ANORECTAL Flashcards
workup of anal incontinence?
Ultrasonographic examination of
accurately localize defects and asymmetry.
reliable for mapping defects of the external sphincter and is more comfortable for patients than is electromyographic mapping.
Gracilis muscle transposition, for anal incontinence?
has fallen out of favor because of an unsatisfactory
short-term success rate of approximately 50%.
This striate muscle is capable of producing voluntary contraction to occlude the anal canal. It is, however, unable to preserve a closed lumen at all times because of lack of an inherent tone within the muscles, unlike the resting anal tone generated by the internal sphincter muscle.
Use of an electrostimulating device for anal incontinence
short-term success rate of 75%.
Long-term, low-frequency electrical stimulation of skeletal muscle converts fast-twitch muscle into slow-twitch muscle capable of sustained activity.
This operation is expensive and is experimental.
artificial anal sphincter
inflatable cuff of silicone rubber placed around the upper anal canal.
The pressure-regulating balloon is placed to the left or right of the bladder, and the pump with which the patient can inflate and deflate the cuff is placed in the labia majora or in the scrotum.
This operation has been received with enthusiasm in Europe but is not approved for clinical application by the U.S. Food and Drug Administration.
result with chemotherapy and radiation therapy and rectal cancer in terms of local recurrence and survival
Postoperative combination therapy improved BOTH local control and survival in two randomized trials.
A National Cancer Institute Consensus Conference in 1990 recommended that patients with:
T3 (this STAGE II) and/or N1 to N3 tumors should receive fluorouracil-based chemotherapy plus concurrent pelvic irradiation.
NEOadjuvant has been shown to decrease local recurrence but not definitive improve on survival
NEOadjuvant radiation stumor shrinkage and downstaging to allow sphincter preservation with excellent functional results.
to
associated symptoms with rectal radiation therapy
Diarrhea preoperative radiation therapy in fewer than 50% of patients in most series.
Uncontrolled nausea and vomiting occur in only 5%.
physiology of to external beam radiation therapy works on rectal cancer
cytotoxic effect
damaging the helical configuration of the nucleic acids’ DNA,
thereby interfering with the ability of cancer cells to reproduce.
intersphincteric fistula
intersphincteric plane.
external opening usually is in the perianal skin close to the anal verge.
transsphincteric fistula
starts in the intersphincteric plane
or
deep postanal space.
track traverses external sphincter,
external opening is at the ischioanal fossa.
Horseshoe fistulas are in this category.
Horseshoe fistulas
type of trans-sphincteric fistula that starts in deep post anal space or intersphincteric plane and exits at ischioanal fossa.
Suprasphincteric fistulas
start in the intersphincteric plane
in the mid-anal canal
pass upward to a point above the puborectalis muscle.
fistula passes laterally over this muscle and downward between the puborectalis and levator ani muscles into the ischioanal fossa.
extrasphincteric fistula
passes from perineal skin
through the ischioanal fossa and the levator ani muscle
penetrates the rectal wall.
Extrasphincteric fistulas can arise from what causes
cryptoglandular origin, trauma, foreign body, or pelvic abscess.
Chronic anal fissure usually is deep, exposing the what is operative treatment at a rate of potential complication
internal anal sphincter.
Lateral internal sphincterotomy is effective but has been associated with decreased continence in up to 7% of patients.
Biopsy of a lesion in the anus revealed an invasive apocrine gland neoplasm. The deep margins include striated muscle infiltrated by neoplastic cells. what is the diagnosis
perianal Paget disease
Biopsy of a lesion in the anus revealed an invasive apocrine gland neoplasm. The deep margins include striated muscle infiltrated by neoplastic cells. what is the treatment
Wide local excision is the best treatment in the absence of invasive carcinoma.
multiple punch biopsies may be needed to determine the extent of involvement.
For more advanced lesions with underlying carcinoma: abdominoperineal resection is indicated.
Inguinal lymph node dissection is performed only if groin lymph nodes are clinically positive for metastasis.
perianal Paget disease metastasis where
sites of metastasis, in order of frequency:
inguinal and pelvic lymph nodes,
liver, bone, lung, brain, bladder, prostate, adrenal gland.