Flashcards in Basics of Rectal Tears Deck (23):
Rectal Tears causes
best way to avoid Rectal Tears
don't force against a contraction
who is predisposed to Rectal Tears
ponies, small breedds
Ways to avoid Rectal Tears
appropriate restraint like stocks, sedation, and twitches
Classification of rectal tears
1. only muc/submucosa
2. only muscularis
4. all the way through
How are grade 3A and 3B differnt Rectal Tears?
A. leaves serosa intact = serosal diverticulum
B. into the mesentery (dorsally) which is in the retro-peritoneal space
what is a complication of the grade 2 rectal tear?
prolapsing muc/submucosa causes a site for fecal impaction.
what are typical locations for Rectal Tears?
parallel to long axis.
dorsal rectum, 15-55 cm in
What are clinical signs of Rectal Tear?
release of pressure
can palpate things directly now.
large amount of blood on the sleeve
rectum relaxes while horse is straining
2 hours later - peritonitis and endotoxic shock
How do you dx a grade 1 rectal tear?
feels like a flap
how do you dx a grade 3 Rectal Tears?
rigid and thick edges and seperated
Other ways than palpation to dx rectal tears?
(sedate to prevent further damage - epidural or sedation)
abdominocentesis - rule out septic peritonitis
What is initial treatment for Rectal Tears?
1. minimizing what you can - pull out feces, get ready to refer
2. AM - Pen/Gent/Metron
3. FLinixin Meglumine (anti-inflamm/anti-endotoxin)
4. laxatives to soften
5. FLuids - hypertonic followed by isotonic colloids at shock dose
6. rectal packing
7. Reduce rectal activity - epidural anesthesia and catheter not to exceed 10 mls of mepiv
What is sufficient treatment for grade 1 and 2 Rectal Tears?
AB, Laxatives (mineral oiL), and dietary changes
why do we do rectal packing?
prevent progression to gr 3 or 4
prevent fecal cont
How do we rectally pack?
put 3 inch stockinette with cotton and poviodine/lubed gel 10 cm proximal to the tear
purse-string the anus closed.
then reduce activity of the rectum
when do we turn to surgical management? and what is the goal?
when GR 3 or 4
turn feces away from tear
surgical procedure for rectal tears
loop colostomy (will need reversal) - we do double incision
prepare the loop in the upper incision
make lower 8 cm incision and have loop so that the antimesenteric side can be incised.
Aftercare for surgery
petroleum-ointment around the stoma
Reversal for the colostomy
requires anesthesia and all that, then anastomose the small colon
What can be done as adjunct to gr 3 rectal tear?
prognosis of grade 1 tears