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Gastroentrology > 3: Anal Lesions > Flashcards

3: Anal Lesions Flashcards

1
Q

Define a haemorrhoid

A

Abnormal enlargement of anal vascular cushion

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2
Q

What is a first-degree haemorrhoid

A

Remains in rectum

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3
Q

What is a second-degree haemorrhoid

A

Protrudes on defecation - spontaneously reduces

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4
Q

What is a third-degree haemorrhoid

A

Protrudes on defecation - needs to be manually reduced

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5
Q

What is a fourth-degree haemorrhoid

A

Continually protruding - cannot be manually reduced

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6
Q

Aside from ‘degree classification’ how can haemorrhoids be categorised

A

Internal vs. External

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7
Q

Where do internal haemorrhoids arise

A

Superior Haemorrhoidal Plexus

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8
Q

What is the difference between internal and external haemorrhoids

A

Internal - painless

External - cutaneous pain

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9
Q

When is the peak incidence of haemorrhoids

A

45-65y

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10
Q

What are 5 risk factors for haemorrhoids

A
  1. Age
  2. Straining eg. chronic constipation
  3. Raised intra-abdominal pressure (pregnancy, obesity)
  4. FH
  5. Portal HTN - due to HF
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11
Q

How do internal haemorrhoids present

A

Painless
Pruritus
Bright-red bleeding

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12
Q

How do external haemorrhoids present

A

Painful mass

Pruritus

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13
Q

What is the most common position for haemorrhoids by ‘clock face’

A

3, 7 and 11 O’Clock

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14
Q

How are haemorrhoids investigated

A

DRE

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15
Q

What imaging may be used to confirm diagnosis of haemorrhoids

A

Protoscopy

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16
Q

How are the majority of haemorrhoids managed

A

conservatively

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17
Q

What are the 4 conservative measures for managing haemorrhoids

A
  1. Increase fibre
  2. Fluids
  3. Stool-softening laxatives
  4. Topical analgesia
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18
Q

How can first and second degree haemorrhoids be managed

A

Rubber band ligation

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19
Q

What surgical procedure is indicated for third and fourth degree haemorrhoids

A

Haemorrhoidectomy

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20
Q

What is the dentate line

A

A circular line comprised of anal valves. It separates upper from lower anus.

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21
Q

Where is the embryological origin above the dentate line

A

Endoderm

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22
Q

Where is the embryological origin below dentate line

A

Ectoderm

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23
Q

What is the cell type above the dentate line

A

Simple columnar

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24
Q

What is the cell type below the dentate line

A

Stratified squamous

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25
Q

What is blood supply above dentate line

A

Superior rectal artery

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26
Q

What is the superior rectal artery a branch of

A

Inferior mesenteric. a

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27
Q

What supplies blood to below the dentate line

A

Inferior rectal artery

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28
Q

What is the inferior rectal artery a branch of

A

Internal pudendal artery

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29
Q

Explain venous drainage above the dentate line

A 
Internal haemorrhoid plexus 
Superior rectal vein 
Inferior mesenteric vein 
Splenic vein 
Portal vein 
Hepatic vein
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30
Q

Explain venous drainage from below the dentate line

A

External haemorrhoid plexus
Internal pudendal vein
Common iliac vein

31
Q

What is the lymphatic drainage above the dentate line

A

Inferior iliac lymph nodes

32
Q

What is the lymphatic drainage below the dentate line

A

Superficial inguinal lymph nodes

33
Q

What type of muscle comprises the internal-anal sphincter

A

Involuntary muscle

34
Q

What type of muscle comprises the external anal sphincter

A

Skeletal muscle

35
Q

What innervates the external anal sphincter

A

Pudendal Nerve

36
Q

When may injection sclerotherapy be used to treat haemorrhoids

A

Grade I or II haemorrhoids

37
Q

What is injection sclerotherapy

A

5% Phenol is injected into haemorrhoids

38
Q

What is the main complication of injection sclerotherapy

A

High failure rate

39
Q

What are the indications for rubber band ligation of haemorrhoids

A

Internal haemorrhoids

40
Q

What are 2 complications of rubber band ligation

A

Pain

Bleeding

41
Q

When is a haemorrhoidectomy indicated

A

Grade 3 or 4 haemorrhoids

42
Q

What is an anorectal abscess

A

Collection of pus in anal or rectal region

43
Q

How do anorectal abscesses present clinically

A

Intermittent perianal pain - worse on sitting down

44
Q

On examination how will a perianal abscess appear

A

Red tender mass, possibly with purulent discharge

45
Q

How are peri-anal abscesses investigated

A

DRE under anaesthesia

46
Q

How are peri-anal abscesses managed

A

Drainage

47
Q

What is a complication of pero-anal abscesses

A

Peri-anal fistula

48
Q

What is the most common cause of perianal abscesses

A

E.coli

49
Q

What imaging is gold-standard for investigation of perianal abscesses

A

Trans perianal US

50
Q

What are two risk factors for perianal abscesses

A

DM

Crohn’s disease

51
Q

What is an anorectal fistula

A

Abnormal connection between anal canal and perianal skin

52
Q

In which gender are anorectal fistulas more common

A

Males

53
Q

What causes anorectal fistulas

A

Often secondary to perianal abscess

54
Q

What are 3 risk factors for anorectal fistulas

A 
Diabetes 
Crohn's disease 
Previous radiotherapy 
HIV 
Previous anal trauma
55
Q

How do anorectal fistulas present

A

Continuous faecal discharge

Can cause: pain, change in bowel habit and systemic features of infection.

56
Q

In what position are 90% of fistulas located

A

Posterior midline (6 O’ Clock position)

57
Q

What imaging is used to investigate fissures in ano

A

Rigid sigmoidoscopy

58
Q

How will an anal fissure present clinically

A

Intense pain post-defecation that may last for several hours

Bright red blood on defecation

59
Q

What is rectal prolapse

A

Where a portion or all of the rectum protrudes out of the anus

60
Q

What is partial thickness rectal prolapse

A

Where rectal mucosa protrudes out the anus

61
Q

What is full-thickness rectal prolapse

A

Where entire rectal wall protrudes out the anus

62
Q

What is an anal cancer

A

cancer that lies exclusively in the anal canal

63
Q

What age-group does anal cancer typically occur

A

85-89

64
Q

What causes 90% of anal cancers

A

HPV Infection

65
Q

What strands of HPV are cancerous

A

HPV16 + HPV18

66
Q

Give 5 risk factors for anal cancers

A

MSM: especially if higher number sexual partners

HIV

Women with CIN or cervical cancer

Smoking

Immunosuppressive drugs

67
Q

How do anal cancers present

A

Pain and bleeding

68
Q

What type of cancer are anal cancers mostly

A

Squamous cell carcinoma

69
Q

What precedes development of invasive anal cancer

A

Anal intra-epithelial neoplasm (AIN)

70
Q

What is development of AIN associated with

A

HPV

71
Q

What investigations are performed for anorectal cancer

A 
Protoscopy 
Examination under anaesthesia 
HIV test 
Cervical smear (females) 
US-guided FNA lymph nodes 
CT CAP to stage 
MRI to stage
72
Q

What is used to manage anal cancer

A

Chemoradiotherapy

73
Q

What is used for advanced anal cancers

A

Abdominoperineal resection (APR)

Gastroentrology (18 decks)

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