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What is the difference between constipation and obstipation?
- Constipation: difficulty emptying the bowels
- Obstipation: complete inability to pass feces
What is dyschezia?
difficult or painful defecation; diseases of anal and perianal tissues
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
What types of neurologic disease can cause constipation? (3)
lumbosacral disk herniation (type II- slow extrusion), cauda equina syndrome, injury
What types of medications can cause constipation? (2)
opioids, cholinergic antagonists
What are breed predispositions for constipation and why?
- malformation of sacral spinal cord: english bulldogs, boston terriers, max cats
- perianal fistulas : GSDs
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
Megacolon is seen most commonly in _________; PE findings include... (3)
middle-aged cat; fecal impacted colon, dehydration, abdominal dicomfort
How do you define megacolon in a dog?
- colon diameter > 1 x length of L2
- or > 1.5 x length of L7
What is the most repeatable measure of megacolon in cats?
maximal colon diameter of L5 length suggests megacolon
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)
Describe the process of deobstipation. (4)
- general anesthesia
- rehydrate first!
- lots of lube
- finger, hand, siphon
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
What animals should NOT get bulk-forming laxatives?
animals with function constipation (megacolon)...it'll just make it worse
What type of laxative is lactulose?
What prokinetic agents are used to promote motility? (2)
Cisapride, [new] mosapride
What chronic diet and lifestyle modifications are recommended for animals with constipation? (4)
highly digestible, maybe fiber supplementation, increase water consumption, exercise
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
What is proctitis and its clinical signs? (3)
inflammation of rectal mucosa; tenesmus, dyschezia, hematochezia
How is proctitis diagnosed and treated?
- Dx: biopsy +/- colonscopy
- Txt: similar to IBD- diet changes, immunomodulatory
Perineal hernia may be secondary to... (2)
constipation and tenesmus
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
How is perineal hernia treated? (2)
surgical correction, address underlying disease
What are some potential causes of rectal prolapse? (2)
chronic tenesmus, endoparasites
You must differentiate rectal prolapse from ___________.
What is the treatment of rectal prolapse? (4)
replace manually, purse-string suture, +/- surgical correction, address underlying disease
Rectoanal stricture is usually secondary to... (2)
circumferential neoplasia, severe inflammation (FB, perianal fistula, rectal resection and anastomosis)
What are clinical signs of rectoanal stricture? (3)
tenesmus, duschezia, constipation
What is the treatment of rectoanal stricture? (3)
balloon dilation, bougienage, surgical resection
What is atresia ani?
rare congenital anal agenesis with poodles, boston terriers, terriers predisposed
What is the treatment for atresia ani?
surgical correction: type I (out of 4 types) has best prognosis; potential for lifelong complications
Describe the characteristics of perianal fistulas.
chronic, progressive inflammatory disorder (DDx- anal sac abscess, perianal neoplasia, trauma)
What breed is perdisposed to perianal fistulas?
What is the treatment for perianal fistulas?
immunosuppression, diet change [IBD therapy]
What causes perianal fistulas?
unknown- anatomy, bacterial etiology, immune dysfunction are proposed factors
How do you diagnose and treat anal sac abscesses?
- Dx: rectal palpation
- Txt: clip, clean, flush, antibiotics
Describe the behavior of anal sac adenocarcinoma.
unilateral, highly invasive, local and distant metastasis
What clinical findings help you diagnose anal sac adenocarcinoma? (5)
rectal exam, cytology/ biopsy, PU/PD (from hyperCa), hypercalcemia, anorexia
What is the treatment for anal sac adenocarcinoma? (3)
surgery, radiation, chemo