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ABSITE > Anal > Flashcards

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

A

IBD

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
Q

What is a pilonidal cyst?

A

Sinus/abscess formation over sacrococcygeal junction

26
Q

Do you excise tract of a fistula-in-ano?

A

No

27
Q

What is Goodsall’s rule?

A

Anterior fistulas connect with anus/rectum in straight line; posterior fistulas go toward a midline internal opening in anus/rectum

28
Q

Treatment of lower 1/3 external anal sphincter fistula

A

Draining seton stitch; possible fistulotomy; heal by secondary intention

29
Q

Treatment of upper 2/3 external anal sphincter fistula

A

Draining seton stitch; +/- rectal advancement flap

30
Q

Most worrisome complication following anal fistula repair

A

Incontinence; no fistulotomy above the lower 1/3 of external anal sphincter

31
Q

MCC simple recto-vaginal fistula

A

OB trauma; treatment – trans-anal rectal mucosa advancement flap

32
Q

MCC complex recto-vaginal fistula

A

Diverticulitis; resection and re-anastamosis of rectum, close hold in vagina, interpose omentum, ileostomy

33
Q

MCC cancer in AIDS patients

A

Kaposi’s sarcoma; nodule with ulceration

34
Q

1 rectal ulcer in AIDS

A

HSV

35
Q

Shallow ulcers in AIDS rectum

A

CMV

36
Q

T/F B cell lymphoma can look like rectal/anal abscess or ulcer

A

True

37
Q

Anal canal vs anal margin

A

Anal canal: above dentate

Anal margin: below dentate

38
Q

Anal cancer is a/w this virus and XRT

A

HPV

39
Q

Anal canal lesions include

A

SCC, AC, Melanoma

40
Q

Anal margin lesions include

A

SCC, basal cell ca

41
Q

Nodal mets following ano-recal cancer

A

Superior, middle rectum: IMA
Lower rectum: IMA, II nodes
Anal canal: Int iliac nodes
Anal margin: Inguinal nodes

42
Q

Anal canal SCC

A

Pruritis, bleeding, palpable mass

43
Q

What is Nigro protocol?

A

For anal canal SCC

- Chemo-XRT with 5-Fu and mitomycin; not surgery (cures 80%; APR for treatment failure, or recurrent cancer)

44
Q

Treatment for anal canal adenocarcinoma

A

APR, WLE if < 4 cm, < 1/2 circumference limited to submucosa; T1, 2-3mm margins

45
Q

Top 3 sites for melanoma

A

Skin, eyes, Anal canal

46
Q

What accounts for most anal melanoma early deaths

A

Heme spread to liver, lung

47
Q

Most common symptoms of anal melanoma

A

Rectal bleeding

48
Q

Treatment, usual for anal canal melanoma

A

APR

49
Q

Which have better prognosis: anal margin or anal canal?

A

Anal margin

50
Q

Anal margin SCC

A

WLE for lesions < 5 cm

5-FU and cisplatin

51
Q

Treatment for anal BCC

A

Central ulcer, raised edges, rare mets; 3-mm margins; rare need for APR unless spinchter involved

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