Small Ani. Sx- Perineal Hernias 2

drraythe's version from 2016-04-29 14:20

alternative approach/ neoplasia

Question Answer
what is the alternative approach to the perineal approach?colopexy, cystopexy, deferentopexy
If both intra-abdominal and perineal procedures are made, which procedure should be done first?intra-abdominal procedures should be done first (cleaner procedure first)
how should the colopexy be done? (what side of body etc)L hand side (thats where descending colon is) make incision on abd wall and through seromuscularis of colon, then suture back wall together and then front wall **LENGTH OF INCISION SHOULD BE NO LESS THAN 3-4 CM (as usual).
which side do you do the cystopexy on?R hand side (bc colopexy on the left, so balance it out) make 3-4cm incision in abd wall and 3-4cm incision into seromuscularis of bladder, suture back walls together and then front wall.
would you do pexys or castration first?start with pexy and then castration (clean to dirtier procedure)
why do we do the colopexy, cystopexy, deferentopexy ?reduce chances of a protrusion of the colon/rectum into ruptured pelvic diaphragm, and no risk of retroflexion of the bladder. ALSO, if pelvic diaphragm is not that compromised, it might heal on its own so you can just do these pexys and then let the pelvic diaphragm heal
how to do deferentopexy?cut the deferens (later on going to remove the testicles) then do a kinda "belt loop" procedure where the belt is a deferens and the loop is the abd wall, then reflected after looped around and sutured (2-3 stitches) -->
how should diet be after the procedure?stool softeners recommended, and low residue diets, so no pressure of patient defecating impacting the repair you did.
what are the two perineal neoplasias?Perianal gland adenoma and Apocrine cell adenocarcinoma of the anal sac or apocrine gland adenocarcinoma
which perineal neoplasia is common in males? females?MALES: Perianal gland adenoma. (esp if intact!!) FEMALES: Apocrine cell adenocarcinoma of the anal sac or apocrine gland adenocarcinoma (and neutered male dogs)
which is more common- adenoma or adenocarcinoma?adenocarcinoma much less common than adenoma
which perineal neoplasia doesnt occur in cats, and why?Perianal gland adenoma does not occur in cats (no perianal or circumanal glands)
which peineal neoplasia is associated with a paraneoplastic syndrome?Apocrine cell adenocarcinoma of the anal sac or apocrine gland adenocarcinoma
how can you differentiate a Apocrine cell adenocarcinoma of the anal sac or apocrine gland adenocarcinoma from a hernia?bulging is similar to a perineal hernia but its harder, tends to infiltrate pelvic area, and high Ca+!!!! (normal Ca++ is more than 10)

anal sac dz

Question Answer
how do you medically manage anal sac dz?Empty sacs, Instill antibiotics +/- corticosteroids (suppositories can also help soothe the area)
how do you sx manage anal sac dz?Anal sac excision
how are the anal sacs oriented in the body? what is their purpose?5 and 7 o'clock of anus. produce pheramones
pathgnomonic sign of anal sac dz/problem in anal region?pt is scooting
2 ways to do anal sac excision is...closed or open technique
how does the closed technique for anal glands work? cautions with this technique?incision parallel to anal sphincter, open skin and SQ, and then gently bluntly dissect whole sac up to the neck *careful not to rupture bc if you leave any tissue behind that will produce secretion and cause problems in the future. can help avoid this by injecting like a jello or plaster or formaldehyde so that the gland is roughened and tougher and less likely to rupture. Then remove the gland up to the neck!!! to be successful. No closing sutures, just the circumferential at the level of where you removed the sac
how does the open techniqe for anal glands work?cut perpendicular to the anal sphincter-- then insert scissors (iris scissors/strabismus scissors- (the super fine ones like we use in the perineal urethrostomy in cats) ) insert one blade into the ductus or the opening of the anal sac, then make incision that will encompass the mm of the external anal sphincter and then open this like peeling it off in half, then bluntly dissect rest of sac, and then remove it. Once done, have to suture mm again, then SQ then skin.
which technique is cleaner- open or closed?closed is cleaner