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Surgery > Anal Masses > Flashcards

Anal Masses Flashcards

1
Q

Premalignant Lesions (AIN)

Clinical

A

Pain
Bleeding
Mass +- ulceration
Pruritus

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2
Q

Premalignant Lesions (AIN)

Aetiology

A

HPV 16,18

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3
Q

Premalignant Lesions (AIN)

Risk Factors

A

• Host
-Immunocompromised: HIV

• Contamination

      - Anal intercourse
      - Many sexual partners
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4
Q

Premalignant Lesions (AIN)

Diagnosis

A

• Biopsy

Acetic acid -> white lesions -> biopsy

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5
Q

Premalignant Lesions (AIN)

Histology

A

• SCC

     - LSIL
     - HSIL
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6
Q

Premalignant Lesions (AIN)

Prevention

A

Smear of anus yearly in immunocompromised patients

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7
Q

Anal Cancer

Clinical

A

Pain
Bleeding
Mass +- ulceration
Pruritus

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8
Q

Anal Cancer

Aetiology

A

HPV 16,18

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9
Q

Anal Cancer

Risk Factors

A

Host:
-Immunocompromised: HIV

Contamination:

  - Anal intercourse
  - Many sexual partners
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10
Q

Anal Cancer

Diagnosis

A

• Biopsy

Acetic acid -> white lesions -> biopsy

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11
Q

Anal Cancer

Histology

A

Proximal (glandular epithelium): adenocarcinoma

Distal (skin): SCC; MM

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12
Q

Anal Cancer

Staging (TNM)

A

• T

  1. > 2cm
  2. 2-5cm
  3. > 5cm
  4. Local invasion

• N

  1. Perirectal
  2. Ipsilateral groin/pelvis (internal iliac)
  3. 1 +2 OR both sides of groin/pelvis (internal iliac)

• M
Mets

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13
Q

Anal Cancer

Stages

A
  • Stage 1: confined T1
  • Stage 2: confined T2,T3
  • Stage 3: local invasion T4 and/or LNs (Any T, Any N)
  • Stage 4: mets
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14
Q

Anal Cancer

Management

A

• Curative: T1,2,3,4
− < 1cm/doesn’t involve sphincter muscle: local resection
− All the others: Chemoradiation (nigro protol: 5-fluorouracil and mitomycin and medical radiation) if remains/recurrent: APR (abdominoperineal resection)

• Palliative: M1

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15
Q

Anal Cancer

Prevention

A

Smear of anus yearly in immunocompromised patients

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16
Q

Pilonidal Disease

Clinical

A

• Sacrococcygeal mass

    - Cyst
    - Abscess: pain + sinus: purulent discharge
17
Q

Pilonidal Disease

Epidemiology

A

M>F

15-40 years

18
Q

Pilonidal Disease

Risk Factors

19
Q

Pilonidal Disease

Pathogenesis

A

Obstruction of Hair Follicles

20
Q

Pilonidal Disease

Management

A

• Abscess
− Drainage

− Surgery
Indications
♣ failure of healing after drainage
♣ Recurrent disease
Options
Pilonidal cystotomy

21
Q

Rectal Prolapse

Mucosal/Partial Thickness

Clinical

A

• Increased intra-abdominal pressure: straining, coughing, laughing, Valsalva
− Pain
− Blood and mucus from the anus
− +- extrusion of mass
− Persistent desire to defecate

22
Q

Rectal Prolapse

Mucosal/Partial Thickness

Epidemiology

A

• Extremes of ages: <5 yr old and >5th decade (most common in children)

23
Q

Rectal Prolapse

Mucosal/Partial Thickness

Aetiology

A

Primary
• Children
− Bowel more loosely attached to muscle
− Hypertrophy of the submucosal lymphoid aggregates: Peyer’s patches

Secondary
• Increased abdominal pressure
− Obesity
− Chronic cough – smoking, bronchitis
− Constipation
− Jobs requiring heavy lifting + strain

