Ano-rectal Disorders

Question 1

what are haemorrhoids

Answer 1

enlarged vascular cushions in the lower rectum and anal canal

Question 2

presentation of haemorrhoids

Answer 2

painless bleeding - fresh, bright red blood, not mixed with stool, usually on the paper
perianal itchiness

Question 3

clinical findings of haemorrhoids

Answer 3

maceration of perianal skin
3rd degree piles presents obvious haemorrhoids
rectal exam - normal unless thrombosed

Question 4

classical position of haemorrhoids

Answer 4

corresponds to branches of superior haemorrhoids artery - occurring at 3, 7 and 11 o’clock position with the patient in lithotomy position

Question 5

tests for haemorrhoids

Answer 5

PR examination
rigid sigmoidoscopy
proctoscopy
flexible sigmoidoscopy (patient > 50)

Question 6

management for haemorrhoids

Answer 6

only if symptomatic;
sclerosation therapy 
rubber band ligation 
open/stapled haemorrhoidectomy 
HALO/THD procedure

Question 7

sclerosation therapy in haemorrhoid treatment

Answer 7

5% phenol in almond oil

Question 8

HALO/THD procedure in haemorrhoid treatment

Answer 8

haemorrhoidal artery ligation causing haemorrhoid to shrink over subsequent days and weeks stitch is placed in lower rectum, no sensory serves, and so procedure is pain free

Question 9

types of rectal prolapse

Answer 9

partial (anterior mucosal prolapse)

complete ( full thickness)

Question 10

what is rectal prolapse

Answer 10

protruding mass from anus especially during defecation

Question 11

clinical features of rectal prolapse

Answer 11

bleeding and passing mucus per rectum - common
por anal tone
may reduce spontaneously

Question 12

management of complete rectal prolapse

Answer 12

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

Question 13

surgery for complete rectal prolapse

Answer 13

Delorme’s procedure
perineal rectopexy
abdominal rectopexy
anterior resection

Question 14

management of incomplete prolapse - children

Answer 14

dietary advise

treatment of constipaiton

Question 15

management of incomplete prolapse - adults

Answer 15

similar to haemorrhoids;
sclerosation therapy 
rubber band ligation 
open/stapled haemorrhoidectomy 
HALO/THD procedure

Question 16

what is an anal fissure

Answer 16

tear in anal margin due to passage of constipated stool

Question 17

where do anal fissures occurs

Answer 17

usually in the midline posteriorly but may be occasionally anterior

Question 18

cause of multiple anal fissures

Answer 18

Crohn’s

Question 19

clinical presentation of anal fissure

Answer 19

acute onset of severe anal pain - following episode of constipation
pain lasts up to half an hour after defection
bright rectal bleeding

Question 20

treatment for anal fissures

Answer 20

dietary advice 
stool softeners 
pharmacological sphyncterotomy 
lateral sphyncterotomy 
botox injection

Question 21

pharmacological sphyncterotomy treatment in anal fissures

Answer 21

GTN ointment

diltiazem ointment

Question 22

what is a fistula in ano

Answer 22

abnormal communication between 2 epithelial surfaces;

internal opening in anal canal and one or more external openings on peri-anal skin

Question 23

rare causes of fistula in ano

Answer 23

Crohn’s
TB
carcinoma

Question 24

causes of fistula in ano

Answer 24

arise from delay in treatment, or inadequate treatment of anorectal abscess

Question 25

tests for fistula in ano

Answer 25

EUA of anorectic
rigid sigmoidoscopy, proctoscopy
flexible sigmoidoscopy
MRI

Question 26

management of fistula in ano

Answer 26

laying open
fistulotomy 
2 stage procedure 
insertion of seton 
LIFT procedure 
glue/permacol 
defuncitoning colostomy

Question 27

insertion of seton procedure in management of fistula in ano

Answer 27

draining and cutting

Question 28

complications of fistula in ano

Answer 28

pain 
bleeding 
incontinence of flatus or stool 
recurrence 
further surgery