Ano-rectal Disorders Flashcards
What are haemorrhoids?
enlarged vascular cushions in the lower rectum and anus
What is the lithotomy position?
laid on back, knees bent and raised above the hips - rather like the childbirth position
In the lithotomy position, what are the most common locations of haemorrhoids? Why?
3, 7 and 11 o’clock. these are the areas where the 3 major arteries feed vascular plexuses of the anal canal
What type of blood appears with haemrrhoids?
bright red
Why is there no pain with haemorrhoids?
there are no sensory fibres below the dentate line
situation where haemorrhoids might become painful?
if they thrombose and the venous blood cant return
what should not be associated with haemorrhoids?
no change in bowel habit or weight loss
Causes of haemorrhoids?
constipation with straining is most common. May also be pregnancy, compressing tumours or portal hypertension
What are 1st degree haemorrhoids?
remain in the rectum
What are 2nd degree haemorrhoids?
prolapse during defecation but spontaneously reduce
What are 3rd degree haemorrhoids?
prolapse during defecation but require digital reduction
What are 4th degree haemorrhoids?
remain persistently prolapsed
Investigations of haemorrhoids?
PR exam, Rigid or flexible sigmoidoscopy, proctoscopy
Options for management of symptomatic haemorrhoids?
scleroisation therapy (5% phenol in almond oil), rubber band ligation, open haemmorrhoidectomy, stapled haemorrhoidectomy, HALO (USS identifies supplying artery branches which are stitched off and causes haemorrhoids to shrink)
Types of rectal prolapse - which is more common?
partial and complete (more common)
what is a partial rectal prolapse?
when the mucosa prolapses
What is a complete rectal prolapse?
all layers of the rectum prolapse
presentation of a rectal prolapse?
Protruding mass from the anus particularly during defecation that may or may not reduce spontaneously, bleeding and passing mucus from the rectum, examination usually shows poor anal tone
For patients too frail for rectal prolapse surgery, what is the management option?
bulking agents and instructions for reduction
surgical options for rectal prolapse
perianal rectoplexy, abdominal rectoplexy, derlomes procedure, anterior resection
management for incomplete prolapse
dietary advice and scleroisation therapy (5% phenol in almond oil)
What is an anal fissure?
a tear in the anal margin due to the passage of constipated stool
Where may multiple fissures be seen?
in crohns disease
What is the presentation of an anal fissure?
acute onset of severe anal pain usually following an episode of constipation. pain lasts for up to half an hour after defecation. bright red rectal bleeding
treatment of anal fissures?
dietary advice and stool softeners, pharmacological sphycterotomy (0.3% GTN and 2% diltiazem ointment), botox injection (2nd line with diltiazem), lateral sphyncterotomy
What is fistula in ano?
abnormal communication between two epithelial surfaces where there is an internal anal opening and an external
investigations of anal fistulas?
Endoanal US, rigid sigmoidoscopy (flexible if frail), protoscopy, MRI
Management of anal fistulas?
fistulotomy and excision, seton suture, laid open
Complications of anal fistulas?
pain, bleeding, incontinence of flatus or stool, recurrence, further surgery.