• Neurological disorders
− Spinal: trauma; non-trauma

• Muscles
− Weakened pelvic floor muscles
⎫ Obstetric trauma
⎫ Non-obstetric trauma
♣ Physical trauma e.g. pelvic fractures
♣ Radiotherapy
♣ Surgery
⎫ Menopause
⎫ Connective tissue disorders
− Weakened anal sphincter muscles

24
Q

Rectal Prolapse

Mucosal/Partial Thickness

Classification

A

Protrusion of mucosa only

25
Q

Rectal Prolapse

Mucosal/Partial Thickness

Complications

A

• GIT
− Permanently extruded rectum with excoriation, ulceration
− Faecal incontinence
− Strangulation + ischaemia

• Urinary
− Urinary incontinence

26
Q

Rectal Prolapse

Mucosal/Partial Thickness

Diagnosis

A

• Ask patient to squat and cough/strain bulge
− Haemorrhoids vs rectal prolapse
⎫ Not circumferential like rectal prolapse
⎫ Can’t feel in-between haemorrhoid and skin; with rectal can feel rectal wall on top of anus

• No bulge, but suspect partial thickness prolapse -> defecating proctography

27
Q

Rectal Prolapse

Mucosal/Partial Thickness

Management

A

• Conservative (in children)
− Reduce if possible; table sugar has been used to reduce incarcerated rectal prolapse by absorbing the edema of the rectal , thus making it easier to reduce

• Surgery (in adults)
− Perineal
-Mucosal excision

28
Q

Rectal Prolapse

Full Thickness

Clinical

A

• Increased intra-abdominal pressure: straining, coughing, laughing, Valsalva
− Pain
− Blood and mucus from the anus
− Extrusion of mass
− Persistent desire to defecate

29
Q

Rectal Prolapse

Full Thickness

Epidemiology

A
  • Extremes of ages: <5 yr old and >5th decade (most common in adults)
  • F (85%) – child birth > M
30
Q

Rectal Prolapse

Full Thickness

Aetiology

A

Primary
• Children
− Bowel more loosely attached to muscle
− Hypertrophy of the submucosal lymphoid aggregates: Peyer’s patches

Secondary
• Increased abdominal pressure
− Obesity
− Chronic cough – smoking, bronchitis
− Constipation
− Jobs requiring heavy lifting + strain

• Neurological disorders
− Spinal: trauma; non-trauma

• Muscles
− Weakened pelvic floor muscles
⎫ Obstetric trauma
⎫ Non-obstetric trauma
♣ Physical trauma e.g. pelvic fractures
♣ Radiotherapy
♣ Surgery
⎫ Menopause
⎫ Connective tissue disorders
− Weakened anal sphincter muscles

31
Q

Rectal Prolapse

Full Thickness

Classification

A
  • External: entire rectal wall, muscle and mucosa become displaced through the anus; mucosal covering and anal skin are continuous
  • Internal: internal intussusception): prolapse is internal, concealed, or occult * mucosal covering and anal skin are not continuous*
32
Q

Rectal Prolapse

Full Thickness

Complications

A

• GIT
− Permanently extruded rectum with excoriation, ulceration
− Faecal incontinence
− Strangulation + ischaemia

• Urinary
− Urinary incontinence

33
Q

Rectal Prolapse

Full Thickness

Diagnosis

A

• Ask patient to squat and cough/strain bulge
− Haemorrhoids vs rectal prolapse
⎫ Not circumferential like rectal prolapse
⎫ Can’t feel in-between haemorrhoid and skin; with rectal can feel rectal wall on top of anus

• No bulge, but suspect partial thickness prolapse -> defecating proctography

34
Q

Rectal Prolapse

Full Thickness

Management

A

• Conservative
− Reduce if possible; table sugar has been used to reduce incarcerated rectal prolapse by absorbing the edema of the rectal , thus making it easier to reduce

• Surgery
− Abdominal
⎫ Transabdominal rectopexy: mobilization of the rectum and suturing to the presacral fascia
− Perineal
⎫ Delorme’s perineal rectopexy: mucosal excision with suture plication of the excessively long rectal muscle tube in an effort to shorten it)
⎫ Altemeier perineal rectal resection: rectosigmoidectomy with primary anastomosis

Surgery (5 decks)

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