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Flashcards in Rectal tears Deck (34)
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1

what are common causes of rectal tears?

palpation

2

what are less common causes of rectal tears

enema administration
dystocia
chronic impaction (dry) and stricture--impaction causes lesions at mucosa of rectum
breeding injuries
spontaneous rupture

3

how do you avoid a rectal tear?

do not force against straining or peristaltic wave

4

what animals do you have to take special precautions with with rectal tears?

arabian horse
ponies
small breeds
fractious horses
horses with colic

5

how can you appropriately restrain horses?/what other precaution to take?

1. stocks
2. twitch
3. sedation
4. lubrication
5. lidocaine--IV set

6

What are the grades of rectal tears?

1. grade 1
2. grade 2
3. grade 3a
4. grade 3b
5. grade 4

7

What is a grade 1 rectal tear

only mucosa and submucosa are torn

8

What is a grade 2 rectal tear

only the muscular layer is disrupted and causes mucosa and submucosa to prolapse through defect

9

what is a consequence of a a grade 2 rectal tear?

creates a site for feces impaction

10

What is a grade 3A rectal tear?

the serosal area is intact but the tear causes formatino of a serosal diverticulum.
This serosal diverticulum is li kely to be larger than defect cause by grade 2

11

What is a grade 3B rectal tear?

a tear that enters the mesentery--enters retroperitoneal space. occurs dorsally. That only leaves fat-filled mesocolon as a barrier preventing fecal contamination of abdominal cavity

12

what is a grade 4 rectal tear?

disrupts all layers of rectum. allows direct palpaton of abdominal organs and gross fecal contamination of abdominal cavity

13

where do rectal tears usually occur?

dorsal aspect of the rectum. located 15-55cm from anus and parallel to the longitudinal axis

14

what do you feel with a grade 4 rectal tear?

sudden release pressure
able to directly palpate abdominal organs

15

what are the clinical signs of a rectal tear?

within 2 hours see signs of peritonitis and endotoxic shock:
tachycardia
intestinal ileus
pyrexia
sweating
depression

16

How do you diagnose rectal tears?

1. avoid straining--epidural, sedation (xylazine, butorphanol)
2. digital palpation
3. endoscopy
4. abdominocentesis

17

differentiate feeling of grade 1 vs grade 3 rectal tear

grade 1--feels like a flap of mucosa
grade 3-there are thick rigid and seperated edges that are packed by feces

18

why would you do abdomiocentesis with a rectal tear?

to rule out septic peritonitis. good diagnostic test

19

What are the initial treatments for rectal tears?

1. reduce activity of rectum--epidural etc
2. remove feces from rectum and tear
3. treat shock and peritonitis
4. rectal packing
5. broad spectrum peritonitis
6. flunixin meglumine
7. mineral oil--lube rectum,
8. diet changes--cow pie feces

20

what antibiotics should be used with a suspected rectal tear

1. penicillin, gentamicin, metronidazole

21

What are the benefits of flunixin meglumine?

antiinflammatory
anti-endotoxin

22

what is the benefit of mineral oil?

coat feces, don't break it down so there aren't small pieces--don't want small pieces because could go through tear

23

beyond initial treatment, what steps should be taken with grade 3-4 tears?

1. aggressive intravenous fluid therapy, hypertonic saline, isotonic crystalloids

24

How do you protect tears from conversion to another grade?

1. rectal packing (stokinet with cotton, povidone iodine, lubricated gel)
2. anus closed using purse-string suture
3. epidural anesthesia

25

what is the surgical treatment for rectal tears?

divert feces away form tear--prevents contamination, impaction, enlargement, progression of peritoniti

26

What are the general steps of surgical treatment of rectal tears?

1. procedure to form stoma
2. procedure to reverse stoma

27

What is a loop colostomy?

make a loop of small colon--suture together, then make an incision in tenia--large surgery probe, and take loop down to lower incision. Cut and fold back and suture to body wall.

28

What is the after care for loop colostomy?

broad spectum (pen, gen, metronidazole)
laxatives
pretrolatum based ointment around stoma!

29

How do you reverse the stoma? (colostomy)

do anastomosis of the small colon.

30

What are complications of colostomy?

dehiscence
abscessation
peristma herniation
prolapse
rupture colostomy
spontaneous closure
anastomic impaction
dehiscence after reversal