Lecture 21: Sx of the Perineum, Rectum, & Anus 3 (Exam 3)

Question 1

What is a rectal prolapse?

Answer 1

protrustion or eversion of the rectal mucosa from the anus

Question 2

What is seen here?

Answer 2

rectal prolapse

Question 3

What animals are more prone to rectal prolapse?

Answer 3

younger animals (max cats maybe due to anal laxity)

Question 4

What key things in a patient history make them more likely to experience rectal prolapse?

Answer 4

• straining (tenesmus)
• recent perineal surgery
• young animal
• parasites
• acute enteritis

Question 5

If the patient did not recently recover from perineal surgery, what do you need to ensure you do after treating a rectal prolapse?

Answer 5

find/treat whatever caused the straining in the first place

Question 6

What must a rectal prolapse be differentiated from?

Answer 6

ileocolic intussusception

Question 7

Insertion a finger or probe alongside the outer surface of the prolapsed mass is possible with a ileocolic intussusception or rectal prolapse?

Answer 7

ileocolic intussussception

Question 8

How do you treat an acute prolapse with minimal tissue damage?

Answer 8

manual reduction & placement of a purse-string suture around the anus

Question 9

What should you do prior to a manual reduction of a rectal prolapse?

Answer 9

• warm saline lavages
• massage
• lubrication (water soluble gel)

Question 10

What procedure is shown here?

Answer 10

manual reduction of an anal prolapse

Question 11

How do you perform a manual reduction of a anal prolapse?

Answer 11

• digitally reduce small prolapses with healthy mucosa
• place a purse-string suture around the rectum

Question 12

Do you tie a purse-string at the top or the bottom of your rectum?

Answer 12

yes (either is fine)

Question 13

What can you do to stop a patient from straining during or after a prolapse reduction?

Answer 13

retention enema of several mL of Kaopectate

Question 14

What important considerations must be made with your purse-string suture in a rectal prolapse reduction?

Answer 14

• tight enough to maintain reduction of prolapse
• loose enough to allow passage of soft stool

Question 15

What anesthetic method can you utilize to decrease straining during a rectal prolapse repair?

Answer 15

epidural

Question 16

When should you perform a colopexy to repair an anal prolapse?

Answer 16

if rectal prolapse repeatedly recurs after manual reduction or amputation

Question 17

1. What procedure is seen here?
2. When do you utilize it?

Answer 17

1. Resection with probe
2. Irreducible or traumatized anal prolapses

Question 18

What can you utilize in a resection with probe if you do not have a probe?

Answer 18

syringe case

Question 19

How should a patient be positioned for a anal prolapse repair?

Answer 19

• ventral recumbency with hind legs over the end of the table
• pelvis elevated with padding
• tail secured
• end of table should be padded to prevent femoral nerve pressure

Question 20

When performing a resection with probe what should you avoid cutting at all costs?

Answer 20

the distal 1.5 cm of the colon

Question 21

How long should you use stool softeners after resection?

Answer 21

2-3 weeks

Question 22

How long do you wait to remove the purse-string in a manual reduction?

Answer 22

3-5 days

Question 23

How long do you wait to remove purse-string after a resection?

Answer 23

1 -2 days

Question 24

Prognosis of chronic rectal prolapse without surgery?

Answer 24

poor

Question 25

prognosis of chronic rectal prolapse with surgery and treatment of primary cause?

Answer 25

good

Question 26

What condition is seen here?

Answer 26

Perianal fistulae

Question 27

Should you perform surgery on a perianal fistulae?

Answer 27

NOOO!!!!

Question 28

What do we know about perianal fistulaes?

Answer 28

immune mediated

Question 29

What is required to diagnose perianal fistulae?

Answer 29

histiologic examination to rule out carcinoma, pythiosis & other erosive conditions

Question 30

What patients have increased chance of getting a perianal fistulae?

Answer 30

* German Shepards most common * Irish Setters predisposed * in-tact males * very rare in cats

Question 31

What is important to keep in mind when examining perianal fistulae?

Answer 31

* pain may cause dogs to become viscous * may abstain from getting a Temperature if extremely painful

Question 32

What medical management is used to treat perianal fistulae?

Answer 32

* immunosupression * hygiene * dietary therapy

Question 33

Is perianal fistulae an easy fix?

Answer 33

no, requires diligence and is frustrating to all parties

Question 34

Do perianal cleansing and antibiotic therapy allow perianal fistulae to heal and halt disease progression?

Answer 34

NO, seldom allow healing and may allow disease progression

Question 35

Is it cheap to treat a perianal fistulae?

Answer 35

no, can often require lifelong treatment, requires re-evaluation every 3 to 5 weeks, hematologic and biochemical monitoring may be required

Question 36

What is the most important part about perianal fistulae management?

Answer 36

Client Expectations Management!