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Rectum and Anus Flashcards

1
Q

What parts of the anatomy comprise rectum and anus?

A

Rectum, anal canal, internal and external anal sphincters, muscles of pelvic diaphragm, perianal skin, subcutaneous tissues

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2
Q

What type of tissue makes up the rectal mucosa?

A

Columnar epithelium, lymphoid follicles, many mucous secreting goblet cells

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3
Q

What kind of tissue is at the rectal-anal junction?

A

Stratified squamous epithelium

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4
Q

What is the function of the rectum and anus?

A

Storage and evacuation of feces

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5
Q

What kind of muscle is in the internal and external spincters?

A

Internal- smooth muscle, involuntary

External- skeletal, voluntary

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6
Q

What do the muscles of the pelvic diaphragm diaphragm do?

A
  • Provide structure and support of rectoanal canal

- Help with evacuation of feces and compression of rectum during defecation

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7
Q

What are the three types of glands within the anal canal?

A
  1. Anal glands
  2. Circumanal glands (hepatoid)
  3. Glands of the anal sac
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8
Q

What are the anal glands?

A

Modified sweat glands that secret lipids into the anal canal

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9
Q

What are circumanal glands?

A

Non-secretory

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10
Q

What are glands of the anal sac?

A

Contain protein, bacteria, sebaceous fluid, desquamated cells

  • Scent gland
  • Anal sac sit in between the inner and external muscle layers just inside anal sphincter
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11
Q

What provides parasympathetic supply to the anus and rectum?

A

Pelvic nerve- stimulate rectal motility and relaxes internal anal sphincter

Allows for defecation when relaxed

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12
Q

What provides sympathetic supply to the anus and rectum?

A

Hypogastric nerve from lumbar spine- inhibits rectal motility and causes contraction of internal sphincter

Retention of fecal material

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13
Q

What provides somatic supply to the anus and rectum?

A

Pudendal nerve- allows maximum distension of rectum for fecal storage and anal control

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14
Q

What other non-GI signs do you see in animals with hypogastic and pudendal nerve issues?

A

Dysuria or urinary incontinence

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15
Q

What are the two most common pathologies in the anus and rectum?

A

Neuromuscular and mucosal pathologies

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16
Q

T/F: Disease here is often fatal but doesn’t typically affect quality of life.

A

False- diseases are rarely fatal on their own but severely effect quality of life

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17
Q

What are the usual signs of disease of the rectum and anus?

A
  • Licking at hind end
  • Fecal incontinence
  • Discharge or smell from anal region
  • Some overlap with colonic disease (tenesmus, hematochezia, constipation)
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18
Q

T/F: Clinical signs associated with assimilation of nutrients or water are commonly seen with rectal and anal diseases.

A

False

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19
Q

What are common physical exam findings of rectal and anal disease?

A

Perineum: swelling, masses, fistulas, abscesses, herniation, prolapse

Rectal exam: anal sacs, anal tone, diameter, pelvic canal, smoothness of rectal surface, fecal content

Also palpate urethral, prostate, and assess region LNs

Often painful and may need to sedate

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20
Q

Are clin path tests really rewarding when assessing rectal and anal diseases?

A

No- usually used to exclude other issues

Coag profiles may be useful to assess ongoing bleeding

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21
Q

How do you test for pathogens?

A

Fecal floatation
Cultures or PCR
Giardia, cryptosporidium, tritrichomonas

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22
Q

What are the limitations of radiography and ultrasound?

A

Location of lesion may make interpretation difficult

Rigid proctoscopy may be more useful for assessing caudal lesions

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23
Q

What is the empiric treatment for acute disease?

A

Deworming, addition of fiber, diet change

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24
Q

What is proctitis?

