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Gastrointestinal > Anal-Rectal Pathology > Flashcards

Anal-Rectal Pathology Flashcards

1
Q

What are haemorrhoids?

A

Enlarged and congested mucosal vascular cushions around the anal canal

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2
Q

Describe grade 1 haemorrhoids

A

Do not prolapse outside the anal canal

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3
Q

Describe grade 2 haemorrhoids

A

Prolapse on defecation but reduce spontaneously

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4
Q

Describe grade 3 haemorrhoids

A

Can be manually reduced

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5
Q

Describe grade 4 haemorrhoids

A

Cannot be reduced

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6
Q

Give some predisposing conditions for haemorrhoids

A

Straining with defaecation

Pregnancy

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7
Q

How do haemorrhoids present?

A

Painless rectal bleeding, not mixed with stool

  • Most common presentation

Painful rectal bleeding

  • If thrombosed or external

Constipation

Pruritis

Lumps/swelling in anus

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8
Q

What are the types of haemorrhoids?

A

Internal

  • Above the dentate line

External

  • Below the dentate line
  • Prone to thrombosis, may be painful
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9
Q

What is the dentate line?

A

Line that divides the upper two thirds and lower third of the anal canal

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10
Q

What is the lifestyle management of haemorrhoids?

A

Increase dietary fibre

Increase fluid intake

Stop straining

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11
Q

What is the management of grade 1-3 haemorrhoids?

A

Topical local anaesthetics and steroids

Band ligation

Injection sclerotherapy

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12
Q

What is the management of grade 4 haemorrhoids?

A

Haemorrhoidectomy

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13
Q

Name a complication of haemorrhoids

A

Strangulation

  • Blood supply to a prolapsed haemorrhoid is restricted due to contraction of the anal sphincter, resulting in pain and swelling
  • May become thrombosed
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14
Q

How do thrombosed haemorrhoids present?

A

Significant pain and a tender lump

Purplish, oedematous, tender subcutaneous perianal mass

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15
Q

How are thrombosed haemorrhoids managed?

A

If patient presents within 72 hours then referral should be considered for excision

Otherwise patients can usually be managed with stool softeners, ice packs and analgesia

Symptoms usually settle within 10 days

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16
Q

What is an anal fissure?

A

Longitudinal or elliptical tears of the squamous lining of the distal anal canal

17
Q

How do anal fissures present?

A

Painful bright red rectal bleeding

18
Q

Give risk factors for anal fissures

A

Constipation

IBD

STIs

19
Q

Where is the most common location of anal fissures?

A

Posterior midline

20
Q

How are acute anal fissures managed?

A

High fibre

High fluid

Laxatives

Topical anaesthetics

Analgesia

21
Q

How are chronic anal fissures managed?

A

Topical GTN

Sphincterotomy or botulinum toxin if GTN not effective after 8 weeks

22
Q

What is a perianal abscess?

A

Collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincte

23
Q

How do perianal abscesses present?

A

Pain around the anus, which may be worse on sitting

Hardened tissue in the anal region

Pus-like discharge from the anus

If the abscess is longstanding, the patient may have features of systemic infection

24
Q

What organism are perianal abscesses most commonly linked to?

A

E-coli

(Also staph aureus)

25
Q

What investigations are used in perinanal abscess diagnosis?

A

Transperianal US

  • Only used if part of more serious underlying issue such as IBD
26
Q

How are perianal abscesses managed?

A

Incision and drainage

  • Heals in 3-4 weeks

Antibiotics used if systemic upset secondary to abscess

27
Q

Give a complication of perianal abscesses

A

Anal fistula

28
Q

What organism is associated with Proctitis?

A

C Difficle

29
Q

What is the most common histological subtype of anal cancer?

A

Squamous, unlike rectal which is Adenocarcinoma

30
Q

Give risk factors for anal cancer

A

HPV infection

Gay men/anal intercourse

HIV

History of cervical cancer or CIN

Immunosuppressive drugs

Smoking

Gastrointestinal (14 decks)

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