Term
|
Definition
-true diverticulum
-connects to proximal colon
-cecocolic orifice: adjacent to the ileocolic orifice |
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Term
| How does the colon differ from other parts of intestines? |
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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 |
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Term
| What is the typical clinical presentation of colonic dz? |
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Definition
-diarrhea
0tenesmus
-hematochezia
-dyschezia
-constipation
-obstipation |
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Term
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Definition
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Term
| Describe enemas in regard to perioperative colon management? |
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Definition
-contraindicated unless performing endoscopy
-incomplete cleansing
-stool consistency changes => leakage |
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Term
| What kind of abx do we use perioperatively for colon sx? |
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Definition
-coliforms, anaerobes in addition to normal stuff: super diverse
-BS: Cefoxitin OR others
-continue postop |
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Term
| Why would we use eipidural for colon sx? |
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Definition
-allows for relaxation fo the colon, especially for resection
-pain control |
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Term
| What kinds of analgesia do we use for periop colon sx management? |
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Definition
-opioids or Tramadol
-NO NSAIDS OR STEROIDS: compromises barrier function & steroids delay healing |
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Term
| True or FAlse: There is rarely a notable delay in return of normal motility post colon anastomosis. |
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Definition
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Term
| How do we modify the diet for colon sx? |
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Definition
-inc fiber: inc motility & healing
-inc carbs: inc motor response
-low fat |
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Term
| All stages of wound healing are present w/ colonic healing. Describe them. |
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Definition
-lag phase: immediate, <4d: inflamm phase/proliferation 4-14d, collagen formation, angiogenesis
-maturation: remodeling of collagen |
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Term
| Is colonic healing known to be quick or slow? Explain. |
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Definition
| -slow b/c higher collagenase levels |
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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 |
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Term
| If dehiscence occurs w/ colonic healing, when does it occur? |
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Definition
| -during lag phase b/c inc levels of collagen |
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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 |
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Term
| What is our approch to colonic sx? |
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Definition
-ventral midline laparotomy from umbilicus to pubiz
-isolate target intestine w/ lap sponges |
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Term
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Definition
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Term
| What are the indications for a typhlectomy? |
|
Definition
-impaction
-perforation
-inversion
-neoplasia
-inflammation |
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Term
| What is our major concern w/ performing typhlectomy? |
|
Definition
| -preserve ildocolic valve |
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Term
| What are the major indications for colotomy? |
|
Definition
-BIOPSY
-FB removal rarely |
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Term
| How do we close a colotomy? |
|
Definition
-full thickness, single layer
-simple interruptred or continuous
-absorbable MONOFILAMENT suture |
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Term
|
Definition
| -removing a section of colon |
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Term
| What are the common indications for colectomy? |
|
Definition
-megacolon
-intussusception
-ischemic injury: trauma, torsion, infarct
-neoplasia
-perforation: FB, trauma |
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Term
| What is a subtotal colectomy? |
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Definition
| -distal end of colon preserved (1-2cm cranial to pelvic brim) AND ileocolic valve preseved (maintains normal fecal consistency) |
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Term
| What is a total colectomy? |
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Definition
-distal end of colon preserved
-ileocecocolic resection is performed |
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Term
| What would be the advantage of preserving the ileocolic valve w/ colectomy? |
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Definition
| -maintains normal fecal consistency |
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Term
|
Definition
| -fixation of colon to abdominal wall |
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Term
| What are the indications for a colopexy? |
|
Definition
-rectal prolapse
-colonic volvulus
-perineal herniation |
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Term
| What are the general closure methods of the colon? |
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Definition
-single layer, fullthickness closure
-appositional pattern, not inverting
-continueous or interrupted
-monofilament, absorbable, long-lasting (PDS or Maxon) |
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Term
|
Definition
| -end-stage obstipation: colonic hypommotility w/ permanent inc in diameter of colon |
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Term
| What are the common etiologies behind megacolon? |
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Definition
-Congenital dysfunction: Manx cats
-mechanical: pelvic outlet obstruction
-functional: spinal cord dz, pelvic n injury, dysautonomia, met dz |
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Term
| What are some causes behind pelvic outlet obstruction leading to megacolon? |
|
Definition
-pelvic fracture malunion
-LI strictures
-naoplasia/extraluminal masses
-idiopathic |
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Term
| What is the typical signalment of megacolon? |
|
Definition
-cats
-manx predisposed
-no gender predisposition
-middle-aged to older |
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Term
|
Definition
-low BCS
-dehydration
-palpably enlarged colon
-depression, lethargy
-anorexia
-tenesmus
-constipation
-obstripation
-vomiting
-st loss
-poor haircoat |
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Term
| What do we see on bloodwork w/ megacolon? |
|
Definition
-nonspecific
-inflamm leukogram
-dehydration |
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Term
| What do we see on rads w/ megacolon? |
|
Definition
-spinal or pelvic abnormalities
-colonic masses
-enlarged colon > 1.5X length of L7 body |
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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 |
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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 |
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Term
| What is the overall prognosis of megacolon? |
|
Definition
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