Atresia ani and the problem bottom

Define atresia

• where a passage in the body is closed/absent

define a hernia

• part of an organ that has been displaced/protrudes through the wall of the cavity that contains it. Normally through a weakness in the muscle/tissue wall

define atresia ani

• anal opening fails to develop

define stenosis

• narrowing of a tubluar structure

Define tenesmus

• painful/ineffective straining to defecate

define reducible hernia

• where protruding tissue can be pushed back into its proper place - often with gentle pressure

define imperforate

• lacking usual opening/aperture

define rectovaginal fistula

• abnormal opening b/w rectum and vagina - stool and fluids leak from rectum to vagina

define fistula

• abnormal connection joining two open spaces

what often occurs b/w the two open spaces in a fistula?

• fluid moves from one area to another

what is the inguinal canal?

• a slit like space b/w internal oblique muscle on one side and pelvic tendon of external oblique aponeurosis on the other side

what happens in males in the inguinal canal shortly after birth

• testicles pass through and descend into the scrotum

what is the word for a testicle that remains in the abdomen?

• cryptorchidism

does cryptorchidism require treatment?

• depends on whether one or both testicles have been retained

  • usually always need abdominal surgery to remove them, as they can post a health risk - still produce hormones

for an animal with cryptorchidism - are they fertile?

• no, often sterile.

  • if only one testicle is retained - can still produce sperm from one testicle.

should cryptorchid dogs be used for breeding?

• no → it’s an inherited condition

what anatomical structures are present in the inguinal canal of a male?

• spermatic cord

• ductus deferens

• testicular artery and vein

• external pudenal vessels

• genitofemoral nerve

• lymphatics

what structures are present in the inguinal canal of a female?

• external pudenal vessels

• genitofemoral nerve

• lymphatics

clinical signs of atresia ani?

• constipation, tenesmus, weight loss, pot-bellied

time frame of atresia ani development?

• from birth - it’s a congenital condition

treatment needed for atresia ani?

• surgical correctino

what species are affected by atresia ani?

• lambs

• calves

• pigs

• cats

• dogs

what is type 1 atresia ani?

• congenital stenosis of anus - membrane over anal opening remains
  

  

What type of atresia ani is this?

• type 1 - congenital stenosis of the anus

what is type 2 atresia ani?

• imperforate anus - rectum is a blind pouch cranial to the membrane

What type of atresia ani is this?

• type 2

what is type 3 atresia ani?

• imperforate anus - rectum terminates further cranial than type 2
  

  

What type of atresia ani is this?

Type 3

what is type 4 atresia ani?

• normal rectum and anus but proximal rectum ends as a blind pouch in pelvic canal

  • no connection b/w anus and rectum
    

    

what is atresia coli?

• section of colon/large bowel that is incomplete

what are clinical signs of atresia coli?

• abdominal distension, lack of faeces/dirty back end/lethargy

what is the time frame of atresia coli development

• congenital

what treatment is needed for atresia coli?

• surgical treatment

in which species do we find atresia ani more commonly?

• large animals - calves and lambs

what species are affected by inguinal/scrotal hernia?

• pigs, dogs, horses

what is the time frame for inguinal/scrotal hernia

• congenital

• acquired by trauma

treatment for inguinal/scrotal hernia?

• surgical correction

clinical signs of umbilical hernia?

• soft swelling underneath skin

• vomiting

• lethargy

• pain

• loss of appetite

treatment of umbilical hernia?

• can be repaired at time of neutering/can be left.

what are symptoms of a diaphragmatic hernia?

• tachypnoea, tachycardia, bowel and lung sounds - depends on organs involved

when are diaphragmatic hernias often acquired?

• surgical correction

what is a perineal hernia?

• weakening/traumatic tear in muscle near peritoneum → bladder/intestines/fat pushing through

what clinical signs may we expect to see with a cat with a bilateral perineal hernia and retroflexed bladder?

• straining to urinate, firm bladder, vomiting, lethargy, anorexia, abdominal distension

what is a retroflexed bladder

• a bladder that has moved upwards and caudally in the pelvis.

