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LAS - RUSS > Rectal Tears and Prolapses > Flashcards

Rectal Tears and Prolapses Flashcards

1
Q

T/F: Rectal tear is rarely a catastrophic event in horses

A

F, it easily can be

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2
Q

Iatrogenic Rectal Tear:

  1. Occur when? Result from?
A
  1. during palpation per rectum, from straining against operator’s hand and arm
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3
Q

Most iatrogenic rectal tears are (dorsal/ventral)?

A

dorsal.

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4
Q

Best ways to prevent iatrogenic rectal tear?

A

Copious lubrication, adequate restraing (sedation/muscle relaxation if needed), avoid palpating beyond your reach

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5
Q

Spontaneous Rectal Tears: Pathogenesis?

A

Post-Foaling, due to pressure necrosis at level of pelvic inlet.

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6
Q

How could you diagnose rectal tear immediately after they happen?
1.
2.
3.

A
  1. Sudden release of pressure
  2. Sudden ability to palpate abdominal organs distinctly
  3. blood on sleeve
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7
Q 
Ways to confirm rectal tears 
1.
2.
3.
4.
A
  1. Speculum examination of rectum
  2. Careful palpation with bare hand (consider drugs to stop rectal contractions)
  3. CBC
  4. Abdominocentesis
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8
Q

Signs of Rectal Tear:

____ and ____ occur within a few hours in more serious cases

A

Peritonitis and toxic shock

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9
Q

Signs of rectal tear:

Idiopathic tears may initially present as….

A

colic/hemorrhagic feces/aymptomatic

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10
Q

Describe Grade I rectal tear:

A

through mucosa and submucosa. May be asymptomatic

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11
Q

Describe Grade II rectal tear:

A

Muscular layer disrupted, mucosa/submucosa may prolapse into defect and provide site for fecal impaction

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12
Q

Describe Grade IIIa rectal tear:

A

All layers except serosa affected

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13
Q

Describe Grade IIIb rectal tear:

A

involves mesorectum and retroperitoneal tissue

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14
Q

Describe Grade IV rectal tear:

A

All layers into abdomen, may be associated with prolapse of small colon or small intestine through the defect

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15
Q

Rectal Tear: Location:

  1. Most tears are (ventral/dorsal)?
  2. Most tears are (longitudinal/transverse)?
  3. Distance from anus?
A

dorsal

longitudinal

15-55cm

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16
Q

T/F: Distance from anus is not a good indicator of tear location relative to retroperitoneal reflection and abdominal cavity?

A

T

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17
Q

Initial Treatment of Rectal Tears:

Treat septic shock and peritonitis with :

1.
2.
3.

A

Antibiotics

Flunixin

IV fluids

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18
Q

Initial Treatment of Rectal Tears:

Administer ____ to allow…..

A

epidural anesthesia to allow gentle removal of feces

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19
Q

Initial Treatment of Rectal Tears:

Would you want to increase or decrease rectal motility?

A

decrease

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20
Q

Initial Treatment of Rectal Tears:

Gently pack rectum: Why?
1.
2.
3.

A
  1. protect tear
  2. prevent contamination of abdomen
  3. prevent conversion of Grade II to Grade IV
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21
Q

Non-Surgical Treatment of Rectal Tears:

Grade I or II:
1.
2.

A
  1. Antibiotics and Flunixin

2. Soften Feces with mineral oil/bran mashes/green grass/moistened pellets

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22
Q

T/F Grade III rectal tears often respond to non-surgical treatment

A

T

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23
Q

Non-Surgical Treatment of Rectal Tears:

Two things to consider performing in Grade III:
1
2.

A
  1. Frequent manual removal of feces

2. Peritoneal lavage?

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24
Q

Three methods of surgical repair of rectal tears:

1.
2.
3.

A
  1. Direct suture repair
  2. Temporary indwelling rectal liner
  3. Loop colostomy
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25
Q

Direct Suture Repair of rectal tears:

Best for what kind of tears?

A

fresh clean lesions that are close to the anus

26
Q

Direct Suture Repair of rectal tears:

Drugs?

A

Epidurals

27
Q

Direct Suture Repair of rectal tears:

Suture technique?

A

Stay sutures in the anus.

28
Q

Direct Suture Repair of rectal tears:

If prolapse tear?

A

Hold with multiple Allis tissue foreceps, staple with TA90, than oversew with simple continuous suture

29
Q

Direct Suture Repair of rectal tears:

  1. Lesions usually (are/are not) accessible via midline celiotomy?
A

are not

30
Q

Temporary, indwelling rectal liner as tx for Rectal Tear:

Function?

A

protects tear and allows it to heal spontaneously

31
Q

Temporary, indwelling rectal liner as tx for Rectal Tear:

  1. May be used with our without ____
A

direct suture

32
Q

Temporary, indwelling rectal liner as tx for Rectal Tear:

Create liner by….

A

gluing palpation sleeve or similar thing to rectal prolapse ring

33
Q

Temporary, indwelling rectal liner as tx for Rectal Tear:

Best way to access?

A

caudal midline celiotomy on anesthetized horse in dorsal recumbancy.