A

Inflammation of the rectal mucosa secondary to foreign bodies, prolapse, or extension of colitis

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25
What are the clinical signs of proctitis?
Tenesmus, dyschezia, hematochezia
26
What do you have to exclude when assessing proctitis?
FB, infection, neoplasia If these are excluded perform biopsy to find inflammatory infiltrates
27
What is the treatment of proctitis identical to?
Colitis
28
What is a perineal hernia?
Protrusion of rectal wall and other pelvic/abdominal organs through a weakened portion of the pelvic diaphragm into the ischiorectal fossa
29
What are the organs commonly involved in a perineal hernia?
Bladder, prostate, omentum, SI, descending colon Less common in cats
30
What are the most common muscles that fail to result in a perineal hernia?
Levator ani, coccygeal, internal and external anal sphincter mucles, and fascia
31
What are the clinical signs of a perineal hernia?
Perianal swelling, tenesmus, dyschezia, possible dysuria and stranguria With concurrent disease: constipation, masses, anal sac lesion, prostatomegaly, anything tenesmus causing
32
What animals are the most likely to get perineal hernias?
Middle aged intact male dogs Suggests hormonal component
33
T/F: Many animals will live free of clinical signs of a perineal hernia for many years.
True- often causes to major issues
34
How do you treat perineal hernias?
- Attempt gentle manual reduction - Emergency if they cannot urinate - Surgery (herniorrhaphy to reappose muscles)
35
What is the prognosis of a perineal hernia?
Good as long as there's no tumor Medical management- will likely recurr
36
What will you see in a partial rectal prolapse?
Just rectal mucosa, small, red rosette protruding from the anus
37
What will you see in a complete rectal prolapse?
Entire, rectal wall, red tube structure
38
What animals are usually seen presenting of rectal prolapse?
Young animals secondary to tenesmus associated with severe enteritis
39
How do you diagnose a rectal prolapse?
Inability to pass a probe between the rectal wall and prolapsed tissue
40
How do you treat a small rectal prolapse?
Gentle manual reduction with lubrication, deworm, low residue diet, stool softeners
41
How do you treat a large rectal prolapse?
Gentle manual replacement and placement of pursestring suture to tighten anal sphincter that can be left in 5-7 days
42
What is the prognosis of rectal prolapse?
First time: typically good | Recurrent or requiring surgery: guarded to poor
43
What is a rectal stricture?
Narrowing of rectal or anal lumen usually a consequence of neoplasia, severe inflammation, extraluminal compression, masses of bladder or LN Usually in older animals
44
What are the clinical signs of rectal stricture?
Depends on severity of primary disease Tenesmus, dyschezia, constipation or obstipation, hematochezia, ribbon stools
45
What will you find on a physical of an animal with a rectal stricture?
Palpate a narrow firm lumen, may be painful, may feel impacted stool proximally
46
What other diagnostics can you do for a rectal stricture and what will you find?
Radiographs: look for masses Ultrasound: thickening of tissue, can do aspirates Scoping: visualize and biopsy abnormal tissues
47
How do you treat rectal strictures?
Balloon dilation of stricture, treat primary disease, modify diet to soften stools Surgery if required: mass removal or rectal pull through Prognosis good for benign lesions
48
What sort of neoplasms are seen in the rectum?
Benign polyps most commonly Differentials similar to colonic masses
49
What is atresia ani?
Congenital defect in puppies and kittens that is noteable within a few weeks of birth where there is an incomplete formation/opening of the anus Males> females and poodles and bostons most commonly effected
50
What are the clinical signs of atresia ani?
Usually apparent once the animal starts consuming more solid foods Tenesmus, absences of feces, no visible anal opening, perineal swelling or anal membrane protrusion due to accumulated feces Rectovaginal/urethral fistula: watery or small amounts of stool, perivulvar erythema, bacterial cystitis and vaginitis
51
How do you diagnose atresia ani?
Clinical signs and physical exam Imaging useful to determine extent of disease and surgical options
52
How do you treat atresia ani and what is the prognosis?
Surgery- technically demanding Prognosis best for a simple persistant membrane, other types are fair to poor
53
What is a parianal fistula?
aka anal farunculosis Chronic progressive inflammatory disease typically seen in middle aged to older dogs GSDs irish setters and labs
54
What are the clinical signs of perianal fistulas?
Pain, dyschezia, fecal incontinence, hematochezia, over-grooming, self-mutilation Pain may lead to lethargy, anorexia, and weight loss
55
