Today's Veterinary Practice

SEP-OCT 2016

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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T O day' S Ve T erinary Prac T ice | September/October 2016 | tvpjournal.com end OS c OP y e SS en T ia LS Peer r eviewed 80 4. Make sure there is 1 cm between sampled areas to avoid repeated biopsy in the same location. This helps ensure adequate representation of disease and reduces the risk for perforation. Flexible Colonoscopy Navigating the Anatomy 1. Flexible colonoscopy is performed with the patient in left lateral recumbency. 2. Before inserting the endoscope into the rectum, make sure the distal tip of the scope is well lubricated, with care taken to avoid the objective lens. 3. Once the endoscope is inserted into the rectum, have an assistant hold the anus closed to prevent air from escaping. a fter a seal has been formed, insufflate the rectum, providing visualization. 4. Rectocolic junction: a s the scope is advanced orally, the first flexure is encountered at the rectocolic junction, where the colon begins to deviate from midline to the left side of the animal's body (Figure 5). i n most animals, this flexure is easily navigated with insufflation and deflection of the scope tip toward the lumen. Once the rectocolic junction is passed, evaluate the remainder of the descending colon. 5. Splenic flexure: The next turn is at the splenic flexure, where the descending and transverse colon meet at a near 90-degree angle. To pass the splenic flexure, advance the endoscope to the far wall of the descending colon. Then deflect the bending section upward (to the animal's right) and apply pressure while insufflating. a "red out" is usually seen as the distal tip brushes against the colonic mucosa, but the endoscope should move forward with minimal resistance. The mucosa should be seen "sliding by" the tip of the scope until the lumen is again visualized (view a video demonstrating this technique at tvpjournal.com). i f significant resistance is encountered, withdraw the scope and attempt the maneuver again. Once the splenic flexure is passed, re- establish the luminal view and evaluate the transverse colon. 6. Hepatic flexure: a fter the short transverse colon is evaluated, advance the endoscope to the hepatic flexure. The hepatic flexure is passed in a similar fashion as with the splenic flexure to gain access into the ascending colon. The ascending colon is very short in dogs and cats and terminates in the ileocolic and cecocolic junctions. i f the scope is passed without visualization of the lumen of the ascending colon, it is easy to inadvertently advance the endoscope into the cecum, as the cecocolic valve is often open. The cecum is a blind sac, and aggressive advancement of the scope can result in rupture of the cecum. The cecum in the dog is often identified by its spiral course to the distal tip. i f the hepatic flexure is passed and an open lumen cannot be identified, withdraw the scope slowly until the ileocolic valve is seen or the transverse colon is visualized. i f the cecocolic junction is closed, it appears as a flat mucosal fold. 7. Cecocolic & ileocolic junctions: To enter the cecum, center the distal tip of the endoscope on the sphincter, while applying constant gentle forward pressure with intermittent insufflation. Once the cecum is entered, advance the endoscope and evaluate the cecum. Then withdraw the endoscope to the level of the ascending colon and enter the ileocolic junction in a similar fashion. i f multiple unsuccessful attempts are made to enter the ileum, pass closed biopsy forceps through the ileocolic junction to act as a stylet, facilitating the endoscope's entry into the ileum, but take care to avoid perforating the intestine. Figure 5. Anatomy of the canine large intestine. Courtesty Savannah Mauragis

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