What can we use to assess faeces?

• faecal scoring chart

how many levels are there to a feacal scoring chart?

• 7

define diarrhoea

• increased watery content leading to changes in frequency, fluidity or volume of faeces

what is the pathophysiology behind diarrhoea occuring?

• increased secretion

• reduced absorption

• altered permeability

• altered motility

What is the difference between acute and chronic diarrhoea?

• acute = not episodic, present ,7 days

• present for >2 weeks or is episodic/intermittent

what key history must we take when determining cause of diarrhoea?

• if the animal scavenges

• vaccine and worming status

• presence of signs in any in-contact animals

• previous abdominal surgery

• travel history

• foreign body/toxin ingestion

• dietary history

• systemic signs

• weight loss

Of the following signs, which do you think are appropriate to ask for acute vs chronic diarrhoea?

• if the animal scavenges

• vaccine and worming status

• presence of signs in any in-contact animals

• previous abdominal surgery

• travel history

• foreign body/toxin ingestion

• dietary history

• systemic signs

• weight loss

1. acute

2. acute and chronic

3. both

4. acute

5. chronic

6. chronic/acute

7. chronic

8. chronic

9. chronic

what are the key aspects to consider in a clinical exam for a diarrheoa investingation?

• hydration

• vital signs

• BCS

• oral mucous membranes

• check under tongue

• abdominal palpation

• abdomen auscultation

• rectal examination

• skin - for dietary concerns

if the dog is presenting with acute diarrhoea but is well, what diagnostic steps should we take?

• faecal culture and examine for parasites

• ± minimum database

• symptomatic treatment

if a dog is presenting with acute diarrhoea and is unwell, what diagnostic steps should we take?

• haematology and biochemistry - especially electrolytes

• urinalysis

• faecal culture and examination for parasites

• abdominal radiography + ultrasound - rule out need for surgery

give a differential list for acute diarrhoea

D - degenerative liver/kidney disease

A- congenital defect

M - adverse food reaction, irritable bowel syndrome

N - neoplasia/foreign body

I - hepatitis/parvovirus/acute pancreatitis, coronavirus, miscallaneous viruses, endoparasites, idiopathic

t - toxin ingestion

V - foreign body → blocked blood supply? systemic disease → reduced blood flow to GIT

what are advantages to nasogastric feeding tubes?

• well tolerated

• suitable for short-term nutritional support 3-7 days

contraindications of nasogastric tubing?

• unconscious

• vomiting

• disease/dysfunction of pharynx, larynx, nares, swallowing reflex, oesophagus and/or stomach

disadvantages of nasogastric tubes?

• can be uncomfortable

  • can become blocked

what are some advantages to oesophageal feeding tubes?

• used in patients with facial trauma

• direct method of providing feed, bypassing any disease of the oropharynx

what are disadvantages for oesophageal feeding tubes

• high risk of infection

• must be placed under GA

• must be regularly inspected in an aseptic manor

what are advantages for PEG tubes

• can be used for long term nutritional supprt

• bypass any disease of the oral cavity/pharynx/oesophagus/oesophageal sphincter

what are disadvantages to PEG tubes?

• takes several days to heal

• tube cannot be removed for at least 5 days - due to the stoma site needing to heal

what structures can be examined on a small animal rectal exam?

• anus

• anal glands

• rectal wall thickness

• prostate

• contours of pelvis + sacrum

• pelvis urethra

what are the differentials for a sore bottom

• blocked anal glands!!

• urethral stones/masses

• hernia

• perineal fistula

• neoplasia

what are symptoms of anal gland abscess?

• red, swollen bottom

• scooting

• painful pooing

• nibbling/licking anus/lower back

• foul, fishy smell

• wound near bottom

• sitting suddenly

• discharge, blood/matting around bottom

• eating less

• low energy

at what position should the anal glands be?

• 4 and 8 o’clock positions

if it’s not possible to empty anal glands in a consult, what should we do?

• provide anti-inflammatories and potentially anti-biotic if suspected infected abscess

• add fibre to the diet - sugar free bran flakes/bran powder

• don’t allow to lick their bottom