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Exam 2
Dugat: LI
39
Veterinary Medicine
Professional
02/22/2017

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Cards

Term
What is the cecum?
Definition
-true diverticulum
-connects to proximal colon
-cecocolic orifice: adjacent to the ileocolic orifice
Term
How does the colon differ from other parts of intestines?
Definition
-pale in color & larger in diameter
-Three segments: ascending, transverse, descending (longest part)
-arterial supply is different: vasa recti (mainly from cranial mesenteric a) w/ segmental arterial supply
Term
What is the typical clinical presentation of colonic dz?
Definition
-diarrhea
0tenesmus
-hematochezia
-dyschezia
-constipation
-obstipation
Term
How do we dx colon dz?
Definition
-do everything ever
Term
Describe enemas in regard to perioperative colon management?
Definition
-contraindicated unless performing endoscopy
-incomplete cleansing
-stool consistency changes => leakage
Term
What kind of abx do we use perioperatively for colon sx?
Definition
-coliforms, anaerobes in addition to normal stuff: super diverse
-BS: Cefoxitin OR others
-continue postop
Term
Why would we use eipidural for colon sx?
Definition
-allows for relaxation fo the colon, especially for resection
-pain control
Term
What kinds of analgesia do we use for periop colon sx management?
Definition
-opioids or Tramadol
-NO NSAIDS OR STEROIDS: compromises barrier function & steroids delay healing
Term
True or FAlse: There is rarely a notable delay in return of normal motility post colon anastomosis.
Definition
-FALSE, pretty common
Term
How do we modify the diet for colon sx?
Definition
-inc fiber: inc motility & healing
-inc carbs: inc motor response
-low fat
Term
All stages of wound healing are present w/ colonic healing. Describe them.
Definition
-lag phase: immediate, <4d: inflamm phase/proliferation 4-14d, collagen formation, angiogenesis
-maturation: remodeling of collagen
Term
Is colonic healing known to be quick or slow? Explain.
Definition
-slow b/c higher collagenase levels
Term
There are significant consequenes to leaking w/ colonic healing.
Definition
higher number of bacteria
-large variety of bacteria
-higher inc in collagen = higher dehiscence rate
Term
If dehiscence occurs w/ colonic healing, when does it occur?
Definition
-during lag phase b/c inc levels of collagen
Term
How do we avoid dehischence w/ colonic sx?
Definition
-accurate suture palcement: must incoporate submucosa (holding layer)
-accurate suture spacing
-NO TENSION
-preseve segmental blood supply
-cover w/ omentum
Term
What is our approch to colonic sx?
Definition
-ventral midline laparotomy from umbilicus to pubiz
-isolate target intestine w/ lap sponges
Term
Definition: typhlectomy
Definition
-resection of the cecum
Term
What are the indications for a typhlectomy?
Definition
-impaction
-perforation
-inversion
-neoplasia
-inflammation
Term
What is our major concern w/ performing typhlectomy?
Definition
-preserve ildocolic valve
Term
What are the major indications for colotomy?
Definition
-BIOPSY
-FB removal rarely
Term
How do we close a colotomy?
Definition
-full thickness, single layer
-simple interruptred or continuous
-absorbable MONOFILAMENT suture
Term
Definition: Colectomy
Definition
-removing a section of colon
Term
What are the common indications for colectomy?
Definition
-megacolon
-intussusception
-ischemic injury: trauma, torsion, infarct
-neoplasia
-perforation: FB, trauma
Term
What is a subtotal colectomy?
Definition
-distal end of colon preserved (1-2cm cranial to pelvic brim) AND ileocolic valve preseved (maintains normal fecal consistency)
Term
What is a total colectomy?
Definition
-distal end of colon preserved
-ileocecocolic resection is performed
Term
What would be the advantage of preserving the ileocolic valve w/ colectomy?
Definition
-maintains normal fecal consistency
Term
Definition: Colopexy
Definition
-fixation of colon to abdominal wall
Term
What are the indications for a colopexy?
Definition
-rectal prolapse
-colonic volvulus
-perineal herniation
Term
What are the general closure methods of the colon?
Definition
-single layer, fullthickness closure
-appositional pattern, not inverting
-continueous or interrupted
-monofilament, absorbable, long-lasting (PDS or Maxon)
Term
What is megacolon?
Definition
-end-stage obstipation: colonic hypommotility w/ permanent inc in diameter of colon
Term
What are the common etiologies behind megacolon?
Definition
-Congenital dysfunction: Manx cats
-mechanical: pelvic outlet obstruction
-functional: spinal cord dz, pelvic n injury, dysautonomia, met dz
Term
What are some causes behind pelvic outlet obstruction leading to megacolon?
Definition
-pelvic fracture malunion
-LI strictures
-naoplasia/extraluminal masses
-idiopathic
Term
What is the typical signalment of megacolon?
Definition
-cats
-manx predisposed
-no gender predisposition
-middle-aged to older
Term
CS of megacolon?
Definition
-low BCS
-dehydration
-palpably enlarged colon
-depression, lethargy
-anorexia
-tenesmus
-constipation
-obstripation
-vomiting
-st loss
-poor haircoat
Term
What do we see on bloodwork w/ megacolon?
Definition
-nonspecific
-inflamm leukogram
-dehydration
Term
What do we see on rads w/ megacolon?
Definition
-spinal or pelvic abnormalities
-colonic masses
-enlarged colon > 1.5X length of L7 body
Term
How do we medically manage megacolon?
Definition
-should always attempt this first
-treat undelrying cause
-generally idiopathic: hydration, high viber diet, repeated enemas (NOT A FLEET ENEMA), prokinetic/motility agent
Term
How do we surgically manage a megacolon?
Definition
-subtotal colectomy
-preservation of ileocolic valve: important for fecal consistency dogs > cats
-maintaining valve may create excessive tension
-defecation frequency may inc
Term
What is the overall prognosis of megacolon?
Definition
-good
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