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General Surgery > Anal/Rectal Pathologies > Flashcards

Anal/Rectal Pathologies Flashcards

1
Q

what are the cause of haemorrhoids?

A
  • Constipation (result of straining)

* Others: pelvic tumour, pregnancy, CCF, portal hypertension

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2
Q

what are haemorrhoids?

A

Are disrupted and dilated anal cushions

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3
Q

what are the locations of anal cushions?

A

3, 7 and 11 o’clock

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4
Q

what are anal cushions?

A

o The anus is lined with mainly discontinuous masses of spongy vascular tissue – the anal cushions, which contribute to anal closure

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5
Q

what is the pathophysiology of piles?

A

The effects of gravity increased anal tone, and the effects of straining at stool may make anal cushions become bulky and loose, and so to protrude become more congested and hypertrophy to protrude again more readily.

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6
Q

what are the consequences of haemorrhoids?

A

vulnerable to trauma and bleeding

may strangulate

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7
Q

what are the types of haemorrhoids?

A

Internal
External
Mixed

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8
Q

what are the features of internal haemorrhoids?

A

o Painless and covered with music
o As they arise internally there are no pain receptors in this area = painless
o Origin above dentate line (internal rectal pleuxus)

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9
Q

what are the classification criteria for internal haemorrhoids?

A

 1st Degree – remain in the rectum
 2nd Degree – prolapse through the anus of defecation but spontaneously reduce
 3rd Degree – as for 2nd degree but require digital reduction
 4th Degree – remain persistently prolapsed

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10
Q

what are the features of external haemorrhoids?

A

o Painful
o Covered with skin
o Form at the anal opening
o Painful if develop thrombus

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11
Q

what are the features of mixed haemorrhoids?

A

o Origin above and below dentate line (internal and external plexus)

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12
Q

what are the clinical features of haemorrhoids?

A
  • Bright red rectal bleeding
  • Discomfort
  • Mucus discharge
  • Pruritus anal
  • Anaemia and thrombosis are complications
  • Pain on passing stool (external haemorrhoids)
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13
Q

how are haemorrhoids diagnosed?

A
  • Abdominal examination
  • PR exam
  • Proctoscopy
  • Sigmoidoscopy
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14
Q

what is the medical management of haemorrhoids?

A

o Increased fluid and fibre +/- topical analgesics and stool softener
o Topical steroids for short term – anusol, proctosedyl, 2% diltiazem cream

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15
Q

for what stages of haemorrhoids is medical management used?

A

1st degree

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16
Q

what is the non-operative management of haemorrhoids?

A

o Rubber band ligation
o Sclerosants
o Infra-red coagulation
o Cryotherapy

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17
Q

for what stages of haemorrhoids is non-operative management used?

A

2nd or 3rd degree, or failed 1st degree

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18
Q

what is the surgical management of haemorrhoids?

A

o Excisional haemorrhoidectomy

o Stapled haemorrhoidopexy

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19
Q

what are the causes of anal fissures?

A
  • Primary problem in young to middle aged adults

* Crohn’s and UC

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20
Q

what is an anal fissure?

A

a tear in the skin that lines the anus below the level of the dentate line

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21
Q

where are anal fissures commonly found?

A

midline posteriorly

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22
Q

what is a sentinel pile?

A

An oedematous skin tag is common next to the lesion

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23
Q

what are the clinical features of anal fissures?

A
  • Acute pain – stinging, occurs after passage
  • Slight bleeding
  • Patient is constipation
  • On examination sphincter is in spasm – sentinel pule
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24
Q

what is the management of anal fissures?

A
  • Heal spontaneously
  • Anaesthetic cream and stool softener - Nitric oxide, 2% diltiazem cream
  • Surgical
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25
Q

what are the causes of a fistula in ano?

A
  • Crohn’s and ulcerative colitis
  • Carcinoma
  • Abscesses? Bacteria?
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26
Q

what is a fistula in ano?

A

Fistulas and sinuses in relation the anal canal

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27
Q

how is a fistula in ano formed?

A

Result from an initial abscess forming in one of the anal glands that pass from the submucosa of the anal canal to open within its lumen

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28
Q

what is the classification of fistulas in ano?

A
  • Submucous
  • Subcutaneous
  • Inter-sphincteric
  • Trans-sphincteric
  • Supra-sphincteric
  • Anorectal
  • Superficial
  • Low anal
  • High anal fistulas –
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29
Q

what is the definition of a superficial fistula in ano?

A

subcutaneous or submucous and are superficial tracks resulting from rupture

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30
Q

what is the definition of a low anal fistula?

A

track is below the anorectal ring

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31
Q

what is the definition of a high anal fistula?

A

supra-sphincter fistulas pass via the inter-sphincter space to open into the anus above the puborectalis

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32
Q

what are the clinical features of fistulas in ano?

A
  • Initial anorectal abscess which discharges
  • Recurrent episodes of perianal infection = persistent discharge
  • External opening of fistula
  • Internal opening may be felt
  • Squirt water in it will come out of anus
33
Q

how are fistulas in diagnosed?

A

Endoanal ultrasound or MRI

34
Q

how are superficial and low fistulas in ano managed?

A

laid open and allowed to heal by granulation

35
Q

how are high fistulas managed?

A

injected with fibrin glue or a bioprosptehitc fistula plug

o If fails laid open and nylon is passed through and left in place for 2-3 weeks

36
Q

anorectal abscesses are more common in which gender?

A

male

37
Q

what are the causes of anorectal abscesses?

A
  • Gay men – penetrative sex

* Crohn’s UC< TB

38
Q

what is a perianal abscess?

A

resulting from infection of a hair follicle, sebaceous gland or a perianal haematoma

39
Q

what is a submucous abscess?

