REMIDI UTS I

PATOLOGI VETERINER UMUM

GANGGUAN PERTUMBUHAN

Oleh :

Nama : Ni Putu Sri Ayu Astini

NIM : 1609511034
Kelas : 2016 D

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA
DENPASAR
2018
UTS PATOLOGI UMUM
 DEGENERASI NEKROSIS
 GANGGUAN PERTUMBUHAN

Lesi yang khas dan bersifat diagnostik definitif terhadap penyakit tertentu disebut
lesi patognomonis (1). Perubahan morfologi dan fungsi sel/jaringan yang bersifat
reversible (sel/jaringan sakit) disebut degenerasi (2). Ketidakseimbangan “Na dan
K pump” dalam sel-sel jaringan dapat menyebabkan degenerasi parenkimatosa (3),
dimana pada hati diberi nama hepatosisi dan jika pada sel ginjal diberi nama
nefrosis (4). Degenerasi vacoula merupakan kombinasi antara degerasi hidropik (5)
dan degenerasi melemak (6). Jika ada lemak diantara sel-sel berparenkim disebut
infiltrasi lemak (7). Akumulasi glikoprotein dengan penampakan eosinofilik dalam
glomerulus ginjal, itu merupakan indikasi degenerasi amiloidosis (8). Akumulasi
asam urat dalam pleura atau ginjal disebut visceral gout (9). Kalsifikasi suatu
jaringan akibat peningkatan kadar ca dalam serum, maka digolongkan kalsifikasi
metastatik (10). Nekrosis adalah kemarian sel/jaringan, dimana ditandai dengan
adanya inti sel mengalami piknosis (11), karyoheksis (12), karyolisis (13). Tipe
nekrosis terdiri dari tiga, mulai yang paling ringan adalah nekrosis koagulatif (14),
nekrosis liquoafaktif (15), dan terberat nekrosis kaseosa (16), yang sering dijumpai
pada paru-paru terinfeksi penyakit tuberkulosis (17). Jika jaringan nekrotik disertai
dengan adanya cemaran bakteri disebut gangren (18). Adanya gangguan respon
makrofag alveolar akibat inhalasi senyawa karbon, disebut anthracosis (19).
Pigmentasi yang dapat menimbulkan jaundice/icterus adalah pigmentasi dari
derivat hemoglobin (20) dan porfirin.

Semakin dewasa hewan, maka kelenjar timus mengalami atrofi fisiologis (1) dan
sama halnya pada jaringan/organ bursa fabricus (2) pada unggas - (3). Tidak
adanya lubang eksresi alami setelah rektum disebut atresia ani (4), yang sering
terjadi pada anak babi. Gonad yang tidak berkembang dan bahkan menurun dratis,
walaupun saat lahir sudah ada, merupakan gangguan pertumbuhan yang disebut
aplasia (5). Peningkatan ukuran jaringan/organ otot akibat peningkatan aktivitas,
disebut hipertrofi (6), sedangkan peningkatan ukuran kelenjar prostat karena faktor
ketuaan, adalah akibat hiperplasia akibat gangguan endokrin (7). Iritasi yang
berulang dan dalam waktu lama merupakan penyebab timbulnya metaplasia (8) dan
hiperplasia (9). Gangguan pertumbuhan sel-sel dimana lebih banyak sel-sel primitif
dan tidak dapat berdiferensiasi disebut anaplasia (10) dan merupakan tingkat awal
kejadian neoplasia (11). Salah satu contoh anomali, terutama pada hewan postnatal
dan bayi adalah tidak menutupnya sekat antara atrium, yang disebut ductus
arteriosus persisten (12).
RINGKASAN JURNAL

SURGICAL MANAGEMENT OF CONGENITAL ATRESIA ANI

(IMPERFORATE ANUS) LEADING TO RECTO-VAGINAL
FISTULA IN A COW CALF

PENGELOLAAN BEDAH KONGENITAL ATRESIA ANI

(IMPERFORATE ANUS) MENGARAH KE RECTO-VAGINAL
FISTULA PADA PEDET (ANAK SAPI)

M.S.S.V. Phaneendra*, N. Dhana Lakshmi, K. Manoj Kumar and K. Sudarshan Reddy

Dept. of Surgery & Radiology, College of Veterinary Science, Tirupati 517502
E-mail: Phani.nov.bujji@gmail.com (*Corresponding Author)
Sumber: International Journal of Science, Environment ISSN 2278-3687 (O) and Technology,
Vol. 4, No 4, 2015

