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*OldSurgery > Anal and Perianal Dz > Flashcards

Anal and Perianal Dz Flashcards

1
Q

where is the rectal blood supply

A

iliac artery

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2
Q

what lymphs nodes can be felt for rectal cancer

A

inguinal lymph nodes

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3
Q

where does the anal canal stand and end?

A

start at dentate line

ends at anal verge

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4
Q

what cause perirectal abscesses?

A

Columns of morgagni each with crypts

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5
Q

most common symptom of rectal cancer?

A

bleeding

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6
Q

can you do radiation on rectal cancer patients?

A

yes, helps reduce size before removal

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7
Q

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

A

low anterior resection (LAR)

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8
Q

For lower third rectal cancers
Rectum and anus removed
Permanent colostomy

A

Abdominal perineal resection (APR)

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9
Q

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

A

full thickness rectal prolapse

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10
Q

prolapse w/ Only the mucosa protrudes from the anus

A

mucosal prolapse

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11
Q

when do rectal polapses peak?

A

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

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12
Q

tx for rectal prolapse

A

abomdinal appraoch- anterior resection w/ rectopexy

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13
Q

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

A

colonscopy pre-op to exclude CA

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14
Q

most common anorectal problem?

A

hemorrhoids

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15
Q

vascular connective tissue originating above the dentate line

A

internal hemorrhoids

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16
Q

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

A

external hemorrhoids

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17
Q

External hemorrhoids become symptomatic with

A

thrombosis

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18
Q

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

A

engorged

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19
Q

pain complaints w/ internal hemorrhoids

A

bleeding and itching

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20
Q

internal hemorrhoid w/ bleeding w/o prolapse

A

stage 1

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21
Q

internal hemorrhoid bleeding w/ prolapse but reduce sponatenously

A

stage 2

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22
Q

internal hemorrhoid bleeding with prolapsed that require manual reduction

A

stage 3

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23
Q

internal hemorrhoid prolapsed and cannot be reduced

A

stage 4

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24
Q

what are hemorrhoids associated w/

A

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

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25
Q

what should you rule out w/ rectal bleeding

A

r/o CA and IBD

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26
Q

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

A

internal hemorrhoid

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27
Q

Sudden severe perianal pain

Perianal mass

A

external hemorrhoids

28
Q

medical tx for hemorrhoids

A

treat constipation or diarrhea
stool softeners and bulking agents
exercise

29
Q

tx for internal hemorrhoids

A

elastic band ligation

30
Q

what is injection sclerotherapy doen for?

A

1st and 2nd degree internal hemorrhoids

31
Q

what is excisional hemorrhoidectomy done for?

A

3rd and 4th degree and mixed

32
Q

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

A

48

33
Q

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

A

anal fissure

34
Q

what are anal fissure associated w/?

A

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

35
Q

cardinal symptom of anal fissure

A

severe anal pain on defecation w/ some BRB

36
Q

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

A

Crohn’s

37
Q

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

A

Neoplastic ulcers

38
Q

Tx for anal fissures

A

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

39
Q

mainstay tx for anal fissure

A

laternal internal spinchterotomy

40
Q

meds for anal fissures

A

nitroglycerine

CCB

41
Q

risk w/ laternal internal spinchterotomy

A

fecal incontinence

42
Q

who have increased risk w/ anorectal abscess

A

diabetes, Crohn’s disease, and the immunocompromised

43
Q

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

A

Anorectal abscess

44
Q

tx for anorectal abscess

A

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

45
Q

An abnormal communication between the anorectum and the perianal skin

A

anorectal fistula

46
Q

causes of anorectal fistula

A

crohn’s
carcinoma
radiation damage
TB

47
Q

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

A

anorectal fistula

48
Q

tx for anorectal fistula

A

fistulotomy or seton

49
Q

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

A

Pilonidal Dz

50
Q

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

A

pilonidal diseaes

51
Q

who is pilonidal dz common in?

A

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

52
Q

diagnosis of pilonidal dz

A

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

53
Q

tx for pilonidal dz (non-operative)

A

hair removal, meticulous hygiene, antibiotics

54
Q

Operative tx for pilonidal Dz

A

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

55
Q

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

A

Perinanal warts (condylomata acuminata)

56
Q

what can perianal warts be a precursor to?

A

invasive squamous cell carcinoma

57
Q

Tx for perinanal warts

A

combination of electrocautery fulguration and sharp excision

58
Q

topical preparation for perinanal warts

A

25% podophyllin

59
Q

what are most anal cancers

A

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

60
Q

risks for anal cancer

A

anal sex, immunodeficiency, anal warts, other STDs

61
Q

Anal margin cancers occur outside the ___________

A

anal verge

62
Q

Anal canal cancers occur inside the _________

A

anal verge

63
Q

how does anal margin CA present

A

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

64
Q

tx for anal margin cancer

A

Wide local excision vs abdominoperineal resection +/- chemoradiation

65
Q

all patients w/ hemorrhoids need what?

A

rectal exam for CA

66
Q

1st line tx for large anal canal tumors

A

Chemoradiotherapy (Nigro regimen)

67
Q

tx for small tumors of anal canal cancer

A

local excision

*OldSurgery (22 decks)

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