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Year 4: General Surgery + GI > Anal + Perianal Disease > Flashcards

Anal + Perianal Disease Flashcards

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1
Q

what are haemorrhoids

A

abnormal swelling/enlargement of anal vascular cushions

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2
Q

what is the function of the anal vascular cushions?

how many are there?

A

they assist the anal sphincter in maintaining continence

- 3

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3
Q

how are heamorrhoids classified

A

according to size:
1st Degree: remain in rectum
2nd Degree: prolapse through anus on defecation but spontaneously reduce
3rd Degree: prolapse through anus on defecation and require digital reduction
4th Degree: remain persistently prolapsed

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4
Q

risk factors for haemorrhoids

A 
excessive straining (from chronic constipation)
increasing age
raised intra-abdominal pressure (e.g. pregnancy, chronic cough, ascites)
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5
Q

presentation of haemorrhoids

A

painless bright red PR bleeding

  • post defecation
  • on surface of stool, not mixed in

itch, rectal fullness, soiling due to impaired continence

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6
Q

presentation of a thrombosed prolapsed haemorrhoid

A

purple/blue, oedematous, tense, tender perianal mass

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7
Q

what investigation confirms haemorrhoids

A

proctoscopy

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8
Q

management of haemorrhoids

A

lifestyle advice: increase daily fibre + fluid intake to avoid constipation
laxatives + topical lignocaine for symptom relief
symptomatic 1st/2nd degree haemorrhoids can be treated with rubber band ligation
3rd/4th degree haemorrhoids may require haemorrhoidectomy

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9
Q

what is pilondial sinus disease

A

formation of a sinus in the inter-gluteal cleft

- due to inflammation + obstruction of hair follicle – pit + cavity formation

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10
Q

who gets pilondial sinus disease

A

caucasian males with course dark body hair
most commonly 16-30 years old
increased risk in those who sit for prolonged periods e.g. lorry drivers / office workers

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11
Q

presentation of pilondial sinus disease

A

intermittent, red painful, swollen mass in sacrococcygeal region
- commonly purulent discharge

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12
Q

non-surgical management of pilondial sinus disease

A

shaving of the affected region

plucking the sinus free of hair that is embedded

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13
Q

surgical management of pilondial sinus disease

A

abscesses: incision + drainage and washout is required

chronic disease: removal of sinus tract

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14
Q

what is a perianal fistula

A

abnormal connection between anal canal + perianal skin

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15
Q

what are the majority of perianal fistulas caused by

A

a perianal abscess

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16
Q

risk factors for a perianal fistula

A

IBD - Crohns or UC
Systemic disease - TB, HIV, Diabetes
Trauma to anal region

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17
Q

presentation of perianal fistula

A

either:

  • recurrent abscesses
  • discharge onto perineum
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18
Q

imaging used to visulise a perianal fistula

A

proctoscopy

- MRI used in complex fistulas

19
Q

what system is used to classify perianal fistulas

A

Park’s classification system

20
Q

most common type of perianal fistula

A

inter-sphincteric fistula

21
Q

surgical options for perianal fistulas

A
  • fistulotomy

- placement of a seton to bring together + close the tract

22
Q

what is an anorectal abscess

A

collection of pus in the anal-rectal region

23
Q

what causes formation of an anorectal abscess

A

plugging of anal ducts resulting in fluid stasis + infection

24
Q

infective organisms in an anorectal abscess

A

E.Coli

Enterococcus

25
Q

presentation of an anorectal abscess

A

pain in the perianal region which is exacerbated by sitting down

26
Q

what is found on examination of an anorectal abscess

A

an erythematous, fluctuant, tender perianal mass

27
Q

management of an anorectal abscess

A

antibiotics + analgesia
surgical incision + drainage under GA
proctoscopy post drainage to look for any perianal fistulae

28
Q

what is an anal fissure

A

tear in the mucosal lining of the anal canal

- most commonly due to trauma from defecation of a hard stool

29
Q

how long does an anal fissure need to be present to be classified as

  • acute
  • chronic
A 
acute = < 6 weeks
chronic = > 6 weeks
30
Q

presentation of an anal fissure

A

intense pain post defecation
PR bleeding - bright red on wiping
itch post defecation

31
Q

where are most anal fissures located

A

posterior midline

32
Q

medical management of an anal fissure

A

increase fibre + fluid intake
stool softening laxatives
topical lidocaine
GTN/Diltiazem cream – increases blood flow + relaxes anal sphincter, decreases pain + promotes healing

33
Q

surgical management of an anal fissure

A

reserved for chronic fissure where medial management has failed to resolve symptoms:

  • botox injections
  • lateral sphincterectomy
34
Q

difference between a

  • partial thickness rectal prolapse
  • full thickness rectal prolapse
A

partial thickness - rectal mucosa protrudes out of anus

full thickness - rectal wall protrudes out of anus

35
Q

risk factors for rectal prolapse

A 
increasing age
female
multiple deliveries
straining 
anorexia
36
Q

presentation of a rectal prolapse

A

rectal mucus discharge
faecal incontinence
PR bleeding
- full thickness prolapses begin internally and may present with rectal fullness + tenesmus

37
Q

investigation of a rectal prolapse

A

PR - weakened anal sphincter

Ask patient to strain

38
Q

definitive management of rectal prolapse

A

surgical repair

39
Q

what are the majority of anal cancers

A

squamous cell carcinomas arising below the dentate line

40
Q

anal cancer risk factors

A 
HPV infection (HPV 16,18)
HIV
Smoking
Crohns disease
Immunosuppression
41
Q

symptoms of anal cancer

A 
rectal pain 
PR bleeding
anal discharge 
itch 
palpable mass
42
Q

investigation of anal cancer

A

PR
proctoscopy
examination under anaesthetic (EUA)

43
Q

management of anal cancer

A

chemo-radiotherapy

abdominoperineal resection for advanced disease

Year 4: General Surgery + GI (13 decks)

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