Ano-rectal disorders

Question 1

Haemorrhoids

Answer 1

Enlarged vascular cushions in lower rectum and anal canal  
Fresh red blood 
Painless bleeding 
Perianal itchiness 
No change in bowel habit

Question 2

Investigation for haemorrhoids

Answer 2

PR exam
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy

Question 3

Management for haemorrhoids

Answer 3

Sclerosation therapy 
Rubber band ligations 
Open haemorrhoidectomy 
Stapled haemorrhoidectomy 
HALO/THD procedure

Question 4

Rectal prolapse

Answer 4

Partial (anterior mucosal prolapse)

Complete (full thickness)

Protruding mass from anus especially during dedication

Question 5

Management of rectal prolapse

Answer 5

Many patients too frail for surgery - bulking agent and education on manual reduction

Delorme’s procedure
Perineal rectopexy
Abdominal rectopexy
Anterior resection

Question 6

Anal fissure

Answer 6

Tear in the anal margin due to passage of constipated stool

Question 7

Treatment for anal fissure

Answer 7

Dietry advice, stool softeners
Lateral sphyncterotomy
Botox injection

Question 8

Anal fistula

Answer 8

Abnormal communication between two epithelial surfaces

Could have Crohn’s, carcinoma or TB as underlying pathology

Question 9

Management of anal fistulas

Answer 9

Laying open 
Two stage procedure 
1) insertion of seton 
2)LIFT procedure 
Defunctiony colostomy