SA Sx - Intestines 4

drraythe's version from 2017-09-15 00:42

Rectal prolapse, Feline Idiopathic Megacolon (FIM)

Question Answer
Who is most likely to get a rectal prolapse & why?Young animals due to heavy parasite load
How would you go about treating a prolapsed rectum? (No necrosis)1st intention after assessing, it is dirty, so anesthetize & do thorough lavage cleaning of whole area - need good assessment of mucosal area. Pinkish is good healthy tissue. Put sugar all over the prolapsed portion - acts as hydroscopic agent & dec edema in the inflamed tissues. Need to work from the tip/opening & w/ fingers push it back in until reduced & then keep pushing to stretching whole telescoping of intestines in. Place purse string w/ enough room for feces to pass (can use finger or forceps to make enough room so it's not totally cinched).
How do you want to reduce the edema of the rectal prolapse? How DONT you want to?Do NOT use ice (will burn the mucosa). Use SUGAR that reduces edema & doesn't harm the mucosa
How do you go about fixing a rectal prolapse where there is necrotic tissue?Insert tube if need to amputate... tube acts as a stint & then by 1/4s (12 to 3, oclock) cut through all layers & then tie & place simple interrupted stitches in quarters & then go all the way around (end to end anastomosis) then push in portion thats been anastomosed (lube finger well) & then purse string. Also give PTx an E collar
What is feline idiopathic megacolon?An acquired disorder of cats characterized by colonic dilation & ineffective transport of feces, resulting in chronic constipation
Can dogs get megacolon?Yes, but often due to a reason (like a broken pelvis) not idiopathic like cats
Etiology of FIM? Possible theories?Neural or smooth muscle defects postulated....but Agangliosis rarely observed & Histological abnormalities rarely seen
Who usually gets FIM? What age?Adult cats, either sex, any breed
Age of onset: range could be 1-15 yrs (so, like, anytime) but the mean age is 4.9 yrs
What is the length of duration of FIM range? Average?Range: 6 mos - 10 yrs (yikes), w/ an average duration of 2.6y
CSs of FIM?Constipation
Weight loss
Poor hair coat
How can you Dx FIM?Palpation of feces filled colon, Survey radiograph to rule out narrowing of bony pelvic canal, Ultrasound, barium enema, proctoscopy - rule out stricture or pelvic mass
Explain the barium enema as a Dx tool for FIMColon must be empty. Use a mushroom-tip or Pezzer catheter
How does Proctoscopy help Dx FIM?Evacuate distal colon... Easier & quicker than barium enema
What can you add to the warm water enema to help FIM?Add a little hydrogen peroxide to bubble & help break apart the feces
How do you Tx FIM through medical management? When should you do this & what should you know about its effectivity?[DONT DO WHILE CAT IS AWAKE] Warm water enemas, Lubrication & digital breakdown of feces (can try doyen forceps or something too), General ANx often required!! Note that Provides only short-term relief
2 options for Sx management of FIM? Which technique is not recc?(1) Colectomy
(2) Subtotal colectomy
Explain Colectomy procedure for FIM. Be mindful of what?Removal of colon plus ileocolic valve & cecum, ileorectal end-to-end anastomosis. -can be done but be careful there is no tension...ileum doesnt allow for a lot of tension
Explain Subtotal colectomy procedure for FIMRemoval of colon only, colorectal anastomosis. (works well & good results)
Why is Colotomy not recc for FIM?Colon has no tone - leaving there an empty balloon - let more accumulation of feces :(
Do you wanna use ABx w/ colectomy? Why?Yes, prophy ABx recc - colon has High bacterial content: aerobes & anaerobes
**Do you want to enema the colon before performing a colectomy?NO!!! Otherwise remnants of enemas in Sx field - if did enema, postpone for 1-2 days if PTx allows.
What determines how far prox you have to go w/ your colectomy for FIM?The extent of the proximal resection is determined by the extent of the dilation
The location of the distal resection for the colectomy of FIM is...(why?).Is 2-3 cm cranial to the pubis - need enough of a stump so can manipulate w/ stay sutures & preserve a decent blood supply - how to tell where to go? Look at vasculature. There is an antimesenteric vessel (only piece of GI that has this)
Which vessels do you need to be mindful of & ligate when performing a colectomy?Colonic, mesenteric & jejunal vessels are identified & selectively ligated
Pic for subtotal vs total colectomy for Tx of FIM - be mindful of ligation sites & transection sites.
Which style of anastomoses (end-to-end, side to end, side to side) do you wanna use for your colectomy? Why?Want end to end (so you can correct for luminal size disparity)
If you are going to suture your colectomy, what kinda suture, in what pattern?3-0 or 4-0 monofilament suture, (he mentioned non-absorbable or PDS) single or double layer closure
If you are going to use a stapler for your colectomy, what kinda stapler & why?EEA stapler provides double-layer inverting closure
What enzyme are you worried about w/ colectomy & why? When are you most worried?Increased collagenase activity occurs 5 - 7 days after colotomy or anastomosis - collagen degradation exceeds collagen synthesis
Is colon a high pressure or low-pressure system?Colon is a high-pressure (storage) conduit system
Is Subtotal colectomy curative?Subtotal colectomy is curative for megacolon in cats
Which drug might be helpful in Tx of FIM? When is it most helpful?Cisapride may be useful in the Tx of cats w/ idiopathic megacolon. Propulsant. Good for beginning of megacolon & there isnt too severe of damage to innervation musculature.
What are 3 postoperative considerations/signs you might see after a colectomy?(1) Tarry feces
(2) Tenesmus
(3) Anorexia
How long might the cat have tarry feces after a colectomy?2-3d
How long might the cat have tenesmus after a colectomy? (How long till 2-3 stools per day?)5-7d...after 4-6 mos 2-3 stools/day
If a cat is suffering from anorexia after colectomy, how long does this usually last? How can you make sure they are still getting nutrition?Appetite usually returns to normal w/in 7-10 days - Naso-gastric or PEG tube (aks gastrostomy tube) feeding if needed
How severely is the electrolyte/fluid/vitamin absorption affected?No clinically significant changes in fluid, electrolyte or vitamin absorption (Remaining bowel increases absorptive capacity)
Should you change the diet of the cat after a colectomy?Low residue diets may improve fecal consistency & decrease fecal volume
What will the feces be like after a colectomy?Some cats develop normal feces, most continue to have soft feces
What is the prog of a cat after a colectomy?Good to excellent
So, what is the current most recommended surgical management of FIM?Currently, the surgical management of megacolon consists of subtotal colectomy w/ the recommendation that the ileocolic jnxn be preserved
1 of the big benefits of the subtotal over the total colectomy?Sub is better bc prevents colonization of small bowel by large bowel flora
What is the only part of the GI that has vessels visible on its anti-mesenteric side?Ileum