5: Ano-rectal disorders Flashcards
What are the two layers of muscle lining the rectum?
Circular muscle
Longitudinal muscle
What is the muscle, also known as the pelvic diaphragm, which controls the contraction and relaxation of the external anal sphincter via the puborectalis muscle?
Levator ani
What are the two sphincters controlling the opening and closing of the anus?
External anal sphincter
Internal anal sphincter
Which line divides the upper 2/3rds and the lower 1/3rd of the anal canal?
Pectinate line
PR bleeding history
particularly blood - fresh, dark, mixed with stool, in the pan, just on the paper?
What are haemorrhoids?
Enlarged vascular cushions in the rectum and anal canal
Haemorrhoids are associated with (painful / painless) rectal bleeding.
painless
What colour is blood associated with haemorrhoids?
Where is it found?
Bright red
Usually found on the toilet paper
People with haemorrhoids may also have an annoying perianal ___.
itch
In haemorrhoids, the perianal skin may become macerated.
What does this mean and why does it occur?
Skin becomes white and soft because it’s constantly wet
If a patient with haemorrhoids was in the lithotomy (childbirth) position, at what positions on the clock face will their haemorrhoids tend to be?
3, 7, 11 o’clock
How are haemorrhoids investigated?
PR exam
Sigmoidoscopy / Proctoscopy
How are haemorrhoids treated?
Sclerotherapy (shrinking the blood vessels with injections)
Rubber band ligation
Open / stapled haemorrhoidectomy
Newer treatments being developed
What is the HALO procedure used to treat haemorrhoids?
Ultrasound used to locate haemorrhoidal arteries found in the lower rectum, which are then ligated, causing the haemorrhoids to shrink
Procedure is pain free because there aren’t any sensory nerves in the lower rectum
What is the presentation of rectal prolapse?
Large mass protruding from the rectum
+/- blood, sputum
Examination of someone with rectal prolapse usually shows (good / poor) anal tone.
poor anal tone
Rectal prolapse can be either ___ or ___.
complete
incomplete
What is an anal fissure?
What can cause it?
Tear in the anal canal
Hard, packed stools (e.g constipation)
Which IBD is associated with multiple anal fissures?
Crohn’s disease
What are the main symptoms of anal fissures?
Acute onset anal pain after an episode of constipation
(lasts up to half an hour after defecation)
Bright red rectal bleeding
How are anal fissures treated?
Dietary advice
Laxatives
GTN/Diltiazem (relax muscle and increases blood flow)
What is a fistula?
Abnormal communication between two epithelial surfaces
What is an anal fistula?
Passage between the anal canal and the peri-anal skin (usually the buttocks)
Which IBD is associated with anal fistulae?
Crohn’s disease
What diseases are associated with anal fistulae?
Crohn’s disease
Carcinoma
TB
Which special stitch is used to treat anal fistulae?
Seton stitch
holds the fistula open and allows it to drain without closing again