Atresia adalah anomaly anus dan rektum yang paling sering dilaporkan (Roberts, 1986).
Atresia anal merupakan kegagalan membrane anal untuk memecah sehingga tidak terbentuk
lubang anus alami sejak dilahirkan. Penyebab cacat kongenital ini bersifat genetik (bawaan sejak
lahir) dan lingkungan. Terdapat empat jenis utama atresi anal, yaitu stenosis kongenital anus (Type
I), imperforata anus saja (Type II), penyumbatan membrane pada bagian cranial rectum yang
berakhir sebagai kantong buntu (Type III), diskontinuitas anus normal dengan bagian kranial
rectum (Type IV).
Pada kasus dalam penelitian ini, berdasarkan sejarah dan pemeriksaan klinis, didapati
seekor sapi berusia lima belas hari, fesesnya dikeluarkan melalui vulva. Setelah pemeriksaan
daerah perineum, menunjukkan tidak adanya lubang anus, tenesmus, daerah anus menonjol dan
terdapat penyatuan antara dasar rektal dan vagina, di mana feses cair. Berdasarkan klinis dan
observasi, kasus ini dikonfirmasi sebagai atresia ani kongenital dengan fistula rekto-vaginal dan
diputuskan untuk intervensi bedah.
Sebelum dibedah, pedet direstrain dalam posisi berbaring lateral. Perbaikan untuk ketiga
anomaly, yaitu penutupan kerusakan vagina, penutupan kerusakan anus, dan rekonstruksi
pembukaan anus dilakukan terpisah. Pertama, daerah bawah perineal di bawah pangkal ekor
dipersiapkan untuk operasi aseptic, selanjutnya dilakukan anastesi. Pedet diinisisi pada cruciatum
dan sayatan dipanjangkan ke kranial. Ketika kerusakan bagian atas vagina teridentifikasi ditutup
dengan menggunakan catgut No. 1-0 dengan jahitan sederhana. Setelah itu kerusakan anus juga
ditutup. Rekonstruksi pembukaan dubur dibuat dengan penjahitan mukosa rektum dan kulit
perianal. Selanjtnya, patensi pembukaan anus dipertahankan dengan memasukkan 5 ml ujung
suntikan barrel, dijahit pada kulit dengan menjahit jahitan. Antibiotik dan analgesic diberikan
dalam periode 3-5 hari. Anus dicuci dua kali sehari dan diikuti pemberiam salep neomisin. Laras
syringe dihilangkan setelah 5 hari dan jahitan kulit diangkat pada hari ke 12 pasca operasi.
Malformasi kongenital dari rectum dan anus sering ditemukan pada semua spesies hewan
(O’Connor, 1998). Beberapa kelainan bentuk dapat menerima intervensi bedah dan beberapa
lainnya tidak dapat diperbaiki secara alami. Kelainan yang terjadi pada kasus ini adalah kongenital
rectovaginal fistula ditandai dengan adanya hubungan antara dinding dorsal vagina dan bagian
ventral rectum, sehingga vulva berfungsi sebagai saluran urogenital dan saluran gastrointestinal
dan biasanya berhubungan dengan tipe II atresia ani, di mana rectum berakhir sebagai kantong
buntu terus menuju anus imperforated (Bademkiran et al, 2009). Azizi dkk (2010)
menggambarkan tingkat kelangsungan hidup yang baik dalam menanggapi atresia ani rektifikasi
dengan menghapus potongan kulit melingkar dan menyatukan loop rektum dengan kulit. Fistula
recto-vaginal dan atresia ani biasanya diobati dengan dua teknik operasi. Dalam satu metode, cacat
pada rektum dan bibir vulvular tertutup setelah mengisolasi dan mentransmisikan fistula (Mahlar
dan Williams, 2005). Dalam metode kedua, tisection rectum hanya dari anterior ke fistula, bagian
rectum yang rusak dipotong diikuti dengan penjahitan bagian terakhir rectum dengan pembukaan
margin kulit pembukaan anal. Pemeriksaan radiografi pada kasus ini tidak diperlukan karena
tanda-tanda klinis dan temuan pemeriksaan fisik cukup memadai untuk menegakkan diagnosis.
Tindakan bedah merupakan solusi terbaik untuk mengatasi anomali kongenital di hewan.
LAMPIRAN JURNAL YANG DIRINGKAS
International Journal of Science, Environment ISSN 2278-3687 (O)
and Technology, Vol. 4, No 4, 2015, 1110 – 1113 2277-663X (P)

SURGICAL MANAGEMENT OF CONGENITAL ATRESIA ANI

(IMPERFORATE ANUS) LEADING TO RECTO-VAGINAL
FISTULA IN A COW CALF
M.S.S.V. Phaneendra*, N. Dhana Lakshmi, K. Manoj Kumar and K. Sudarshan Reddy
Dept. of Surgery & Radiology, College of Veterinary Science, Tirupati 517502
E-mail: Phani.nov.bujji@gmail.com (*Corresponding Author)

Abstract: A case of perineal congenital defect (atresia ani) with recto-vaginal fistula in a 15
day old cow calf and its successful surgical management has been reported.
Key words: Atresia ani, recto-vaginal fistula, calf.