What will you find on physical exam of a dog with perianal fistulas?
Perianal ulceration, foul smelling discharge, PAIN, may find stricture, assess anal glands May need sedation or anesthesia to fully evaluate depending on pain level and extent of disease
56
What are the differentials for perianal fistulas?
Neoplasia, ruptured anal sac, trauma
57
What may be an etiology of perianal fistulas and what supports this?
Immune dysfunction supported by responsiveness to immune modulation medications
58
How do you treat perianal fistulas?
Deep cleaning of lesions (usually requires anesthesia) with continued at home cleanings, diet change, immune modulation therapy (predinsone or cyclosporine, topical tacrolimus) Surgery may be required in cases of underlying anal sac pathology
59
What is the prognosis of perianal fistulas?
Guarded for cure but management is usually sucessful Common complications: fecal incontinence, stricture, fisutla recurrence
60
What is typically a cause for euthanasia in a perianal fistula patient?
Quality of life issues
61
What are some causes of anal sac impaction?
Inflammation, impaction of glandular material, abscess
62
What are the clinical signs of anal sac impaction?
Excessive grooming, dyschezia, tenesmus, malodor, scooting/dragging hind end on the ground
63
T/F: You can diagnose anal sac impaction on a normal physical exam.
Only if severely impacted- abscess, erythema, protrusion of perineal area, draining tracts More likely you'll have to perform a recal exam
64
What is the findings in sacculitis?
Pain, granular, greenish yellow material, often hemorrhage Associated with bacterial infection
65
What will the material in the anal sac look like if you have a true case of impaction?
Thick, foul smelling, grey-brown paste
66
What are the differentials for anal sac impactions?
Fistula, neoplasia, trauma
67
How do you treat anal sac impactions?
Gentle expression Can flush with saline and try again if very thick material or plugged
68
How do you treat sacculitis?
Express material and flush the anal sac with saline of 0.5% chlorhex and instill with topical antibiotic
69
How do you treat an anal sac abscess?
Lance lesion (if not already ruptured), clip and clean area, systemic antibiotics
70
When would you consider anal saculectomy??
With recurrent or chronic issues that are becoming a quality of life or owner management issue
71
What is the prognosis of anal sac issues?
Usually very good
72
What is an anal sac apocrine gland adenocarcinoma?
Malignant, highly invsice and metastatic tumor mostly seen in dogs of the anal gland
73
What are the clinical signs of an apocrine gland carcinoma?
Tenesmus, constipation, anorexia, weight loss Palpable firm nodule in or encompassing the anal sac often irregularly shaped May be incidental
74
What are the diagnostic criteria for apocrine gland carcinoma?
Hypercalcemia, commonly lung mets, mass aspirates, surgical resection and histology of mass
75
How do you treat apocrine gland carcinomas and what is the prognosis?
Surgical resection, radiation, therapy Prognosis is fair to guarded pending mets and hypercalcemia at time of diagnosis
76
Where do perianal adenomas arise from?
Circumanal glands
77
What dogs typically get perianal adenomas?
Usually seen in cockers, english bulldogs, samoyeds, beagles Intact males predominate
78
What are the findings and clinical signs of perianal adenomas?
Usually solitary masses in perineal region, usually no CS, may see pain, obstruction, secondary infection, or pruritis
79
How do you tread perianal adenomas and what is the prognosis?
Surgical excision with castration Prognosis is good but biopsy is recommended to confirm
80
What is fecal incontinence?
Loss of voluntary ability to retain feces or the involuntary passage of fecal material
81
What are the usual etiologies of fecal incontinence due to pathology?
Reservoir disease- stricture, fibrosis, or mural thickening, previous colonic sx Sphincter disease- denervation or structual damage of rectum or anus
82
Which type of disease causing fecal incontinence usually leads to more severe clinical signs?
Sphincter disease since they are unaware that they NEED to defecate
83
T/F: Fecal incontinence can be seen in older/senior pets without any major underlying pathology.
True
84
How will your physical exam findings differ between fecal incontinence due to sphincter disease and reservoir disease?
Reservoir disease: usually no significant findings Sphincter disease: anal sphincter tone diminished
85
How is fecal incontinence typically diagnosed?
History and physical exam findings Look for underlying causes if nothing in history
86
How do you treat fecal incontenence?
Treat the primary disease Change in diet and "bathroom" schedule, may need diapers and frequent cleaning

SAM 2 (21 decks)

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