Anal and Perianal Dz

Question 1

where is the rectal blood supply

Answer 1

iliac artery

Question 2

what lymphs nodes can be felt for rectal cancer

Answer 2

inguinal lymph nodes

Question 3

where does the anal canal stand and end?

Answer 3

start at dentate line

ends at anal verge

Question 4

what cause perirectal abscesses?

Answer 4

Columns of morgagni each with crypts

Question 5

most common symptom of rectal cancer?

Answer 5

bleeding

Question 6

can you do radiation on rectal cancer patients?

Answer 6

yes, helps reduce size before removal

Question 7

what do you do for Lesions in the middle and upper third of the rectum

Answer 7

low anterior resection (LAR)

Question 8

For lower third rectal cancers
Rectum and anus removed
Permanent colostomy

Answer 8

Abdominal perineal resection (APR)

Question 9

Protrusion of the full thickness of the rectal wall through the anus – concentric rings

Answer 9

full thickness rectal prolapse

Question 10

prolapse w/ Only the mucosa protrudes from the anus

Answer 10

mucosal prolapse

Question 11

when do rectal polapses peak?

Answer 11

Peaks in occurrence are noted in the fourth and seventh decades of life, and most patients (80-90%) are women

Question 12

tx for rectal prolapse

Answer 12

abomdinal appraoch- anterior resection w/ rectopexy

Question 13

what do you need to do before surgical tx for rectal prolapse

Answer 13

colonscopy pre-op to exclude CA

Question 14

most common anorectal problem?

Answer 14

hemorrhoids

Question 15

vascular connective tissue originating above the dentate line

Answer 15

internal hemorrhoids

Question 16

vascular complexes underlying the richly innervated anoderm (below the dentate line)

Answer 16

external hemorrhoids

Question 17

External hemorrhoids become symptomatic with

Answer 17

thrombosis

Question 18

Internal hemorrhoids become symptomatic when the internal complex becomes chronically ________ or the tissue prolapses into the anal canal

Answer 18

engorged

Question 19

pain complaints w/ internal hemorrhoids

Answer 19

bleeding and itching

Question 20

internal hemorrhoid w/ bleeding w/o prolapse

Answer 20

stage 1

Question 21

internal hemorrhoid bleeding w/ prolapse but reduce sponatenously

Answer 21

stage 2

Question 22

internal hemorrhoid bleeding with prolapsed that require manual reduction

Answer 22

stage 3

Question 23

internal hemorrhoid prolapsed and cannot be reduced

Answer 23

stage 4

Question 24

what are hemorrhoids associated w/

Answer 24

associated with constipation, chronic diarrhea, straining, pregnancy, pelvic masses, and family history

Question 25

what should you rule out w/ rectal bleeding

Answer 25

r/o CA and IBD

Question 26

Bright red blood per rectum on TP or outside of stool Mucous discharge Rectal fullness or discomfort

Answer 26

internal hemorrhoid

Question 27

Sudden severe perianal pain | Perianal mass

Answer 27

external hemorrhoids

Question 28

medical tx for hemorrhoids

Answer 28

treat constipation or diarrhea stool softeners and bulking agents exercise

Question 29

tx for internal hemorrhoids

Answer 29

elastic band ligation

Question 30

what is injection sclerotherapy doen for?

Answer 30

1st and 2nd degree internal hemorrhoids

Question 31

what is excisional hemorrhoidectomy done for?

Answer 31

3rd and 4th degree and mixed

Question 32

Thrombosed external hemorrhoids can be excised or the clot evacuated if they present in less than ___ hours after the onset of symptoms

Answer 32

48

Question 33

A linear tear or superficial ulcer of the anal canal at the anal margin Most commonly posterior in the midline

Answer 33

anal fissure

Question 34

what are anal fissure associated w/?

Answer 34

constipation and/or trauma to the anal canal from hard stool

Question 35

cardinal symptom of anal fissure

Answer 35

severe anal pain on defecation w/ some BRB

Question 36

______ fissures or ulcers are usually multiple, in atypical locations, and relatively pain free

Answer 36

Crohn’s

Question 37

_________________ are usually squamous cell cancers and are usually deeper with heaped up edges, in atypical locations, and usually pain free

Answer 37

Neoplastic ulcers

Question 38

Tx for anal fissures

Answer 38

Relax the anal sphincter either medically or surgically to promote healing of the ulcer

Question 39

mainstay tx for anal fissure

Answer 39

laternal internal spinchterotomy

Question 40

meds for anal fissures

Answer 40

nitroglycerine | CCB

Question 41

risk w/ laternal internal spinchterotomy

Answer 41

fecal incontinence

Question 42

who have increased risk w/ anorectal abscess

Answer 42

diabetes, Crohn’s disease, and the immunocompromised

Question 43

Severe anal pain Palpable mass usually present on perianal or digital rectal exam Systemic sepsis

Answer 43

Anorectal abscess

Question 44

tx for anorectal abscess

Answer 44

surgical drainage (I and D) may need to be done in OR

Question 45

An abnormal communication between the anorectum and the perianal skin

Answer 45

anorectal fistula

Question 46

causes of anorectal fistula

Answer 46

crohn's carcinoma radiation damage TB

Question 47

May present with recurrent perirectal abscesses or with a chronic and intermittent bloody/purulent drainage associated with pain and discomfort

Answer 47

anorectal fistula

Question 48

tx for anorectal fistula

Answer 48

fistulotomy or seton

Question 49

An acquired, chronic inflammatory condition in which hair becomes embedded in the subcutaneous tissue causing a foreign body reaction

Answer 49

Pilonidal Dz

Question 50

patients can present with an acute abscess, a chronic draining sinus, or an asymptomatic sinus

Answer 50

pilonidal diseaes

Question 51

who is pilonidal dz common in?

Answer 51

young caucasian men 15-24 w/ dark and stiff hair

Question 52

diagnosis of pilonidal dz

Answer 52

identifying small opening or pits in the midline natal cleft of the sacrococcygeal region

Question 53

tx for pilonidal dz (non-operative)

Answer 53

hair removal, meticulous hygiene, antibiotics

Question 54

Operative tx for pilonidal Dz

Answer 54

excision, incision and drainage must go all the way down to sacral fascia usually left open

Question 55

Sexually transmitted and caused by the human papilloma virus (HPV) Most commonly seen in homosexual males and are associated with anal sex

Answer 55

Perinanal warts (condylomata acuminata)

Question 56

what can perianal warts be a precursor to?

Answer 56

invasive squamous cell carcinoma

Question 57

Tx for perinanal warts

Answer 57

combination of electrocautery fulguration and sharp excision

Question 58

topical preparation for perinanal warts

Answer 58

25% podophyllin

Question 59

what are most anal cancers

Answer 59

Most are squamous cell cancers with rare melanomas and adenocarcinomas of anal gland origin

Question 60

risks for anal cancer

Answer 60

anal sex, immunodeficiency, anal warts, other STDs

Question 61

Anal margin cancers occur outside the ___________

Answer 61

anal verge

Question 62

Anal canal cancers occur inside the _________

Answer 62

anal verge

Question 63

how does anal margin CA present

Answer 63

Typically presents with mass, bleeding, pain, discharge, itching, and tenesmu

Question 64

tx for anal margin cancer

Answer 64

Wide local excision vs abdominoperineal resection +/- chemoradiation

Question 65

all patients w/ hemorrhoids need what?

Answer 65

rectal exam for CA

Question 66

1st line tx for large anal canal tumors

Answer 66

Chemoradiotherapy (Nigro regimen)

Question 67

tx for small tumors of anal canal cancer

Answer 67

local excision