37 Anal and Rectal Flashcards
arterial supply
inferior rectal artery
venous drainage
above dentate line is internal hemorrhoid plexus … below dentate is external hemorrhoid plexus
hemorrhoids: list plexi
left lateral, right anterior, right posterior hemorrhoidal plexi
hemorrhoids: external vs internal
external painful vs internal cause bleeding and prolapse
hemorrhoids: external - describe
cause pain when they thrombose, distal to the dentate line, covered by sensate squamous epithelium, can cause pain, swelling, itching
hemorrhoids: internal - describe, types
cause bleeding or prolapse … primary = slides below dentate with strain … secondary = prolapse that reduces spontaneously … tertiary = prolapse that has to be manually reduced …. quaternary = not able to reduce
hemorrhoids: tx
fiber, stool softeners (prevent straining), sitz baths
hemorrhoids: mgmt of thrombosed external hemorrhoids
lance open (if >72 hours) or elliptical excision (if <72 hours) to relieve pain
hemorrhoids: surgical indications
recurrence, thrombosis multiple times, large external component
hemorrhoids: surgery of external vs internal
external = can be resected with elliptical excision (can NOT band, would be painful) … primary or secondary internal = band …. tertiary or quaternary internal = 3 quadrant resection, need to resect down to the internal anal sphincter (do NOT go through it), postop w sitz baths, stool softener, high-fiber diet
rectal prolapse: location
6-7cm from anal verge
rectal prolapse: cause
pudendal neuropahy and laxity of anal sphincters
rectal prolapse: inc risk
F gender, straining, chronic diarrhea, previous pregnancy, reducdant sigmoid colons
rectal prolapse: layers
prolapse involves all layers of the recum
rectal prolapse: medical tx
high-fiber diet
rectal prolapse: surgical tx
perineal rectosigmoid resection (Altemeier) transanally if pt is older and frail … low anterior resection and pexy of residual colon if good condition patient
condylomata acuminata: px, cause, tx
cauliflower mass, papillomavirus (HPV), tx w laser surgery
anal fissure: caused by what?
split in anoderm
anal fissure: location
90% in posterior midline
anal fissure: causes what
pain and bleeding after defecation, chronic ones will see a sentinel pile (skin tag)
anal fissure: medical tx
sitz bath, bulk, lidocaine jelly, stool softener … 90% heal
anal fissure: surgical tx
lateral subcutaneous internal sphincterotomy
anal fissure: MC complication of surgery
fecal incontinence
anal fissure: contraindications to surgery
do NOT perform if 2/2 crohn’s or UC
anal fissure: lateral or recurrent
worry about IBD
anorectal abscess: px
can cause severe pain