A

infected fissure or laceration of the anal canal

40
Q

what is a ischioanal abscess?

A

from infection of an anal gland leading from the anal canal into the submucosa, spread of infection from a perianal abscess, or penetration of the ischiorectal fossa by a foreign body. The abscess may form a track like a horse-shoe behind the rectum to the opposite ischiorectal fossa.

41
Q

what is a pelvirectal abscess?

A

spread from pelvic abscess

42
Q

what are the clinical features of an anorectal abscess?

A

Painful tender swellings and discharge

43
Q

what is the surgical management of an anorectal abscess?

A

Surgically excised and drained, Antibiotics follow up

44
Q

what are the causes of a rectal prolapse?

A
  • Constipation and chronic straining

* Intussception

45
Q

what are the two types of rectal prolapse?

A

Partial and Complete

46
Q

what are the causes of partial rectal prolapses?

A

Infants: otherwise healthy
Adults: piles or sphincter incompetence

47
Q

what is the presentation of partial anal prolapse in adults?

A

pruritis ani

48
Q

what is the definition of a partial rectal prolapse?

A

confined to the mucosa, which prolapses 2-5cm from the anal verge. Palpation of the prolapse between the finger and thumb reveals that there is no muscular wall within it.

49
Q

what are the clinical features of complete rectal prolapse?

A

incontinence

mucus discharge

50
Q

what is the definition of complete rectal prolapse?

A

involves all layers of the rectal wall

51
Q

who is commonly affected by complete rectal prolapse?

A

elderly women

52
Q

what is the management of partial rectal prolapse?

A

excision of redundant mucosa, or a submucosal phenol-in-oil injection in order to produce sclerosis. Children, self cure

53
Q

what are management options for rectal prolapse?

A
  • Transabdominally – transabdominal mesh rectopexy
  • Perineal – anal encirclement with a Thiersch wire
  • Delorme’s Procedure
  • Altemeier perineal rectosigmoidectomy
54
Q

what are the complications of rectal prolapse?

A
  • Intussusception

* Solitary Rectal Ulcer Syndrome

55
Q

what are hyperplastic polyps?

A

these are small 2-3mm, sessile, wart-like lesions. Often multiple and virtually always benign, this is an incidental finding on sigmoidoscopy.

56
Q

what are neoplastic polyps?

A

three histological types of benign neoplastic polyp, all of which may undergo malignant change. Multiple polyps are present in familial adenomatous polyposis

57
Q

what are tubular adenomas?

A

usually small and rounded, the most common type of adenomatous polyp; the epithelium is arranged in tubular fashion

58
Q

what are villous adenoma?

A

appears like an anemone with many frons growing from its base on the rectal wall. Often grows very large, and produces a large amount of mucus. Greatest potential for malignant change, so best completely removed

59
Q

what are hamartomatous polyps?

A

developmental malformation which presents in children and adolescents and which looks like a cherry on a stalk. It is always benign, presents with bleeding and may prolapse during defaecation

60
Q

what are inflammatory polyps?

A

associated with colitis; is not true polyp but is oedematous mucosa against a background of ulcerated, mucosadenuded bowel wall

61
Q

how are rectal polyps diagnosed?

A

biopsy

62
Q

how are rectal polyps managed?

A

excision

63
Q

what are the causes of rectal carcinomas?

A

same as colon cancers

64
Q

what is the most common kind of rectal carcinoma?

A

adenocarcinoma

65
Q

what is a less common kind of rectal carcinoma and where can it occur?

A

squamous carcinoma at the anal verge

66
Q

what are the macrosocpic features of rectal carcinomas?

A

papillieferous, ulcerating (most common), stenosing, mucinous

67
Q

what is the local spread of rectal carcinomas?

A

 Circumferentially around the lumen of the bowel
 Invasion through the muscular coat
 Penetration into adjacent organs, for example prostate, bladder, vagina, uterus, sacrum, sacral plexus, ureters and lateral pelvic wall

68
Q

what is the lymphatic spread of rectal carcinoma?

A

to regional lymph nodes along the inferior mesenteric vessels. At a late stage, there is invasion of the iliac lymph nodes and of the groin lymph nodes (by retrograde spread) and involvement of the supraclavicular nodes via the thoracic duct

69
Q

where does seeding of colonic and rectal carcinomas occur?

A

peritoneal cavity

70
Q

what are the clinical features of rectal carcinomas?

A 
o	Constipation and/or diarrhoea
o	Bleeding 
o	Mucus discharge rectal pain, tenesmus 
o	Ascites, abdominal distension, hepatosplenomegaly
o	Supraclavicular nodes, groin, jaundice
71
Q

what imaging is done to diagnose rectal carcinomas?

A
  • Sigmoidoscopy
  • Colonoscopy
  • CT
  • MRI
72
Q

how are rectal carcinomas treated?

A
  • Surgery

* Preoperative radiotherapy +/- chemotherapy

73
Q

what are the causes of anal carcinomas?

A
  • HPV
  • Genital warts and cervical cancer
  • Immunosuppression
74
Q

what are the types of anal carcinomas?

A

commonly squamous celled

rarely adenocarcinoma, basal cell, melanoma

75
Q

what are the clinical features of anal carcinomas?

A
  • Inguinal lymphadenopathy
  • Passage of mucus/blood
  • Pain
  • Lump at anal verge
  • Faecal incontinence
76
Q

how are anal carcinomas diagnosed?

A
  • Biopsy?
  • MRI or CT
  • Transrectal ultrasound
77
Q

how are low grade anal carcinomas managed?

A

observation, may revert to normal

78
Q

how are high grade and small T1 squamous anal carcinomas managed?

A

local resection

79
Q

how are large anal carcinomas managed?

A

radiotherapy and chemotherapy

General Surgery (14 decks)

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