Difference between revisions of "Colonic Impaction - Dog and Cat"
| Line 35: | Line 35: | ||
Abdominal radiographs reveal a colon filled with faecal material. Radiographs are not normally needed to make a diagnosis of colonic impaction as it can usually be identified on clinical exam, however in certain cases it can identify the cause. A fractured pelvis, dislocated hip, enlarged prostate and colonic or rectal mases can be found on radiographs. | Abdominal radiographs reveal a colon filled with faecal material. Radiographs are not normally needed to make a diagnosis of colonic impaction as it can usually be identified on clinical exam, however in certain cases it can identify the cause. A fractured pelvis, dislocated hip, enlarged prostate and colonic or rectal mases can be found on radiographs. | ||
| − | ==Endoscopy== | + | ===Endoscopy=== |
Colonoscopy will identify a colonic or rectal mass or stricture and facilitates obtaining biopsy specimens. | Colonoscopy will identify a colonic or rectal mass or stricture and facilitates obtaining biopsy specimens. | ||
| Line 42: | Line 42: | ||
Dehydrated patients should receive IV fluid therapy, with correction of any concurrent electrolyte and acid-base abnormalities. | Dehydrated patients should receive IV fluid therapy, with correction of any concurrent electrolyte and acid-base abnormalities. | ||
| − | A warm water enema can be used to soften and allow the impaction to pass. Laxatives such as Emollient laxatives (docusate sodium), Stimulant laxatives (bisacodyl), saline laxatives and disaccharide laxatives (lactulose) are also beneficial. | + | A warm water enema can be used to soften and allow the impaction to pass. Laxatives such as Emollient laxatives (docusate sodium), Stimulant laxatives (bisacodyl), saline laxatives and disaccharide laxatives (lactulose) are also beneficial. Mineral oil and white petroleum lubricants should be avoided due to the risk of aspiration because of their tasteless nature. |
| − | Cisapride, a motility modifier is indicated in early cases of megacolon. | + | Cisapride, a motility modifier is indicated in early cases of megacolon but is contraindicated in cases of obstruction. |
Owners should be educated with regard to management. An appropriate wet diet should be fed, dietary supplementation with bran is helpful in some cases, fresh water should be freely available and activity should be encouraged. | Owners should be educated with regard to management. An appropriate wet diet should be fed, dietary supplementation with bran is helpful in some cases, fresh water should be freely available and activity should be encouraged. | ||
| + | |||
| + | Anitduirectic and anticholinergic drugs should be avoided. | ||
===Surgery=== | ===Surgery=== | ||
Revision as of 08:23, 10 August 2010
 |
This article is still under construction. |
Description
Colonic impaction is intractable constipation which can occur in all species, including the dog and cat. There are hardened faeces in the colon and a delayed or failure of faecal passage. The slower transit time allows more salt and water to be reabsorbed, leaving drier faeces in the colon which are more difficult to pass. Peristalsis may increase initially but is then significantly reduced or even absent due to chronic distension and smooth muscle degeneration.
Chronic cases may progress to Obstipation, the faeces become so hard and dry that defecation is no longer possible and ultimately there is secondary degeneration of the colonic musculature.
Signalment
Animals most commonly affected depend on the cause of the impaction. Significant risk factors include metabolic disease causing dehydration, inapproaprate diet, and drug therapy affecting gastrointestinal motility such as anticholinergics.
Diagnosis
Clinical signs
- Failure to pass faeces
- Tenesmus
- Dyschezia
- Anorexia
- Lethargy
- Vommiting
On abdominal palpation the colon is filled with firm faecal material. Digital rectal examination will reveal hardened faecal balls, there may be a palpable mass or sticture, anal sac disease or perineal hernia depending on the cause.
Ultrasound
Abdominal ultrasound shows a colon imapacted with faecal material. It may also reveal the cause in some cases such as foreign body, colonic mass, enlarged prostate or stricture.
Radiology
Abdominal radiographs reveal a colon filled with faecal material. Radiographs are not normally needed to make a diagnosis of colonic impaction as it can usually be identified on clinical exam, however in certain cases it can identify the cause. A fractured pelvis, dislocated hip, enlarged prostate and colonic or rectal mases can be found on radiographs.
Endoscopy
Colonoscopy will identify a colonic or rectal mass or stricture and facilitates obtaining biopsy specimens.
Treatment
The treatment depends on the severity and duration of the impaction.
Dehydrated patients should receive IV fluid therapy, with correction of any concurrent electrolyte and acid-base abnormalities. A warm water enema can be used to soften and allow the impaction to pass. Laxatives such as Emollient laxatives (docusate sodium), Stimulant laxatives (bisacodyl), saline laxatives and disaccharide laxatives (lactulose) are also beneficial. Mineral oil and white petroleum lubricants should be avoided due to the risk of aspiration because of their tasteless nature.
Cisapride, a motility modifier is indicated in early cases of megacolon but is contraindicated in cases of obstruction.
Owners should be educated with regard to management. An appropriate wet diet should be fed, dietary supplementation with bran is helpful in some cases, fresh water should be freely available and activity should be encouraged.
Anitduirectic and anticholinergic drugs should be avoided.
Surgery
Surgical removal of faeces under general anaesthesia is neccessary in severe cases where enemas and laxitives have been unsuccessful. A colectomy is required in cases of obstipation or recurrent cases.
Prognosis
References
| Also known as: | Faecal impaction Constipation and Obstipation |