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Clin Med I- GI > Anorectal > Flashcards

Anorectal Flashcards

1
Q

Resection in low vs. high rectal tumors

A

Low anterior resection in high tumor. Abdominoperineal resection in low tumor

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2
Q

Diagnosis of rectal cancer

A

palpable on DRE (maybe), biopsy on colonoscopy or anoscopy, endorectal US or CT/MRI for staging

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3
Q

Anal canal cancer associated with…

A

HPV. also cervical, vaginal cancer hx, immunosuppression, long-term steroids, cigarette smoking

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4
Q

Tumor is internal, aggressive biologic behavior, non-keratinizing, and associated with HPV infection-

A

tumor of anal canal

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5
Q

External tumor, well differentiated, keratinizing

A

tumor of anal margin

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6
Q

Workup of anal and perianal cancer

A

DRE, anoscopy, palpation of inguinal nodes

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7
Q

Tumors of the anal canal (internal cancers)

A

Epidermoid, melanoma, small cell

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8
Q

Tumors of the anal margin (external cancers)

A

basal cell, bowen disease, paget disease, squamous cell

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9
Q

Bowen’s disease aka

A

intraepithelial squamous cell carcinoma

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10
Q

Paget disease aka

A

Intraepithelial adenocarcinoma

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11
Q

Which of the anal margin tumors can crossover and involve both anal margin and anal canal?

A

Bowen’s disease

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12
Q

Bowen’s disease associated with…

A

condyloma

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13
Q

split or rip in the anoderm at midline…

A

anal fissure

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14
Q

Patient presents with severe burning and ripping pain that is worst right after BM. It usually lasts 1-3 hours. Bleeding occurs that makes water in toilet red. Sentinel pile seen on PE. Also see hypertrophied papilla and fissure. Dx?

A

anal fissure

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15
Q

triad in anal fissure

A

fissure, sentinel pile, and hypertrophied papilla

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16
Q

Anal fissure tx

A

sitz baths, lidocaine, vidodin, fiber, milk of magnesia, hydrocortisone cream, nitroglycerine, nifedipine ointment, botulinum toxin injection

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17
Q

origin of anorectal abscess

A

cryptoglandular

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18
Q

types of anorectal abscess

A

perirectal, ischiorectal, perianal, intersphicteric

19
Q

Perianal abscess tx

A

drained under local anesthesia

20
Q

intersphincteric abscess tx

A

drained in OR under anesthesia

21
Q

Ischiorectal and perirectal abscess

A

drained by catheter placement or I&D under anesthesia

22
Q

Fistuala in ano usually result from…

A

abscess in adults

23
Q

fistula in ano emergency?

A

No

24
Q

Tx of fistula in ano if internal sphincter involved

A

internal sphincterotomy

25
Q

tx of fistula in ano if external sphincter involved

A

Collagen fistula plug, mucosal advancement flap, seton placement

26
Q

When do hemorrhoids become pathologic?

A

When they are chronically engorged with blood

27
Q

causes of hemorrhoids

A

pregnancy, obesity, straining. lifting, cirrhossi

28
Q

Locations of hemorrhoids

A

3 major pedicles- L lateral, R anterior and posterior. And 3 minor pedicles- R lateral, L anterior and posterior

29
Q

patient presents with painless rectal bleeding,mucus discharge, rectal fullness or discomfort. Cannot be palpated on DRE. ORder anoscopy- see…

A

internal hemorrhoid

30
Q

Grade 1 -IV internal hemorrhoid

A

1- do not come out. 2- come out but spontaneously reduce. 3- come out but can be pushed back in. 4- cannot push back in

31
Q

Tx of Grade 1 and II internal hemorrhoids

A

fiber, cathartics, hydrocortisone. otherwise rubber band ligation, or sclerotherapy

32
Q

tx of Grade III and IV internal hemorrhiods

A

excised, removed with PPH- removes a ring of tissue above dentate line

33
Q

tx of thrombosed external hemorrhoids and anal fissure

A

sitz baths, lidocaine, vicodine, mild of magnesia, hydrocrotisone

34
Q

Thrrombosed external hemorrhoids have severe pain that peaks at

A

48-72 hours, then subsides over a week

35
Q

Thrombosed external hemorrhoid turns into…

A

skin tag

36
Q

patient presents with severe perianal itching that is worse at night. Skin white and leathery. Dx?

A

pruritis ani

37
Q

Pruritis ani causes

A

poor hygiene/seepage, excessive hygiene, moisture, yeaast, pinworms- in children

38
Q

Pruritis ani tx

A

keep area dry, baby wipes for hygiene, avoid soap, too much hygiene not good either

39
Q

Proctalgia fugax aka

A

levator ani syndrome

40
Q

L-sided, short lived pain that awakens person from sleep.Pain relieved by heat, defecation, muscle relaxants. Migraines history, and stress can set it off

A

Proctalgia fugax

41
Q

cyst full of hair in the intragluteal fold, single or multiple sinuses in midline of intragluteal fold (in chronic form)

A

pilonidal disease

42
Q

tx of pilonidal disease

A

phase 1- abscess I&D, oral abs. Phase 2- remove focus, excise cyst and contents.

43
Q

Pilonidal disease associated with

A

poor hygiene and hairiness

Clin Med I- GI (10 decks)

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