Dz's of the Donk: Rectum & Anus

Question 1

Blue box: The following describes what

Columnar epithelium
Lymphoid follicles
Many mucous secreting goblet cells

Answer 1

Rectal mucosa

Question 2

Blue box: Stratified squamous epithelium can be found where?

Answer 2

At rectal: anal jxns

Question 3

There are 3 glands within the anal canal. What are they and do they do?

Answer 3

1. Anal glands: sweat glands; secrete lipids into canl
2. Circumanal glands (hepatoid): non secretory
3. Glands of the anal sac: contain protein, bacteria, sebaceous fluid, desquamated cells; scent gland; anal sac sits btwn inner and external m layers around 3 and 9:00 just inside anal sphincter

Question 4

The PNS supply comes from S1 - S3 –> pelvic nerve. What is its job?

Answer 4

Relaxes internal sphincter

Allows defection when patient is relaxed

Question 5

The SNS supply –> hypogastric n from lunar spine. What’s its job?

Answer 5

Contraction of internal sphincter

Patient doesn’t poop when they run

Question 6

Striated m and pelvic canals = skeletal m –> pudendal n. What is their job?

Answer 6

Allows maximum distension of rectum for fecal storage and anal control

Question 7

In diseases affecting hypogastric and pudendal n, what else can be seen?

Answer 7

Dysuria bc these nn also innervate the bladder

Question 8

What are some clinical signs of disease?

Answer 8

Licking at hind end, fecal incontinence, discharge or smell from anal region, some overlap w colonic dz (tenesmus, dyschezia, hematochezia, constipation); NOT involved in assimilation of nutrients or water so clinical signs like wt loss, anorexia, V & D are uncommon

Question 9

Blue box: What diagnostic method should we not forget with anal diseases if there is concern for ongoing or severe bleeding?

Answer 9

Don’t forget coagulation testing!

Question 10

T/F Rads and US might be limited in dx of rectal dz.

Answer 10

True; limited d/t location

Question 11

What is the empiric tx for acute disease?

Answer 11

Deworming
Change in dietary fiber–> addition of fiber such as psyllium
Diet change –> low residue or high fiber

Question 12

Inflammation of rectal mucosa is called _____.

Answer 12

Proctitis

Question 13

Protrusion of rectal wall and/or other pelvic and abdominal organs through weakened portion of pelvic diaphragm into ischiorectal fossa is called what?

Answer 13

Perineal hernia

Question 14

What is the common signalment for perineal hernias?

Answer 14

Middle aged, INTACT male dogs –> likely hormone induced

Question 15

A “small, red rosette” is often the way what is described?

Answer 15

Rectal prolapse

Question 16

How do we diagnose rectal prolapses?

Answer 16

Differentiate from intussusception!! By passing probe or lubed finger. Cannot pass finger btwn rectal wall and prolapsed tissue = rectal prolapse

Question 17

How do we tx rectal prolapses?

Answer 17

Small = gentle manual replacement w lube, deworm, low residue diet, stool softeners, treat underlying disease

Large= gentle manual replacement, purse string suture to tighten anal sphincter; if prolapses again then colopexy

Question 18

Rectal stricture is a narrowing of rectal or anal lumen. The signalment is in older animals as a consequence of neoplasia, severe inflammation (fistulas) etc What is the major, noticeably clinical sign we see?

Answer 18

RIBBON STOOLS!!!! Comes out in ribbons bc of narrow diameter !

Question 19

What can we expect to see on PE of rectal stricture ?

Answer 19

Palpate –> narrow, firm lumen
May be painful
May feel impacted stool proximally

Question 20

How do we dx rectal strictures?

Answer 20

“oscopy”- rigid protoscopy OR flexible endoscopy to directly visualize and biopsy abnormal tissue

Question 21

How do we tx rectal stricture?

Answer 21

Balloon dilation of stricture- like w esophageal stricture

Medical: diet, fiber, stool softeners, laxatives, Abs

Question 22

Rectal neoplasia has similar differentials to colon neoplasia. Having said that, which 2 neoplasias are overrepresented in cats and dogs?

Answer 22

Adenocarcinoma and lymphosarcoma

Question 23

Atresia ani is a congenital defect in puppies and kittens. It’s notable within a few weeks of birth or after weaning.

What breed and sex is this condition common in?

Answer 23

Males > females

Poodles and Boston Terriers over represented

Question 24

What clinical signs do we see in Types 1, 2 and 3 of atresia ani vs type 4?

Answer 24

Types 1, 2 and 3: tenesmus, absence of feces, no visible anal opening, perineal swelling or anal membrane protrusion d/t accumulated feces

Type 4: watery, small amounts of stool, perivalvular erythema; bacterial cystitis and vaginitis

Question 25

What type of atresia ahi has the best prognosis?

