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Surgery 2 > Lecture 20: Sx of the Perineum, Rectum, & Anus 2 (Exam 3) > Flashcards

Lecture 20: Sx of the Perineum, Rectum, & Anus 2 (Exam 3) Flashcards

(62 cards)

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1
Q

Define

Inflammation of the anal sacs

A

Anal saculitis

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2
Q

Define

infection of the anal sacs

A

anal sac abscess

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3
Q

Define

obstruction of the anal sac ducts

A

impaction

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4
Q

Where are the anal sacs located in the rectum?

A

4:30 and 7:30 “o’ clock” positions

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5
Q

What percent of dogs have anal saculitis?

A

10%

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6
Q

Fill in the ?s

What clinical signs are associated with anal saculitis?

  • ?secretion
  • sac is ? expressed
  • liquid secretions with ? granules
  • can have duct obstruction or no duct obstruction
A
  • hypersecretion
  • sac is easily expressed
  • liquid secretions with yellowish-white granules
  • can have duct obstruction or no duct obstruction
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7
Q

What can lead to anal sacculitis?

A
  • diarrhea
  • obesity
  • in general decreased bowel movements
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8
Q

What breeds of dogs are most likely to develop anal saculitis?

A

small and toy breeds

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9
Q

Is anal saculitis common in cats?

A

no

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10
Q

What physical exam findings usually indicated anal saculitis?

A
  • swelling
  • draining leasion at 4 or 7 o’clock positions
  • +/- fever
  • palpate enlarged
  • firm and sometimes painful sac
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11
Q

How do you describe normal anal gland secretions?

A
  • serous
  • slightly viscid
  • granular
  • pale-yellow liquid
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12
Q

How do you describe abnormal anal gland secretions?

A
  • whitish gray
  • brown
  • yellow
  • green
  • blood
  • purulent
  • gritty
  • turbid
  • opaque
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13
Q

When should you check the anal glands of your patient?

A

every PHYSICAL EXAM that you do (externally)

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14
Q

What diagnostic imagine is recommended for neoplasia of the anal sacs?

A
  • survey radiographs
  • CT
  • MRI
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15
Q

What is the typical presentation of anal sac impaction?

A
  • sac is distended
  • mildly painful
  • cannot be readily expressed
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16
Q

What is the typical presentation of anal saculitis?

A
  • moderate to severe pain is elicited on palpation
  • secretions are liquid, yellowish, blood-tinged or purulent
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17
Q

What is the typical presentation of anal sac abscessation?

A
  • distention of sac with purulent exudate
  • cellulitis of surrounding tissues
  • erythema of overlying skin
  • pain and fever
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18
Q

When do you use a culture & sensitivity in an anal gland infection?

A

if first Abx used aren’t responding

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19
Q

What should you consider doing before performing anal saculectomy?

A
  • manual expression
  • lavage
  • topical antibiotics
  • dietary change
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20
Q

What form of treatment is NOT recommended for anal sacculitis?

A

chemical cauterization

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21
Q

What situations is an anal saculectomy indicated for?

A
  • chronic infected sacs
  • anal sac fistulae
  • neoplasia
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22
Q

What structures must be meticulously preserved to prevent fecal incontinence during an anal saculectomy?

A

anal sphincter muscle & nerves

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23
Q

(True/False) If you damage one nerve on one side of the rectum, fecal incontinence with occur.

A

false (fecal incontinence is the result of damage to the nerves on BOTH sides)

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24
Q

What does the anal sac look like externally?

A

grayish and glistening

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25
What can you pack the anal sac with to better visualize it?
iodoform umbilical tape
26
What should you always do with tissues removed from anal sac tumors?
histopathologic examination
27
What anal saculectomy technique is preferred?
Closed
28
Describe the closed anal saculectomy technique.
* external anal sphincter muscle is not transected * lumen of the anal sac remains closed
29
What procedure is shown here?
Anal saculectomy - closed technique
30
What procedure is shown here?
Anal saculectomy - open technique
31
When do perineal hernias occur?
perineal muscles separate, allowing rectum, pelvic and or abdominal contents to displace perineal skin
32
Where is a caudal perineal hernia located?
between levator ani, external anal sphincter, and internal obturator muscles
33
Where is a sciatic perineal hernia located?
between sacrotuberous ligament and coccygeus muscles
34
Where is a dorsal perineal hernia located?
between levator ani and coccygeus muscles
35
Where is a ventral perineal hernia located?
between the ischiourethralis, bulbocavernosus, and ischiocavernosus muscles
36
What causes perineal hernias?
* We don't know for sure. * hormones may be involved
37
Why do we see perineal hernias more often in males?
pelvic diaphragm is stronger in female dogs than in males
38
What can predispose a patient to developing a perineal hernia?
straining when defecating
39
What is usually within a feline perineal hernia?
rectum
40
What forms the buldge of the hernia?
perineal fascia (hernial sac)
41
If you see a perineal hernia with postrenal uremia, what is mostly likely true?
The bladder is entrapped (life threatening)
42
What percent of perineal hernias occur in male dogs?
93%
43
When does the risk of perineal hernia occurence increase until?
14 years
44
What side does a perineal hernia tend to form on?
right
45
(True/false) not all dogs with perineal hernias have perineal swelling.
true
46
What is used to determine if fluid is present in an bladder entrapment?
* ultrasound * perineal centesis
47
What is the treatment for perineal hernias?
herniorrhaphy
48
What is the downside of performing a bilateral herniorrhaphy repair?
postoperative discomfort and tenesmus may be greater than after unilateral procedures
49
What do some surgeons do to avoid performing a bilateral herniorrhaphy?
wait 4 to 6 weeks before performing second herniorrhaphy
50
What important structures may be displaced from their normal anatomy location by the hernial contents?
perineal vessels and nerves
51
What do you have to be care not to mistake for a mass in a perineal hernia repair?
prostate
52
What perineal herniorrhaphy technique is shown here?
traditional technique
53
What perineal herniorrhaphy technique is shown here?
internal obturator transposition technique
54
What can most postoperative complications be prevented by in a perineal herniorrhaphy?
meticulous surgical technique
55
What surgery is often done the same time as a herniorrhaphy to reduce hernia recurrence or contralateral herniation?
castration
56
What is recurrence of perineal hernia correlate to?
expertise of the surgeon
57
How can you prevent infection and dehiscence in a perineal hernoirrhaphy?
appropriate antibiotic prophylaxis and surgical technique
58
What post-op herniorrhaphy complication is associated with pain, non-weight-baring lameness and knuckling?
sciatic nerve entrapment
59
How do you fix sciatic nerve entrapment as a complication of herniorrhaphy?
remove offending suture from caudolateral approach
60
What is the prognosis of a perineal herniorrhaphy?
fair to good (when an experienced surgeon performs surgery)
61
Which perineal hernia patients have the poorest prognosis?
patients with bladder retroflexion
62
Can you repair preexisting neurologic abnormalities (i.e. anal sphincter incompetence or compromised urinary bladder innervation) with a herniorrhaphy?
**nope!**

Surgery 2 (22 decks)

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