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MC > Anoreactal disorders > Flashcards

Anoreactal disorders Flashcards

1
Q

________cause pain on defecation and usually
develop after a period of constipation (may be a
brief period) and tenesmus

A

Anal fissures

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2
Q

Usual location of anal fissure

A

On inspection the anal fissure is usually seen in
the anal margin, situated in the midline posteriorly
(6 o’clock)—90% of fissures

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3
Q

If there are multiple fissures, ______should
be suspected. These fissures look different, being
indurated, oedematous and bluish in colour

A

Crohn disease

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4
Q

In chronic anal fissures a sentinel pile is common
and in long-standing cases a _________ is
seen at the anal margin, with fibrosis and anal stenosis

A

subcutaneous fistula

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5
Q

Anal fissure

A combined_________ointment applied
to the fissure can provide relief and promote healing

A

local anaesthetic and corticosteroid

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6
Q

Purpose of hot sitz bath

A

Hot

baths relax the internal anal sphincter

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7
Q

________ is indicated in
patients with a recurrent fissure and a chronic fissure
with a degree of fibrosis and anal stenosis

A

Lateral internal sphincterotomy

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8
Q

An alternative
__________ which is as effective as
surgical treatment, is injection of botulinum toxin
into the sphincter

A

‘chemical’ sphincterotomy,

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9
Q
  • Episodic fleeting rectal pain
  • Varies from mild discomfort to severe spasm
  • Last 3–30 minutes
  • A functional bowel disorder
  • Affects adults, usually professional males
A

Proctalgia fugax (levator ani spasm)

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10
Q

These ulcers occur in young adults; they can present
with pain but usually present as the sensation of
a rectal lump causing obstructed defecation and
bleeding with mucus.

A

Solitary rectal ulcer syndrome

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11
Q

Solitary rectal ulcer syndrome findings of sigmoidoscopy

A

The ulcer, which is usually seen
on sigmoidoscopy about 10 cm from the anal margin
on the anterior rectal wall, can resemble cancer.

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12
Q

_______ is an unpleasant sensation of incomplete
evacuation of the rectum. It causes the patient to
attempt defecation at frequent interval

A

Tenesmus

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13
Q

MC cause of tenesmus

A

The most

common cause is irritable bowel syndrome.

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14
Q

Other causes of tenesmus

A

Cancer, functional

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15
Q

A _________ is a purple tender swelling at the
anal margin caused by rupture of an external
haemorrhoidal vein following straining at toilet or
some other effort involving a Valsalva manoeuvre

A 
perianal haematoma (thrombosed external
haemorrhoid)
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16
Q

Tx of hematoma depends on?

A

the time of presentation after the

appearance of the haematoma

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17
Q

Mx of perianal hematoma

________Perform simple
aspiration without local anaesthetic using a 19
gauge needle while the haematoma is still fluid.

A

Within 24 hours of onset.

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18
Q

Mx of perianal hematoma

________The blood
has clotted and a simple incision under local
anaesthetic over the haematoma with deroofing
with scissors (like taking the top off a boiled
egg) to remove the thrombosis by squeezing

A

From 24 hours to 5 days of onset.

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19
Q

Mx of perianal hematoma

______ The haematoma is best left alone
unless it is very painful or (rarely) infected.
Resolution is evidenced by the appearance of
wrinkles in the previously stretched skin

A

Day 6 onwards.

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20
Q

A marked oedematous circumferential swelling will

appear if all the haemorrhoids are involved

A

Strangulated haemorrhoids

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21
Q

Strangulated haemorrhoids Tx

A

Initial treatment is with rest and ice packs and then

haemorrhoidectomy at the earliest possible time

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22
Q

This is caused by infection by polymicrobial organisms

of one of the anal glands that drain the anal canal

A

Perianal abscess

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23
Q

Tx of perianal abscess

A

Drain via a cruciate incision, which may need to be
deep (with trimming of the corners) over the point of
maximal induration. A drain tube can be inserted for
7 to 10 days.

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24
Q

Abx for perianal abscess

A

• metronidazole 400 mg (o) 12 hourly for 5–7 days
plus
• cephalexin 500 mg (o) 6 hourly for 5–7 days

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25
Q

An________ presents as a larger, more
diffuse, tender, dusky red swelling in the buttock.
The presence of an abscess is usually very obvious but
the precise focus is not always obvious on inspection

A

ischiorectal abscess

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26
Q

Recurrent abscesses and discharge in the sacral region
(at the upper end of the natal cleft about 6 cm from
the anus) caused by a ____ and ______

A

midline pilonidal sinus, which

often presents as a painful abscess

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27
Q

Pilonidal means ‘a
nest of hairs’ and the problem is particularly common
in ______

A

hirsute young men

28
Q

An _____ is a tract that communicates between
the perianal skin (visible opening) and the anal canal,
usually at the level of the dentate line

A

anal fistula

29
Q

Examples of Prolapsing lumps

A

Second- and third-degree haemorrhoids
Rectal prolapse
Rectal polyp
Hypertrophied anal papilla

30
Q

Example of persistent lumps

A 
Skin tag
Perianal warts (condylomata accuminata)
Anal cancer
Fourth-degree haemorrhoids
Perianal haematoma
Perianal abscess
31
Q

The______is usually the legacy of an untreated
perianal haematoma. It may require excision for
aesthetic reasons, for hygiene or because it is a source
of pruritus ani or irritation

A

skin tag

32
Q

How to Tx skin tag

A

A simple elliptical excision at the base of the skin is
made under local anaesthetic. Suturing of the defect
is usually not necessary

33
Q

It is important to distinguish the common viral warts

from the ______ of secondary syphilis

A

condylomata lata

34
Q

Tx of warts

A

Local therapy includes the application of podophyllin

every 2 or 3 days by the practitioner or imiquimod

35
Q

This is protrusion from the anus to a variable degree
of the rectal mucosa (partial) or the full thickness
of the rectal wall.

