Page 1526 - Cote clinical veterinary advisor dogs and cats 4th

774 Perineal Hernia

• Effusion cytology: generally low yield; valvular heart disease; otherwise, chronic • Normal cardiac silhouette on radiographs
does not rule out PE.
higher with infectious cause, lymphoma, diuretic treatment for delaying recurrence • PE is rapidly depleted of clotting factors and
VetBooks.ir • Histopathology of pericardium ± mass tissue • Antiinflammatory doses of glucocorticoids should not clot during/after pericardiocen-
of primary PE is controversial.
and effusates with hematocrit < 10%
are controversial but can be used in dogs
after pericardiectomy and sample collection
tesis; if clotting is observed, suspect acute
hemorrhage or intravascular stick and sample.
pericardiectomy is not pursued.
TREATMENT with presumed idiopathic effusion when • Reactive mesothelial cells on pericardial
cytology reports may be present with either
Treatment Overview Possible Complications mesothelioma and benign pericarditis.
• Short-term: pericardiocentesis to relieve • Recurrent effusion
cardiac tamponade but not indicated if no • Constrictive pericarditis can develop with Technician Tips
evidence of cardiac tamponade, as usually recurrent effusions regardless of cause. • Dogs undergoing pericardiocentesis often feel
occurs when PE is secondary to CHF • Cardiac arrhythmias and/or sudden cardiac much better partway through the procedure;
• Long-term: treatment of primary cause; death (depends on cause) adequate restraint is critical.
pericardiectomy can reduce/prevent recur- • Dyspnea from severe pleural effusion or • If the procedure must be terminated
rence of tamponade in many cases. ascites prematurely, PE usually resolves anyway
• Pericardiocentesis related (p. 1150) because the PE continues to leak through
Acute General Treatment the pericardiocentesis site.
• Pericardiocentesis (p. 1150): necessary Recommended Monitoring
to resolve cardiac tamponade; relatively Follow-up exam and echocardiography 2-4 Client Education
contraindicated in coagulopathy, left atrial weeks after pericardiocentesis or depending • Monitor for recurrence of presenting signs
rupture, and acute hemorrhage on return of clinical signs as a sign of recurrent PE.
○ Ascites resorbs over 24-48 hours after • Rapid deterioration (including sudden death)
relief of tamponade and does not require PROGNOSIS & OUTCOME is possible.
drainage unless it is causing respiratory • Surgical pericardiectomy may prevent recur-
compromise or overt discomfort. • Guarded (average: days to months) with rence and improve survival time (depends
• Treatment of primary cause hemangiosarcoma on cause).
• Diuretics contract intravascular volume • Guarded to fair with heart base tumors and
and are contraindicated for treating cardiac idiopathic effusion; survival time increased SUGGESTED READING
tamponade acutely. with surgical pericardiectomy Cagle LA, et al: Diagnostic yield of cytologic analysis
• Hemorrhagic effusion that recurs hours to of pericardial effusion in dogs. J Vet Intern Med
Chronic Treatment days after pericardiocentesis is rarely benign; 28(1):66-71, 2014.
• Management/resolution of systemic disorder prognosis is worse. AUTHOR: Erin Anderson, VMD, DACVIM
if present EDITOR: Meg M. Sleeper, VMD, DACVIM
• Recurrent pericardiocentesis as needed PEARLS & CONSIDERATIONS
• Pericardiectomy may prevent recurrent
cardiac tamponade caused by idiopathic Comments
pericarditis or heart base mass. • Malignant PE and benign PE can appear
• Diuretics are indicated for animals with equally hemorrhagic; cytology is rarely
CHF (secondary PE) due to myocardial or helpful for differentiation.

Perineal Hernia Client Education
Sheet

BASIC INFORMATION ○ Anal sacculitis PHYSICAL EXAM FINDINGS
○ Diarrhea: inflammatory bowel disease, • Unilateral or bilateral swelling in the perianal
Definition lymphoma, parasites, other region
Atrophy and breakdown of the muscles of the • History of anal sacculectomy • External digital exam: may reduce hernia
pelvic diaphragm with prolapse of tissue/organs • Cats: history of tenesmus, megacolon, previ- contents
ous perineal surgery (perineal urethrostomy), • Rectal palpation: may need to manually
Epidemiology trauma evacuate feces
SPECIES, AGE, SEX ○ Weakened and/or disrupted pelvic dia-
• Primarily canine: highest incidence (83%-93% ASSOCIATED DISORDERS phragmatic muscles with possible rectal
of cases) among middle-aged to older, intact • Constipation sacculation to the side of the hernia
male dogs or dogs castrated later in life ○ Large rectal ampulla if bilaterally
• Rare in cats and female dogs (often secondary Clinical Presentation affected
to trauma) HISTORY, CHIEF COMPLAINT
• Tenesmus Etiology and Pathophysiology
RISK FACTORS • Ribbon-like stools • Likely multifactorial in nature
• Older intact males or males castrated late • Dysuria (bladder or prostate entrapment) • Congenital or acquired weakness of the pelvic
in life • Unilateral or bilateral perineal swelling lateral diaphragm
• Any cause of tenesmus to the anus that may change in size ○ Potentially androgen mediated
○ Prostatitis/prostatomegaly • Vomiting, abdominal pain (intestinal ○ Relaxin produced by prostate may inhibit
○ Constipation entrapment) collagen synthesis

www.ExpertConsult.com