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RM - GI Conditions Profile > Ano-Rectal Disorders > Flashcards

Ano-Rectal Disorders Flashcards

1
Q

Define Haemorrhoids

A

Enlarged vascular cushions in the lower rectum and anal canal

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2
Q

What percentage of the population will have symptomatic haemorrhoids at some point in their life?

A

10%

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3
Q

What are the 3 components of haemorrhoid presentation?

A

Normally painless bleeding (can be some discomfort)
Perianal itchiness
No other associated symptoms (weight loss, change in bowel habits etc)

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4
Q

Describe the bleeding from haemorrhoids

A

Fresh, bright red blood on the paper or around the surface of the stool

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5
Q

What are the 2 possible findings upon PR inspection of haemorrhoids?

A

Normal

Softening of perianal skin

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6
Q

What is the normal PR finding for haemorrhoids?

A

Nothing (unless thrombosed)

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7
Q

What are the 3 classic locations of haemorrhoids?

A

3, 7 and 11 o’clock in the lithotomy position

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8
Q

What are the 4 investigations that should be done to a patient presenting with haemorrhoids?

A 
PR exam (exclude cancer)
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy
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9
Q

What patients presenting with haemorrhoids should be given a flexible sigmoidoscopy and why?

A

Those over 50 y/o to exclude cancer

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10
Q

What is a primary haemorrhoid?

A

Internal

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11
Q

What is a second degree haemorrhoid?

A

Prolapsing

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12
Q

What is a third degree haemorrhoid?

A

Prolapsed

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13
Q

What is the management of haemorrhoids based on?

A

Symptoms

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14
Q

If haemorrhoids have very little/no symptoms, what should be done? (2)

A

No treatment

Constipation relief/advice

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15
Q

What is the best method for treating hemorrhoids?

A

HALO procedure

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16
Q

What does the HALO procedure involve?

A

Using a doppler to identify the blood vessels supplying the haemorrhoid and ligating them

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17
Q

What are the 4 treatments that can be given for haemorrhoids instead of the HALO procedure?

A

Sclerosation therapy
Rubber band ligation
Open/stapled haemorrhoidectomy
Suppositories containing local anaesthetic and corticosteroids

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18
Q

What is the purpose of sclerosation therapy in haemorrhoids?

A

Thicken blood vessels

is painful and outdated

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19
Q

What is a patient left with after a open haemorrhoidectomy?

A

An open wound that takes 6-8 weeks to heal

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20
Q

What group of people do you have to be cautious about when considering an open haemorrhoidectomy and why?

A

Women - need to make sure you dont damage the pelvic floor

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21
Q

What can some patients be left with after a stapled haemorrhoidectomy?

A

A feeling of urgency

22
Q

What is a partial rectal prolapse?

A

Just the anterior mucosa prolapsing

23
Q

What is a complete rectal prolapse?

A

All the bowel layers prolapsing

24
Q

What is the typical rectal prolapse patient?

A

Older women with kids

25
Q

Prolapses tend to be (recurrent/one offs)

A

Recurrent

26
Q

What are the 2 main presentations of a rectal prolapse?

A

Protruding mass from the anus, especially during defecation

Bleeding and mucus PR

27
Q

Why does a rectal prolapse become ulcerated?

A

If it is left outside the body for a while

28
Q

What is apparent on a PR examination of a rectal prolapse patient?

A

Poor anal sphincter tone

29
Q

What is the gold standard management for a complete prolapse?

A

Perineal rectopexy

30
Q

Many rectal prolapse patients are too frail for surgery.

What is the alternative treatment given to these patients?

A

Bulking agents and education for manual reduction

31
Q

What is the management for children with incomplete rectal prolapses?

A

Dietary advice and constipation treatment

32
Q

What is the management for adults with incomplete rectal prolapses?

A

Similar to that of haemorrhoids

33
Q

Define an anal fissure

A

Tear in the anal margin due to the passage of a constipated stool

34
Q

Normally, where does an anal fissure occur?

A

In the midline, posteriorly

35
Q

What bowel disease can cause multiple anal fissures?

A

Crohn’s

36
Q

What are the 2 presentations of anal fissures?

A

Pain after defecation (lasts about 1/2 hour)

Bright blood PR

37
Q

Why does anal fissure pain last so long?

A

Sphincter spasm

38
Q

What is the primary treatment for anal fissures?

A

Dietary advice and stool softeners

39
Q

What does treatment of an anal fissure via a pharmacological sphincterotomy involve?

A

GTN and diltiazem ointment

6 weeks

40
Q

During botox injections for anal fissures, what is paralysed?

A

Internal anal sphincter

41
Q

How long does botox treatment for an anal fissure last?

A

3 months

42
Q

How does botox work to treat anal fissures?

A

Relaxes the sphincter, therefore opening the blood vessels and allowing blood to flow

43
Q

If pharmaceutical intervention does not help treat an anal fissure, what should be done?

A

Surgery - lateral sphincterectomy

44
Q

Define a fistula

A

Abnormal connection between 2 epithelial surfaces

45
Q

What is an anal fistula normally caused by?

A

An abscess that is not treated, therefore growing and bursting either internally or externally

46
Q

What are the 3 rarer (systemic) causes of anal fistulas?

A

Crohn’s
TB
Cancer

47
Q

What are the 4 investigations for an anal fistula?

A

Endoanal ultrasound
Rigid/flexible sigmoidoscopy
MRI
Proctoscopy

48
Q

What 3 things should you aim to identify during the investigations of an anal fistula?

A

Primary and secondary tracts
Exclude sepsis
Identify any underlying diseases

49
Q

What does the treatment of an anal fistula normally involve?

A

Draining and cutting open the anal fistula and then allowing it to heal

50
Q

What are the key questions to ask in a history about anorectal diseases? (6)

A 
Symptom duration
First episode or recurrence
Bleeding (type and association with stool)
Pain
Any protrusions
Any associated discharge

RM - GI Conditions Profile (4 decks)

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