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Fiser Absite > 37 - Anorectal > Flashcards

37 - Anorectal Flashcards

1
Q

Arterial supply to the anus

A

inferior rectal artery

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2
Q

Venous drainage of the anus above and below the dentate line

A

Above the dentate line - Internal hemorrhoid plexus

Below the dentate line - External hemorrhoid plexus

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3
Q

Hemorrhoid distal to dentate line, causes pain when thrombosed

A

External

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4
Q

External hemorrhoids covered by what cell type

A

Squamous epithelium (sensate)

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5
Q

Hemorrhoid that slides below dentate line with strain

A

Primary/Grade 1 internal hemorrhoid

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6
Q

Hemorrhoid that prolapses and reduces spontaeously

A

Secondary/Grade 2 internal hemorrhoid

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7
Q

Hemorrhoid that prolapses and has to manually be reduced

A

Tertiary/Grade 3 internal hemorrhoid

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8
Q

Hemorrhoid that prolapses and not able to be reduced

A

Quaternary/Grade 4 internal hemorrhoid

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9
Q

Tx for thrombosed external hemorrhoid

A

<72 hrs - excision

>72 hrs - lance

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10
Q

Can tx _ hemorrhoids with banding

A

Grade 1/2 INTERNAL hemorrhoids

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11
Q

On internal hemorrhoid resection, need to resect down to _

A

Internal anal sphincter

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12
Q

Surgical tx of rectal prolapse if pt is elderly/frail

A

Perianal rectosigmoid resection (Altermeier) transanally

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13
Q

Surgical tx of rectal prolapse if pt is good condition

A

LAR with pexy

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14
Q

Cauliflower mass, associated with HPV

A

Condylomata Acuminata

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15
Q

Chronic anal fissures are also associated with a finding of _

A

sentinel pile (anal skin tag)

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16
Q

90% anal fissures location

A

Posterior midline

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17
Q

Percent of anal fissure heal with medical tx

A

90%

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18
Q

Surgical tx for anal fissure

A

Lateral subcutaneous internal sphincterotomy

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19
Q

Lateral or recurrent anal fissures concerning for _

A

Inflammatory bowel disease (Crohn’s/UC)

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20
Q

Types of anorectal abscess that can be drained through skin (3)

A

Perianal
Intersphincteric
Ischiorectal

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21
Q

Types of anorectal abscess below the levator ani (3)

A

Perianal
Intersphincteric
Ischiorectal

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22
Q

Types of anorectal abscess that can form horseshoe abscess

A

Ischiorectal

Intersphincteric

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23
Q

Types of anorectal abscess requiring transrectal drainage

A

Supralevator

24
Q

Goodsall’s rule

A

Anterior fistulas connect in straight line

Posterior fistulas track towards a midline internal opening of anus

25
Q

When can you perform fistulotomy

A

Fistula in lower 1/3 of external anal sphincter

26
Q

MCC of simple rectovaginal fistula

A

Obstetrical trauma

27
Q

Simple rectovaginal fistula location

A

low to mid-vagina

28
Q

Complex rectovaginal fistula location

A

high in vagina

29
Q

MCC of complex rectovaginal fistula

A

Diverticulitis

30
Q

Tx of simple rectovaginal fistula

A

Rectal mucosa advancement flap

31
Q

Tx of complex rectovaginal fistula

A

Abd or perineal/abd approach with resection and anastomosis

32
Q

Chronic damage to levator ani muscle and pudendal nerves; anus falls below levators

A

Abdominoperineal descent anal incontinence

33
Q

Tx of obstetrical trauma anal incontinence

A

Anterior anal sphincteroplasty

34
Q

Most common cancer in AIDS pts, nodule with ulceration

A

Kaposi’s sarcoma

35
Q

Shallow ulcers, similar presentation as appendicitis in immunocompromised pts

A

CMV (cytolomegalovirus)

36
Q

1 rectal ulcer in immunocompromised pts

A

HSV (herpes simplex virus)

37
Q

In immunocompromised pts, cancer that can look like an abscess or ulcer

A

B-cell lymphoma

38
Q

Common associations with anal cancer (3)

A

HPV
HIV
XRT (radiation)

39
Q

Anal canal cancer lesions are located _

A

Above dentate line

40
Q

Anal margin cancer lesions are located _

A

Below dentate line

41
Q

Tx for anal canal squamous cell CA

A

Nigro protocol (5-FU, mitomycin C, chemo-rads)

42
Q

What is the nigro protocol

A

5-FU
Mitocycin C
Chemo-rads

43
Q

When can you tx anal canal adenocarcinoma with WLE

A

WLE with 2-3mm margin if <4cm, <50% circumference, limited to submucosa, well differentiate and no neurovasc invasion

44
Q

Tx for anal canal adenocarcinoma

A

Surgery (APR vs WLE) + chemo-rads

45
Q

3 most common sites for melanoma

A

1-skin
2-eyes
3-anal canal

46
Q

Most common sx for anal melanoma

A

Rectal bleeding

47
Q

Tx for anal melanoma

A

APR

48
Q

Mets of squamous cell CA of anal margin go to _

A

inguinal nodes

49
Q

Tx of anal margin squamous cell CA <5cm

A

WLE with 0.5cm margin

50
Q

Tx of anal margin squamous cell CA >5cm, involve sphincter or node involvement

A

Chemo-rads (5-FU and cisplatin)

51
Q

Cancer with central ulcer, raised edges, below dentate line

A

Basal cell CA of the anal margin

52
Q

Tx of basal cell CA of anal margin

A

WLE with 3mm margin

APR if sphincter involved

53
Q

Nodal metastases of superior and middle rectum

A

IMA nodes (inf mesenteric artery)

54
Q

Nodal metastases of lower rectum

A

IMA and internal iliac nodes

55
Q

Nodal metastases of anal canal

A

internal iliac nodes

56
Q

Nodal metastases of anal margin

A

inguinal nodes

Fiser Absite (14 decks)

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