34
Q

Temporary, indwelling rectal liner as tx for Rectal Tear:

Describe the procedure to implant one:

A

Assistant passes lubricated ring guided by surgeon to cranial of where tear is. Secure ring with tight circumferential suture.
Incorporate circumferential suture into individual sutures through all layers of colon and Dacron loops in ring.
Bury circumferential suture with lember tpattern.

Can cross tie to prevent cranial movement of sleeve when horse lies down.

35
Q

Loop Colostomy:

  1. Is/ Is not preferable to end-colostomy
A

Is

36
Q

Loop Colostomy:

Indications:
1
2
3.

A
  1. Grade IV, +/- Grade III
  2. Tear > 25% of rectal diameter
  3. Tear > 50 cm from anus
37
Q

Loop Colostomy:

Sites:
1
2
3.

A
  1. High left flank
  2. Low left flank
  3. ventral midline
38
Q

Loop Colostomy:

post care?

A

cradle = prevent self-mutilation

39
Q

Loop Colostomy:

Complications
1
2

A

Dehiscence

Infection

40
Q

Survival % for Rectal Tears:

Grade I?
II?
III?
IV?

A

93%
80%
70%
6%

41
Q

T/F: Rectal prolapses are most common in horses

A

F, more rarely in horses

42
Q

Predisposing factors of Rectal Prolapse:

Most common in what kind of cattle?

A

younger feedlot cattle

43
Q

Predisposing factors of Rectal Prolapse:

1
2.
3
4. sheep?

A
  1. Altered pressure gradient (abdominal/pelvic cavity vs anus)
  2. Decreased sphincter tone
  3. Urogenital/Repro concerns (Constipation/diarrhea/colitis/cysyitis/dystocia)
  4. Excessively short tail cropping
44
Q

Classification of Rectal Prolapse:

only mucosa projects through anus = Type ___

A

I

45
Q

Classification of Rectal Prolapse:

Small colon intussucepts into rectum = Type ___

A

III

46
Q

Classification of Rectal Prolapse:

Prolapse of all layers of rectum = Type ___

A

II

47
Q

Classification of Rectal Prolapse:

Rectum/colon intussusception through anus

A

IV

48
Q

Most common classifications of rectal prolapse?

A

Type I and Type II

49
Q

What can palpation reveal about rectal prolapse classification?

A

Type I - III will be continous with anus,

Type IV will have a palpable depression (TRENCH) inside rectum

50
Q

Management techinques to reduce rectal prolapse:

1.
2.
3.
4.
5.
A
  1. Eliminate predisposing factors
  2. Eliminate straining
  3. sooth mucosa
  4. resolve prolapse
  5. Caudal epidural anesthesia
51
Q

Purposes of Caudal Epidural Anesthesia with Rectal Prolapse Cases:

1.
2.
3.
4.

A
  1. Temporarily resolves straining
  2. Allows evaluation
  3. May facilitate re-positioning/replacement
  4. May allow surgery
52
Q

Rectal Prolapse: Treatment Options

1.
2.
3.

For Type IV specifically:
4. ____/____/____

A
  1. Replacement and purse string suture
  2. Submucosal resection
  3. Stair Step Amptuation / Amputation after through - and through- sutures
  4. celiotomy/resection/anastomosis
53
Q

Replacement and Purse String Suture as Tx for Rectal Prolapse:

Drugs to admin?

A

Caudal epirdual, lidocaine jelly

54
Q

Replacement and Purse String Suture as Tx for Rectal Prolapse:

Before placing sutures:

A

Clean prolapse with hypertonic solution/glycerol, apply lidocaine jelly, and reduce prolapse

55
Q

Replacement and Purse String Suture as Tx for Rectal Prolapse:

How tight?

Remove after how long?

A

Tight enough to allow 2-3 fingers

Remove after 1 week

56
Q

Submucosal resection as treatment for Rectal Prolapse

Use when?

A

When you have necrotic ulcerated or traumatized mucosa with healthy underlying tissue

57
Q

Submucosal resection as treatment for Rectal Prolapse

Technique Steps:

A
  1. Epidural and hypertonic solution
  2. Insert flexible tubing, fix with needles (cross pin)
  3. Make two circumferential incisions, just through mucosa, at ends of tissue to be removed
  4. Connect with longitudinal incision to same depth
  5. Remove collar of damaged tissue by blunt dissection (ligating individual vessels)
  6. Anchor tissue with 4 simple interrupted sutures (absorbable monofilament)
  7. Complete apposition with continuous suture for each quadrant
58
Q

Stair Step Amputation for Rectal Prolapse:

Has reduced risk of…

A

Stricture formation

59
Q

Stair Step Amputation for Rectal Prolapse:

  1. Type of incision?
  2. Preserve…..
  3. Create….
A
  1. Circumferential
  2. inner mucosa and submucosa
  3. create plane toward caudal aspect of prolapse
60
Q

Stair Step Amputation for Rectal Prolapse:

Make incision through…

A

inner layer of mucosa

61
Q

Stair Step Amputation for Rectal Prolapse:

Finish by…

A

creating flap of inner mucosa over outer mucosa, and suture

LAS - RUSS (32 decks)

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