Answer 25

Type 1

Question 26

Perianal fistulas are chronic, progressive, inflammatory disease. What is the common signalment?

Answer 26

Middle aged to older dogs | German shepherds, Irish setter, Labs

Question 27

What clinical signs do we see with perianal fistulas?

Answer 27

PAINFUL!, dyschezia, fetal incontinence, *over grooming,* *self mutilation*

Question 28

The following PE is seen on what condition? Perianal ulceration: single or multiple ulcerated sinuses, foul smelling discharge, painful, may need sedation or anesthesia to evaluate, rectal exam may show stricture

Answer 28

Perianal fistulas

Question 29

Perianal fistulas has a complex disease etiology. What does dat mean?

Answer 29

Overriding immune dysfunction = main player as responds to immune modulation medication so we tx w an immune suppressor

Question 30

T/F The treatment of choice for perianal fistulas is surgery.

Answer 30

Nahhhh. medical mgmt >>>>>> sx Sx may be indicated if anal gland involvement is also present

Question 31

***What drug does HP lady loooove for perianal fistulas?

Answer 31

Cyclosporine! 60-100% remission. Oral DOC!!!

Question 32

What is the prognosis for perianal fistulas?

Answer 32

Guarded for cure but can be managed longterm Fecal incontinence, stricture, fistula, and recurrence associated with euthanasia decision

Question 33

What clinical signs do we see with anal sac impaction?

Answer 33

Excessive grooming, malodor, ****scooting and dragging dat ass on the ground

Question 34

T/F Rectal exam may be the only way to detect anal sac impaction.

Answer 34

True

Question 35

Thin, easily expressed, pal to dark brown liquid describes what we would see in what?

Answer 35

Normal anal gland secretions

Question 36

Pain, granular, greenish-yellow, also hemorrhage; bacterial infection describes what we would see in what?

Answer 36

Sacculitis

Question 37

Thick, gray brown paste describes what we would see in what?

Answer 37

Impaction

Question 38

How do we tx an impaction?

Answer 38

Gentle expression of impaction

Question 39

How do we tx a sacculitis?

Answer 39

Expresion, flush w saline or 0.5% chlorhexidine solution | Instill w topical antibiotic --> CURVED TIP SYRINGES

Question 40

How do we tx abscesses?

Answer 40

Lance if not ruptured Clean area and keep clean Systemic antibiotics 10-14 days

Question 41

The following describes which neoplasia? Dogs > Cats Malignant Invasive af Metastasis: 36-96% of cases Clinical signs: tenesmus, constipation, anorexia, wt loss: incidental! PE: firm nodule in/encompassing the anal sac; often irregular

Answer 41

Anal sac apocrine gland adenocarcinoma This is why we do recitals on every visit !

Question 42

What would our clin path and imaging tell us that would suggest it's anal sac apocrine gland adenocarcinoma?

Answer 42

Clin path: HYPERCa: up to 51% !! Imaging: look for metastasis in chest, bone and abdomen

Question 43

What is the best way to tx anal sac apocrine gland adenocarcinoma?

Answer 43

Surgical resection + radiation + therapy: combo of all 3 is the best!

Question 44

What signalment do we expect to see in perianal adenomas?

Answer 44

Little breeds! Cocker spaniel, English Bulldog, Samoyeds, Beagles INTACT male dogs: 85%!!

Question 45

What is the best way to tx perianal adenomas?

Answer 45

Surgical excision with castration to limit recurrence

Question 46

The following describes what? Inability to retain feces The involuntary passage of fecal material

Answer 46

Fecal incontinence

Question 47

Blue box: What age does fecal incontinence frequently affect?

Answer 47

Senior pets!

Question 48

Incontinence is seen in what 2 diseases?

Answer 48

Reservoir dz and sphincter dz

Question 49

Reservoir dz is rectal or colonic dz causes lack of capacity or compliance. Associated with stricture, fibrosis, mural thickening. Post subtotal colectomy. What kinda poop do we see?!

Answer 49

Frequent small fecal balls but can signal need to defecate

Question 50

Sphincter dz is denervation or structural damage of rectum or anus. What is a major giveaway of sphincter dz?

Answer 50

More severe of a disease bc they are not aware that they need to poop Involuntary expulsion so it just slips out :(

Question 51

What would we see on a PE of reservoir exam that we wouldn't see on a PE of sphincter dz?

Answer 51

Neuro exam- everything normal in reservoir dz | Anal sphincter tone diminished in sphincter dz

Question 52

What is our tx for incontinence?

Answer 52

Tx primary dz If postop- often just needs time Diet: low residue for some, high fiber for others Freuqnet oud oor time and exercise blah blah blah

Question 53

Clicker question: T/F The BEST immune suppressant medication for perianal fistulas is prednisone.

Answer 53

False- it's cyclosporine!