A

Rectal prolapse

36
Q

Surgery such as ______ (fixing the
rectum to the sacrum) is the only effective treatment
for a complete prolapse.

A

rectopexy

37
Q

_________ are a
complex of dilated arteries, branches of the superior
haemorrhoidal artery and veins of the internal
haemorrhoidal venous plexus

A

Internal haemorrhoids

38
Q

Stages of Internal haemorrhoids

________
three bulges form above the dentate line. Bright
bleeding is common.

A

Stage 1: First-degree internal haemorrhoids:

39
Q

Stages of Internal haemorrhoids

_____
the bulges increase in size and slide downwards
so that the patient is aware of lumps when
straining at stool, but they disappear upon
relaxing. Bleeding is a feature.

A

Stage 2: Second-degree internal haemorrhoids:

40
Q

Stages of Internal haemorrhoids

______ the
pile continues to enlarge and slide downwards,
requiring manual replacement to alleviate
discomfort. Bleeding is also a featu

A

Stage 3: Third-degree internal haemorrhoids:

41
Q

Stages of Internal haemorrhoids

________________
prolapse has occurred and replacement of the
prolapsed pile into the anal canal is impossible

A

Stage 4:

Fourth-degree internal haemorrhoids:

42
Q 
Invasive treatment of haemorrhoids is based on three
main procedures:
1
2
3
A

rubber band ligation, cryotherapy and

sphincterotomy

43
Q

Tx of hemorrhoid

Injection is now not so favoured while
a meta-analysis concluded that _____
was the most effective non-surgical therapy

A

rubber band ligation

44
Q

________ refers to the involuntary escape

of fluid from or near the anus

A

Anal discharge

45
Q

Types of continent anal discharge

A 
• Anal fistula
• Pilonidal sinus
• STIs: anal warts, gonococcal ulcers, genital
herpes
• Solitary rectal ulcer syndrome
• Cancer of anal margin
46
Q

Types of incontinent anal discharge

  • Minor incontinence—weakness of ____
  • Severe incontinence—weakness of ___
A

internal sphincter

levator ani
and puborectalis

47
Q

Partially continent anal discharge

A
  • Faecal impaction

* Rectal prolapse

48
Q

Mx of anal incontinence

1
2
3
4

A

direct sphincter repair,
directed injections such as collagen and
silicone into the anal sphincter, and an
artificial anal sphincter
A colostomy
may be the last resort

49
Q 
Black tarry (melaena) stool indicates
bleeding from the upper gastrointestinal tract and is
rare distal to the \_\_\_\_
A

lower ileum.

50
Q

Frequent passage of blood and mucus indicates
a ________ whereas more proximal
tumours or extensive colitis present different patterns

A

rectal tumour or proctitis,

51
Q 
Substantial haemorrhage, which is rare, can be
caused by 
1
2
3
4
A

diverticular disorder,
angiodysplasia or
more proximal lesions such as Meckel diverticulum
and even duodenal ulcers

52
Q

_______ are
5 mm collections of dilated mucosal capillaries and
thick-walled submucosal veins, found usually in the
ascending colon of elderly patients who have no
other bowel symptom

A

Angiodysplasias

53
Q

DDx

Bright red blood on toilet paper

A 
Internal haemorrhoids
Fissure
Anal cancer
Pruritus
Anal warts and
condylomata
54
Q

Blood and mucus on

underwear

A 
Third-degree haemorrhoids
Fourth-degree
haemorrhoids
Prolapsed rectum
Mucosal prolapse
Prolapsed mucosal polyp
55
Q

Blood on underwear (no

mucus

A

Ulcerated perianal
haematoma
Anal cancer

56
Q

Blood and mucus mixed

with faeces

A 
Colorectal cancer
Proctitis
Colitis, ulcerative colitis
Large mucosal polyp
Ischaemic colitis
57
Q

Blood mixed with faeces (no

mucus)

A

Small colorectal polyps

Small colorectal cancer

58
Q

Melaena (black tarry stools

A 
Gastrointestinal bleeding
(usually upper) with long
transit time to the anus
59
Q

Torrential haemorrhage

A

Diverticular disorder

Angiodysplasia

60
Q

Large volumes of mucus in

faeces (little blood

A

Villous papilloma of rectum

Villous papilloma of colon

61
Q

What are the red flags in rectal bleeding

A
  • Age >50 years
  • Change of bowel habit
  • Weight loss
  • Weakness, fatigue
  • Brisk bleeding
  • Constipation
  • Haemorrhoids (may be sinister)
  • Family history of cancer
62
Q

Causes of Pruritus ani

A

It is seen typically in adult males with considerable inner drive, often at times of stress and in hot weather when sweating is excessive.

Seborrhoeic dermatitis is a particularly common underlying
factor.

63
Q

T or F

Most cases of uncomplicated pruritus ani resolve
with simple measures, including explanation and
reassurance

A

T

64
Q

How to manage intractable pruritus ani

A

Otherwise prescribe a corticosteroid, especially
methylprednisolone aceponate 0.1%. Once
symptoms are controlled, use hydrocortisone 1

65
Q

Consider _____ and ____ in patients presenting with ‘a sore

bottom

A

perianal lichen simplex and lichen

sclerosus

MC (90 decks)

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