed females. -> Castration (±surgery)
- Perianal adenocarcinoma - malignant, rare -> treat as sac adenocarcinoma

39
Q

How may anal sac apocrine gland adenocarcinoma be diagnosed?

A
  • Paraneoplastic syndrome -> Hypercalcaemia, PUPD
  • PE
  • Haemotology, biochem, urinalysis
  • FNA/incisional biopsy
  • Radiography/ultrasound of thorax and abdo
40
Q

What is the treatment for anal sac apocrine gland adenocarcinoma? What is the prognosis?

A

> Surgery, radiation, chemo
Prognosis
- Treatment including surgery 548d
- All 3 treatments 956d

41
Q

Which breeds are predisposed to anal furunculosis?

A

GSDs

42
Q

What is anal furunculosis?

A

Immune mediated fistulas and draining tracts from abscesses

43
Q

What diagnostics should be performed for anal furunculosis?

A
  • Biopsy (culture, histopath, bacteria)

- Check anal glands are intact

44
Q

What is the usual treatment for anal furunculosis?

A

Immunomodulatory - Cyclosporine high dose until lesion clears then taper
- ketoconazole - prolongs cyclosporine action but side effects so not always used

45
Q

How much does a standard dose regime of cyclosporine cost to treat one GSD?

A

£1000/month for ~4 months until lesions clear

Alimentary (30 decks)

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