GI3- Constipation/ Anorectal

  1. What is the difference between constipation and obstipation?
    • Constipation: difficulty emptying the bowels
    • Obstipation: complete inability to pass feces
  2. What is dyschezia?
    difficult or painful defecation; diseases of anal and perianal tissues
  3. What are causes of constipation? (9)
    low fiber diet, indigestible material in diet (bones, hair), dehydration, electrolyte abnormalities (hypoK, hyperCa), mechanical obstruction, neurologic disease, inflammation (perianal fistula, abscess, proctitis), drugs (opioids, cholinergic antagonists), lack of exercise
  4. What types of neurologic disease can cause constipation? (3)
    lumbosacral disk herniation (type II- slow extrusion), cauda equina syndrome, injury
  5. What types of medications can cause constipation? (2)
    opioids, cholinergic antagonists
  6. What are breed predispositions for constipation and why?
    • malformation of sacral spinal cord: english bulldogs, boston terriers, max cats
    • perianal fistulas : GSDs
  7. What are types of megacolon? (3)
    • idiopathic: dilated colon with permanent loss of function
    • obstructive: hypertrophic colon due to pelvic canal stenosis or anorectal disease
    • neurogenic: lumbosacral disease, traumatic injury
  8. Megacolon is seen most commonly in _________; PE findings include... (3)
    middle-aged cat; fecal impacted colon, dehydration, abdominal dicomfort
  9. How do you define megacolon in a dog?
    • colon diameter > 1 x length of L2
    • or > 1.5 x length of L7
  10. What is the most repeatable measure of megacolon in cats?
    maximal colon diameter of L5 length suggests megacolon
  11. What is the treatment of megacolon? (8)
    • Immediate: manual deobstipation!!
    • improve hydration, address underlying cause (obesity, mechanical disease, neuromuscular dz)
    • Chronic: stool softeners, prokinetics, diet, exercise, +/- subtotal colectomy (last stitich effort)
  12. Describe the process of deobstipation. (4)
    • general anesthesia
    • rehydrate first!
    • lots of lube
    • finger, hand, siphon
  13. What are the types of laxatives and how do they work? (4)
    • Bulk-forming: absorb liquid in intestine--> bulky mss to stimulate motility; mostly fiber
    • Lubricant: impede colonic water absorption; only for mild cases; only per rectum!
    • Hyperosmotic: draw water into intestine and stimulate motility; lactulose
    • Stimulant: stimulate intestinal motility
  14. What animals should NOT get bulk-forming laxatives?
    animals with function constipation (megacolon)'ll just make it worse
  15. What type of laxative is lactulose?
    hyperosmotic laxative
  16. What prokinetic agents are used to promote motility? (2)
    Cisapride, [new] mosapride
  17. What chronic diet and lifestyle modifications are recommended for animals with constipation? (4)
    highly digestible, maybe fiber supplementation, increase water consumption, exercise
  18. What is the most important thing to remember when using a prokinetic agent?
    CLEAN THEM OUT FIRST; do not use a prokinetic in an obstructed patient
  19. What is proctitis and its clinical signs? (3)
    inflammation of rectal mucosa; tenesmus, dyschezia, hematochezia
  20. How is proctitis diagnosed and treated?
    • Dx: biopsy +/- colonscopy
    • Txt: similar to IBD- diet changes, immunomodulatory
  21. Perineal hernia may be secondary to... (2)
    constipation and tenesmus
  22. What are the clinical signs of perineal hernia? How is it diagnosed?
    • Signs: perianal swelling, tenesmus, dyschezia, stanguria/ hematuria (if bladder is trapped)
    • Dx: based on exam and rectal palpation
  23. How is perineal hernia treated? (2)
    surgical correction, address underlying disease
  24. What are some potential causes of rectal prolapse? (2)
    chronic tenesmus, endoparasites
  25. You must differentiate rectal prolapse from ___________.
  26. What is the treatment of rectal prolapse? (4)
    replace manually, purse-string suture, +/- surgical correction, address underlying disease
  27. Rectoanal stricture is usually secondary to... (2)
    circumferential neoplasia, severe inflammation (FB, perianal fistula, rectal resection and anastomosis)
  28. What are clinical signs of rectoanal stricture? (3)
    tenesmus, duschezia, constipation
  29. What is the treatment of rectoanal stricture? (3)
    balloon dilation, bougienage, surgical resection
  30. What is atresia ani?
    rare congenital anal agenesis with poodles, boston terriers, terriers predisposed
  31. What is the treatment for atresia ani?
    surgical correction: type I (out of 4 types) has best prognosis; potential for lifelong complications
  32. Describe the characteristics of perianal fistulas.
    chronic, progressive inflammatory disorder (DDx- anal sac abscess, perianal neoplasia, trauma)
  33. What breed is perdisposed to perianal fistulas?
  34. What is the treatment for perianal fistulas?
    immunosuppression, diet change [IBD therapy]
  35. What causes perianal fistulas?
    unknown- anatomy, bacterial etiology, immune dysfunction are proposed factors
  36. How do you diagnose and treat anal sac abscesses?
    • Dx: rectal palpation
    • Txt: clip, clean, flush, antibiotics
  37. Describe the behavior of anal sac adenocarcinoma.
    unilateral, highly invasive, local and distant metastasis
  38. What clinical findings help you diagnose anal sac adenocarcinoma? (5)
    rectal exam, cytology/ biopsy, PU/PD (from hyperCa), hypercalcemia, anorexia
  39. What is the treatment for anal sac adenocarcinoma? (3)
    surgery, radiation, chemo
Card Set
GI3- Constipation/ Anorectal
vetmed GI3