5: Ano-rectal disorders

Question 1

What are the two layers of muscle lining the rectum?

Answer 1

Circular muscle

Longitudinal muscle

Question 2

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?

Answer 2

Levator ani

Question 3

What are the two sphincters controlling the opening and closing of the anus?

Answer 3

External anal sphincter

Internal anal sphincter

Question 4

Which line divides the upper 2/3rds and the lower 1/3rd of the anal canal?

Answer 4

Pectinate line

Question 5

PR bleeding history

particularly blood - fresh, dark, mixed with stool, in the pan, just on the paper?

Question 6

What are haemorrhoids?

Answer 6

Enlarged vascular cushions in the rectum and anal canal

Question 7

Haemorrhoids are associated with (painful / painless) rectal bleeding.

Answer 7

painless

Question 8

What colour is blood associated with haemorrhoids?

Where is it found?

Answer 8

Bright red

Usually found on the toilet paper

Question 9

People with haemorrhoids may also have an annoying perianal ___.

Answer 9

itch

Question 10

In haemorrhoids, the perianal skin may become macerated.

What does this mean and why does it occur?

Answer 10

Skin becomes white and soft because it’s constantly wet

Question 11

If a patient with haemorrhoids was in the lithotomy (childbirth) position, at what positions on the clock face will their haemorrhoids tend to be?

Answer 11

3, 7, 11 o’clock

Question 12

How are haemorrhoids investigated?

Answer 12

PR exam

Sigmoidoscopy / Proctoscopy

Question 13

How are haemorrhoids treated?

Answer 13

Sclerotherapy (shrinking the blood vessels with injections)

Rubber band ligation

Open / stapled haemorrhoidectomy

Newer treatments being developed

Question 14

What is the HALO procedure used to treat haemorrhoids?

Answer 14

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

Question 15

What is the presentation of rectal prolapse?

Answer 15

Large mass protruding from the rectum

+/- blood, sputum

Question 16

Examination of someone with rectal prolapse usually shows (good / poor) anal tone.

Answer 16

poor anal tone

Question 17

Rectal prolapse can be either ___ or ___.

Answer 17

complete

incomplete

Question 18

What is an anal fissure?

What can cause it?

Answer 18

Tear in the anal canal

Hard, packed stools (e.g constipation)

Question 19

Which IBD is associated with multiple anal fissures?

Answer 19

Crohn’s disease

Question 20

What are the main symptoms of anal fissures?

Answer 20

Acute onset anal pain after an episode of constipation

(lasts up to half an hour after defecation)

Bright red rectal bleeding

Question 21

How are anal fissures treated?

Answer 21

Dietary advice

Laxatives

GTN/Diltiazem (relax muscle and increases blood flow)

Question 22

What is a fistula?

Answer 22

Abnormal communication between two epithelial surfaces

Question 23

What is an anal fistula?

Answer 23

Passage between the anal canal and the peri-anal skin (usually the buttocks)

Question 24

Which IBD is associated with anal fistulae?

Answer 24

Crohn’s disease

Question 25

What diseases are associated with anal fistulae?

Answer 25

Crohn’s disease

Carcinoma

TB

Question 26

Which special stitch is used to treat anal fistulae?

Answer 26

Seton stitch

holds the fistula open and allows it to drain without closing again