Introduction

Atresia is the most commonly reported anamoly of the anus and rectum (Roberts,
1986). Anal atresia is the failure of the anal membrane to break down to make an anal orifice
and it has been reported as the most frequently encountered anamoly in calves (Das and
Hashim, 1996). The causes of this congenital defects may be genetical or environmental of
both, but in many cases the cause is unknown (Bademkiran et al., 2009). The most common
bovine environmental teratogens include toxic plants consumed by the dam and maternal-
fetal viral infections during gestation and the majority of genetic defects in cattle are inherited
as recessives (Newman et al., 1999). Four major types of anal and rectal atresia were reported
including congenital anal stenosis (Type I), imperforate anus alone (Type II), or combined
with more cranial termination of the rectum as a blind pouch (Type III) and discontinuity of
the proximal rectum with normal anal and terminal rectal development (Type IV) (REMI-
Adewunmi et al., 2007). Occasionally, rectum becomes ruptured due to abdominal straining
of animal forming a recto-vaginal fistula, that allows the excreta to pass out through vulvular
opening (Muhammad et al., 2015).
History and clinical observations
A 15 day old cow calf was presented to the college hospital with history of faeces
passing through vulva. Upon examination of perineal region, revealed absence of anal
opening, tenesmus, bulging at the anal region and communication between rectal floor and
vaginal roof, through which the faeces was voiding out (Fig. 1). Based on meticulous clinical
Received July 12, 2015 * Published Aug 2, 2015 * www.ijset.net
1111 M.S.S.V. Phaneendra, N. Dhana Lakshmi, K. Manoj Kumar and K. Sudarshan Reddy

observation, the case was confirmed as congenital atresia ani with recto-vaginal fistula and
decided for surgical intervention.
Surgical management
The calf was restrained in lateral recumbency. All the 3 anamolies i.e. closing of
vaginal defect, closing of rectal defect and reconstruction of anal opening were rectified
separately. Firstly the perineal region below the base of the tail was prepared for aseptic
surgery. Epidural anaesthesia of 2ml 2% lignocaine was given followed by local infiltration
of 2% lignocaine at surgical site. After development of anaesthesia, a cruciate incision was
given at anal depression. The incision extended forward to secure the rectum. The muconium
expelled to outside. The identified fistulous defect of vaginal roof was closed using catgut
No.1-0 by simple continuous sutures. Afterwards the rectal defect was also closed by blind
suturing after further evacuating the faeces. The anal opening reconstruction was made by
suturing rectal mucosa along with perianal skin using silk at 3, 6, 9 and 12’o clock position.
Further, the patency of the anal opening was maintained by inserting a 5ml edges smoothened
syringe barrel, sutured to skin by stay sutures (Fig. 2). A course of antibiotics and analgesics
were administered for a period 5 day and 3 days respectively. The newly constructed anal
opening was washed twice daily with normal saline followed by neomycin ointment
application. the syringe barrel was removed after 5 days and the skin sutures were removed
on 12th postoperative day.
Results and Discussion
The animal recovered well without any recurrence for a follow-up of 4 months.
Congenital malformations of the rectum and anus are common reported in all species of
animals (O’Connor, 1998). Some deformities are amenable to surgical intervention and some
are incorrigible in nature (Shakoor et al., 2011). Congenital rectovaginal fistula is
characterized by the communication between the dorsal wall of the vagina and the ventral
portion of the rectum, so that the vulva functions as a common opening to the urogenital and
gastrointestinal tracts and is usually associated with type II atresia ani, in which the rectum
ends as a blind pouch immediately cranial to the imperforated anus (Bademkiran et al.,
2009), which was also observed in the present case. Agenesis of vagina, urethra, anus and
rectum are discovered rarely and are attributed to the faults lying in chromatin material
(Ghanem et al., 2004). The clinical signs observed were according to the findings of
Bademkiran et al., (2009). Azizi et al. (2010) described a good survival rate in response to
atresia ani rectification by removing a circular skin piece and unifying the excised rectal loop
 Surgical Management of Congenital Atresia ANI (Imperforate Anus) Leading …. 1112

with skin. Recto-vaginal fistula and atresia ani are treated commonly by two surgical
techniques. In one method, the defects of rectum and vulvular lips are closed individually
after isolating and transecting the fistula (Mahlar and Williams, 2005). Anal opening is
reconstructed later on. In the second method, trisection of rectum is done just anterior to
fistula, the defective rectal part is excised followed by the suturing of last rectal part with the
skin margins of opening carved already at possible anal site. In the present case, all the
anamolies were rectified as reported by Mahlar and Williams (2005). The heritability of
intestinal atresia is controversial but has been reported to be heritable condition in calves and
pigs (Kilic and Sarierler, 2004). Since the clinical signs and physical examination findings
were adequate enough to establish the diagnosis, so radiographic studies were not necessary.
Surgical repair is the only and best possible solution to overcome congenital anomalies in
animals to reduce economic losses to the owners.
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Fig. 1 A female cow calf with congenital Fig. 2 Reconstructed anal opening using
5ml Atresia ani and Recto-Vaginal fistula syringe barrel to maintain
patency