Anal Sac Disorders PDF - Canine and Feline, 7th Edition

Canine and Feline, Seventh Edition 77 Anal Sac Disorders A...

Canine and Feline, Seventh Edition 77 Anal Sac Disorders A Compulsive disorder (anal licking). Colitis or other intestinal disorder. Keratinization disorder. Anal sac neoplasia (adenocarcinoma, ­ BASICS squamous cell carcinoma, melanoma). Perianal ­ MEDICATIONS OVERVIEW adenoma, adenocarcinoma. Perianal fistulae. DRUG(S) OF CHOICE Anal sacs are reservoirs for secretions CBC/BIOCHEMISTRY/URINALYSIS Infection normally evacuated by compression during Use of appropriate oral antibiotics: cephalexin defecation. Normal gland secretions vary Impaction/Infection Usually normal. (dog, 22–30 mg/kg q12h), amoxicillin widely in consistency and color. Disorders trihydrate–clavulanate potassium (dog, include impaction, infection/sacculitis, and Neoplasia 13.75 mg/kg q12h; cat, 62.5 mg/cat q12h), neoplasia. Treatment options include Hypercalcemia—anal sac adenocarcinoma. clindamycin (dog, 11–22 mg/kg q24h; cat, manual expression, flushing, antibiotics, and 11–30 mg/kg q24h), trimethoprim–sul- OTHER LABORATORY TESTS surgical excision. famethoxasole (dog, 15 mg/kg q12h); None unless indicated by an underlying cause. SIGNALMENT metronidazole (dog, 15–25 mg/kg q12–24h); IMAGING Impaction/Infection enrofloxacin (dog, 10–20 mg/kg q24h), None unless indicated by an underlying cause. Dogs and cats (rarely)—no age or sex orbifloxacin (dog/cat, 5 mg/kg q24h). DIAGNOSTIC PROCEDURES predisposition. Breeds predisposed CONTRAINDICATIONS/POSSIBLE Digital palpation of anal sacs—should not be (impaction)—smaller breeds (miniature/toy INTERACTIONS palpable externally. Expression of anal sac poodle, Chihuahua, American cocker and Trimethoprim–sulfamethoxasole— contents—varies widely in gross appearance and English springer spaniel). Dobermans highly susceptible to type III microscopic characteristics. Cytology (normal Neoplasia dogs/cats)—one study reports Gram-positive hypersensitivity reactions. Adenocarcinoma—English cocker spaniel cocci/rods, Gram-negative cocci/rods, yeast, most commonly reported. nondegenerate neutrophils without phagocytosis, SIGNS mononuclear cells, and corneocytes; erythrocytes uncommonly found in dogs, rare in cats. Another Impaction/Infection study had similar findings but with intracellular ­ FOLLOW-UP Anal/perianal pruritus—often manifested bacteria in clinically normal dog anal sacs. Impaction/Infection by “scooting.” Hesitancy to defecate. Reassess patients weekly initially, then as Tenesmus. Tail chasing. Foul-smelling, Impaction/Infection Cytology—no statistically significant necessary to monitor healing. Manually nonfeces anal discharge. Refusal to sit and/ express anal sac contents and/or flush contents or lift tail. Cats—excessive licking of the difference in bacterial counts or inflammatory cells found between normal dogs and those with until sacs empty without intervention. ventral abdomen and tail head. Abscess— Trimethoprim–sulfamethoxasole—monitor often unilateral; localized pain and discharge. clinical signs of anal sac disease. Bacterial culture and susceptibility—Bacillus, Escherichia tear production, liver function; affects thyroid Neoplasia coli, Micrococcus, Proteus mirabilis, Streptococcus serum values. Mass or swelling in perianal region. spp., others possible. Tenesmus, constipation, polyuria/polydipsia (due to hypercalcemia with adenocarcinoma). Neoplasia L4-Cd myelopathy reported in one cat Surgical excision with histopathology. (adenocarcinoma). ­ MISCELLANEOUS CAUSES & RISK FACTORS SEE ALSO Adenocarcinoma, Anal Sac Impaction/Infection Perianal Fistula Predisposing factors—changes in muscle ­ TREATMENT tone, fecal form (soft stool/diarrhea), secretion ­Suggested Reading Impaction/Infection Helton Rhodes KA, Werner A. Blackwell’s character/volume leading to decreased/lack of Gentle manual expression and/or flushing of expression; intestinal disease, obesity, endocrine Five-Minute Veterinary Consult: Clinical contents. Sedation may be necessary to flush Companion: Small Animal Dermatology, 3rd disease. Infection/abscess—chronic or severely impacted or painful anal sacs. recurrent impactions. ed. Hoboken, NJ: Wiley-Blackwell, 2018. Feeding high-fiber diets may help natural James DJ, Griffin CE, Polissar NL, Neradilek expression of anal sacs. Identification of MB. Comparison of anal sac cytological underlying causes of predisposing disease. findings and behaviour in clinically normal Chronic disease—anal sac excision. dogs and those affected with anal sac Infection—infusion of antibiotic and/or ­ DIAGNOSIS corticosteroid medications directly into the anal disease. Vet Derm 2010, 22:80–87. Author Heather D. Edginton DIFFERENTIAL DIAGNOSIS sacs, drainage of abscesses, use of appropriate Consulting Editor Alexander H. Werner Impaction/Infection/Neoplasia oral antibiotics and/or antiyeast medication. Resnick Hypersensitivity (flea, atopy, food). Neoplasia Acknowledgment The author acknowledges Tapeworm infestation. Tail fold bacterial Surgical excision and staging; combine with the prior contribution of Alexander H. folliculitis. Malassezia dermatitis. chemotherapy. Werner Resnick.