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Small Animal Surgery > 7 - Large Intestines > Flashcards

7 - Large Intestines Flashcards

1
Q

What are 6 indications for surgery of the large intestines?

A
  1. Obstruction
  2. Perforation
  3. Torsion/entrapment
  4. Colonic inertia (megacolon)
  5. Chronic inflammation
  6. Rectal prolapse
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2
Q

What is NOT an indication for surgery of the large intestine?

A

routine biopsy

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3
Q

What is a colotomy?

A

Incision into the colonic lumen

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4
Q

What is a colectomy?

A

Partial or complete resection of the colon

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5
Q

What is a colopexy?

A

Surgical fixation of the colon

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6
Q

What is a colostomy?

A

Creation of an artificial opening into the colonic lumen

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7
Q

What is the most common reason for R&A of the colon?

A

tumor

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8
Q

What is megacolon?

A

Increased colon diameter and hypomitility associated with severe constipation

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9
Q

What species most commonly gets idiopathic megacolon?

A

cats

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10
Q

What are the 4 steps for medical treatment of megacolon?

A
  1. Evacuate colon
  2. Antibiotics
  3. Osmotic laxatives (lactulose)
  4. Prokinetic drugs (cisapride)
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11
Q

What is the approach to surgical treatment of megacolon?

A
  1. Removal of entire colon except a short segment needed to re-establish intestinal continuity
  2. Subtotal colectomy
  3. +/- address pelvic stenosis
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12
Q

What are 2 ways by which we can do a subtotal colectomy?

A

Ileocolic anastomosis or colocolic anastomosis

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13
Q

What is typhlectomy?

A

Removal of the cecum

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14
Q

What are 5 indications for a typhlectomy?

A
  1. Impaction
  2. Perforation
  3. Inversion
  4. Severe inflammation
  5. Neoplasia
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15
Q

What are 2 indications for a colopexy?

A
  1. Chronic rectal prolapse
  2. Recurrent perineal hernia
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16
Q

What side should a colopexy be done on?

A

left

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17
Q

Why is a colostomy rarely performed?

A

Animals don’t do well with it -

Fecal incontinence occurs and there are very high management requirements

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18
Q

What are the 2 main approaches to the rectum?

A
  1. Ventral midline celiotomy
  2. Caudal/transanal approach
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19
Q

What 2 procedures/techniques can be done at the rectum with a caudal/transanal approach?

A
  1. Mucosal eversion
  2. Rectal pull-through
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20
Q

What part of the GIT has the most bacteria?

A

GIT

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21
Q

T/F: Empty and cleanse after large intestine surgery is no longer recommended.

A

True

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22
Q

Why should perioperative antibiotics be given with large intestine surgery?

A

There is a high risk of infection with coliforms and anaerobes

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23
Q

What perioperative antibiotics should be given with large intestine surgery?

A

2nd or 3rd generation cephalosporins, cefazolin, metronidazole

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24
Q

Why does the large intestine take longer to heal?

A

Collagen lysis, poor collateral, # bacteria, pressure

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25
What are medical treatments for rectal prolapse?
1. Treat underlying disease 2. Reduce (lavage and lube) 3. Purse string around anus
26
What types of lesions would be considered for surgical treatment of a rectal prolapse?
Chronic, traumatized, non-reducible lesions
27
What is used as a guide in surgical treatment of rectal prolapse?
rectal probe
28
In surgical treatment of rectal prolapse, _____ should be placed cranial to the transection site.
stay sutures
29
Rectal prolapses should be transected in \_\_\_\_\_.
stages
30
What type of closure is used for a rectal prolapse transection and what are the margins?
Appositional closure, 2 mm from edge and 2 mm apart
31
What should be done after closing the transection of a rectal prolapse?
Reduce anastomosis into pelvic/anal canal
32
What muscles support the caudal rectum?
1. Levator ani 2. Coccygeus 3. External anal sphincter m.
33
What is the role of the internal and external sphincter mm?
Control continence
34
What innervates the internal anus/perineum?
1. Parasympathetic branch of pelvic n. (S1-3) 2. Sympathetic motor from hypogastric n.
35
What innervates the external anus/perineum?
Caudal rectal branch of pudendal n.
36
The caudal rectal branch of the pudendal n. is _____ and responsible for \_\_\_\_\_.
voluntary, continence
37
What is the main vascular supply to the anus/perineum?
1. Internal pudendal a. 2. Caudal rectal a. 3. Caudal mesenteric a. 4. Cranial rectal a.
38
Where are the anal sacs located?
Between inner smooth and outer striated mm. (between internal and external sphincters)
39
The anal **glands** line the _____ and open into the \_\_\_\_\_.
wall, sac (intermediate zone)
40
What are the 2 most important diagnostic steps to make a working diagnosis regarding the anus/perineum?
1. Visual inspection 2. Palpation
41
What are 2 reasons not to do a rectal exam?
1. No finger 2. No anus
42
Fecal incontinence occurs if more than ___ cm or the final ___ cm of terminal rectum is resected.
4cm, 1.5cm
43
Fecal incontinence occurs if _____ or _____ nerves are damaged.
perineal, caudal rectal
44
Fecal incontinence occurs if more than half of the _____ is damaged.
external anal sphincter
45
What are the 2 most common anal sac diseases?
Infection or impaction
46
How should anal sacculitis be medically managed?
Expression, lavage, AB's, dietary change, treat dermatoses
47
What should not be used in medical management of anal sacculitis?
chemical cauterization
48
When should anal sacculitis be surgically managed?
When there is an abscess or if it is chronic/recurrent
49
What are DDx for a perianal fistula?
1. SCC 2. Perianal tumors 3. Anal sac fistula 4. Pythiosis 5. Tail fold pyoderma fistula
50
What is the more common treatment for a perianal fistula?
Medical - Clyclosporine
51
Which type of anal sacculectomy has less risk of contamination? Which should you never do when there is suspected neoplasia?
Closed, Open
52
What 5 diagnostics can help us determine if there is an anal neoplasia?
1. Rectal palpation 2. Imaging 3. Cytology 4. Labwork (look for hypercalcemia) 5. Histopath
53
80% of anal neoplasias are \_\_\_\_\_.
perianal adenomas
54
What sex is more likely to develop a perianal adenoma?
intact male (12x)
55
Perianal adenomas are hormone \_\_\_\_\_.
dependent
56
What is treatment for perianal adenomas?
Castration +/- local excision
57
What types of carcinomas can occur as an anal neoplasia?
Perianal or apocrine
58
When are anal sac adenocarcinomas common? When are they rare?
Common in older dogs; Rare in cats
59
Anal sac adenocarcinomas have a \_\_\_\_\_% metastatic rate to local LNs at time of Dx.
50-80%
60
What blood work level would be abnormal in an anal sac adenocarcinoma and what mediates this?
Hypercalcemia of malignancy; Mediated by PTHrp
61
What are the treatments for anal sac adenocarcinomas?
1. Primary tumor excision 2. LN removal if enlarged 3. Chemo +/- RT
62
What does atresia ani lead to?
Inability to defecate normally
63
What does a rectovaginal or rectourethral fistula lead to?
Abnormal communication and passage of feces
64
What is the medical treatment for fecal incontinence?
Treat causative disease, low residue diet, opioids, enemas, and rectal stimulation

Small Animal Surgery (17 decks)

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