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Anal Flashcards

1
Q

Arterial supply to anus

A

Inferior rectal artery

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2
Q

Venous drainage of anus

A

Above dentate – internal hemorrhoid plexus; below external hemorrhoid plexus

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3
Q

Cause of hemorrhoids

A

Straining

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4
Q

External hemorrhoids cause pain when…

A

They thrombose

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5
Q

Distal to dentate line, hemorrhoids are covered by

A

Sensate squamous epithelium; pain/swelling/itching

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6
Q

Internal hemorrhoids cause…

A

Bleeding/prolapse

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7
Q

Primary through Quarternary hemorrhoids

A

Primary: slide below dentate with strain
Secondary: reduces spontaneously
Tertiary: manual reducation
Quarternary: Not able to reduce

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8
Q

Treatment of hemorrhoids

A

Fiber and stool softeners; Sitz, fluids

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9
Q

Treatment of thrombosed external hemorrhoid based on 72 hour time mark

A

> 72 hours; lance open

< 72 hours: elliptical excision

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10
Q

Should you band external hemorrhoids

A

No

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11
Q

T/F A three quadrant resection is needed for 3ary/4ary hemorrhoids

A

Need to resect down to internal anal sphincter

- Sitz, stool softener, high fiber

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12
Q

Where does rectum begin from the anal verge?

A

6-7 cm

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13
Q

Why does rectum prolapse?

A

Pudendal neuropathy, laxity of anal sphincters

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14
Q

Increased risk of rectal prolapse

A

Females, straining, diarrhea, previous rpregnancy, redundant sigmoid colon

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15
Q

Medial treatment of rectal prolapse

A

High fiber diet

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16
Q

Surgical treatments of rectal prolapse

A

Old and frail: perineal recto-sigmoid resection

Young: LAR/Pexy

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17
Q

Cause and treatment of anal condylomata acuminata

A

HPV

* Laser surgery

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18
Q

Anal fissure is caused by

A

Straining bowel movements; constipation; split in anoderm

- 90% posterior midline

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19
Q

First-line treatment of anal fissure

A

Sitz, bulk, lido jelly, stool softeners, NG cream

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20
Q

Surgical tx of anal fissure

A

Lateral subcutaneous internal sphincterotomy

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21
Q

Most serious complication of anal fissure surgery

A

Fecal incontinence

22
Q

For lateral or recurrent anal fissures, the main worry is

23
Q

What types of anal absecesses need to be drained transrectally?

A

Supra-levator abscesses

24
Q

When do you provide Abx for ano-rectal abscesses?

A

cellulitis, DM, IS, prosthetic hardware

25
What is a pilonidal cyst?
Sinus/abscess formation over sacrococcygeal junction
26
Do you excise tract of a fistula-in-ano?
No
27
What is Goodsall's rule?
Anterior fistulas connect with anus/rectum in straight line; posterior fistulas go toward a midline internal opening in anus/rectum
28
Treatment of lower 1/3 external anal sphincter fistula
Draining seton stitch; possible fistulotomy; heal by secondary intention
29
Treatment of upper 2/3 external anal sphincter fistula
Draining seton stitch; +/- rectal advancement flap
30
Most worrisome complication following anal fistula repair
Incontinence; no fistulotomy above the lower 1/3 of external anal sphincter
31
MCC simple recto-vaginal fistula
OB trauma; treatment -- trans-anal rectal mucosa advancement flap
32
MCC complex recto-vaginal fistula
Diverticulitis; resection and re-anastamosis of rectum, close hold in vagina, interpose omentum, ileostomy
33
MCC cancer in AIDS patients
Kaposi's sarcoma; nodule with ulceration
34
#1 rectal ulcer in AIDS
HSV
35
Shallow ulcers in AIDS rectum
CMV
36
T/F B cell lymphoma can look like rectal/anal abscess or ulcer
True
37
Anal canal vs anal margin
Anal canal: above dentate | Anal margin: below dentate
38
Anal cancer is a/w this virus and XRT
HPV
39
Anal canal lesions include
SCC, AC, Melanoma
40
Anal margin lesions include
SCC, basal cell ca
41
Nodal mets following ano-recal cancer
Superior, middle rectum: IMA Lower rectum: IMA, II nodes Anal canal: Int iliac nodes Anal margin: Inguinal nodes
42
Anal canal SCC
Pruritis, bleeding, palpable mass
43
What is Nigro protocol?
For anal canal SCC | - Chemo-XRT with 5-Fu and mitomycin; not surgery (cures 80%; APR for treatment failure, or recurrent cancer)
44
Treatment for anal canal adenocarcinoma
APR, WLE if < 4 cm, < 1/2 circumference limited to submucosa; T1, 2-3mm margins
45
Top 3 sites for melanoma
Skin, eyes, Anal canal
46
What accounts for most anal melanoma early deaths
Heme spread to liver, lung
47
Most common symptoms of anal melanoma
Rectal bleeding
48
Treatment, usual for anal canal melanoma
APR
49
Which have better prognosis: anal margin or anal canal?
Anal margin
50
Anal margin SCC
WLE for lesions < 5 cm | 5-FU and cisplatin
51
Treatment for anal BCC
Central ulcer, raised edges, rare mets; 3-mm margins; rare need for APR unless spinchter involved

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