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Yr3 - General Surgery > Anorectal > Flashcards

Anorectal Flashcards

1
Q

Define haemorrhoids

A

Abnormal swelling or enlargement of anal vascular cushions

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2
Q

Risk factors for haemorrhoids

A

Excessive straining
Increasing age
Raised intra-abdominal pressure

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3
Q

Clinical features of haemorrhoids

A

Painless bright red rectal bleeding - blood on surface of stool
Pruitus - due to chronic mucus discharge
Rectal fullness
Soiling
Thrombosed - purple, oedematous, tense and tender perianal mass

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4
Q

Investigations for haemorrhoids

A

Proctoscopy

FBC + coagulation screen

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5
Q

Management of haemorrhoids

A 
Lifestyle advice
- increasing daily fibre
- increasing fluid intake
- prescribing laxatives
Topical analgesia
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6
Q

Non-surgical management of haemorrhoids

A

Rubber-band ligation - 1st + 2nd degree

Haemorrhoid artery ligation

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7
Q

Surgical management of haemorrhoids

A

Haemorrhoidectomy

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8
Q

Complications of haemorrhoids

A 
Thrombosis
Ulceration
Gangrene
Skin tags
Perianal sepsis
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9
Q

Define pilonidal sinus disease

A

Formation of sinus in the cleft of the buttocks

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10
Q

How does a pilonidal sinus form?

A

Hair follicle in intergluteal cleft becomes infected or inflamed
Obstruction of opening of follicle
Foreign body-type reaction
Formation of a cavity

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11
Q

Risk factors for pilonidal sinus disease

A 
Caucasian male with coarse dark body hair
Those who sit for long periods of time
Increased sweating
Buttock friction
Obesity
Poor hygiene 
Local trauma
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12
Q

Clinical features of pilonidal sinus disease

A

Intermittent red, painful and swollen mass in sacrococcygeal region
Does not communicate with anal canal - rigid sigmoidoscopy or MRI will show no internal opening of tract

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13
Q

Non-surgical management of pilonidal sinus disease

A

Shaving affected region
Plucking sinus free of hair
Abscess requires surgical drainage and antibiotics

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14
Q

Surgical management of pilonidal sinus

A

Incision and drainage of abscess
For chronic disease removal of pilonidal sinus tract
- excising tract and laying open wounds - allowing closure by secondary intention
- excising tract and primary closure of wound

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15
Q

Define a perianal fistula

A

Abnormal connection between the anal canal and perianal skin

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16
Q

Risk factors for perianal fistula

A 
Perianal abcess
IBD
Systemic diseases - TB, diabetes, HIV
History of trauma
Previous radiotherapy
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17
Q

Clinical features of perianal fistula

A

Recurrent perianal abcesses
Continuous discharge onto perineum
External opening on perineum seen on examination
Fibrous tract felt under skin

18
Q

Investigations for perianal fistula

A

Proctoscopy - visualise opening of tract in anal canal

MRI imaging

19
Q

Surgical management for perianal fistula

A

Fistulotomy

Seton - bring together fistula and prevent abscess formation

20
Q

Define an anal fissure

A

Tear in mucosal lining of the anal canal

21
Q

Risk factors for anal fissure

A

Constipation
Dehydration
IBD
Chronic diarrhoea

22
Q

Clinical features of anal fissure

A 
Intense pain post-defecation
Bleeding
Itching
Visible or palpable on DRE
Many will reject DRE due to intesnse pain - examination under anaesthesia (EUA)
23
Q

Management of anal fissure

A 
Reducing risk factors
Adequate analgesia
Increasing fibre and fluid intake
Stool softening laxatives
GTN cream or diltiazem cream
24
Q

Surgical management of anal fissure

A

Reserved for chronic fissures
Botox injections
Lateral sphincterotomy

25
Q

Define anorectal abscess

A

Collection of pus in the anal or rectal region

26
Q

How does an anorectal abscess form?

A

Plugging of the anal ducts

Fluid ducts leading to infections

27
Q

Causative organisms of an anorectal abscess form

A

E.coli
Bacteriodes spp
Enterococcus spp

28
Q

Clinical features of anorectal abscess

A

Pain in perianal region - exacerbated when sat down
Localised swelling, itching and discharge
Erythematous, fluctuant, tender mass on examination

29
Q

Management of anorectal abscess

A

Antibiotic therapy
Sufficient analgesia
Incision and drainage - heal by secondary intention
Proctoscopy to check for fistula-in-ano

30
Q

Define rectal prolapse

A

Protrusion of mucosal or full-thickness layer of rectal tissue out of anus

31
Q

Risk factors for rectal prolapse

A 
Increasing age
Female gender
Multiple deliveries
Straining
Anorexia
Previous traumatic vaginal delivery
32
Q

Clinical features of rectal prolapse

A 
Rectal mucus discharge
Faecal incontinence
Per rectum bleeding
Visible ulceration
Tenesmus
33
Q

Conservative management of rectal prolapse

A

Increasing dietary fibre and fluid intake

Minor mucosal prolapses may be banded in clinic - prone to recurrence

34
Q

Surgical management of rectal prolapse

A

Perineal approach - resection

Abdominal approach - laparoscopic rectopexy

35
Q

What is the main type of anal cancer?

A

Squamous cell carcinoma

36
Q

Define AIN

A

Anal Intraepithelia Neoplasia
Precancerous condition linked to development of squamous cell carcinoma
Strongly linked with HPV infection

37
Q

Risk factors for anal cancer

A 
HPV infection
HIV infection
Increasing age
Smoking 
Immunosuppression
Crohn’s disease
38
Q

Clinical features of anal cancer

A 
Rectal pain and bleeding
Discharge
Pruritus
Palpable mass
Ulceration and wart-like lesions
39
Q

Initial investigation for anal cancer

A

Proctoscopy
EUA - biopsy
Smear test to excluse CIN
HIV test

40
Q

Imaging for anal cancer

A

USS-guided fine needle aspiration - palpable inguinal lymph nodes
CT thorax-abdomen-pelivs - distant metastases
MRI pelvis - extent of local invasion

41
Q

Management of anal cancer

A

Chemo-radiotherapy
Wide local incision
Abdominoperineal resection

42
Q

Complication of anal cancer

A

Chemoradiation-related pelvic toxicity

  • dermatitis
  • diarrhoea
  • proctitis
  • cystitis

Yr3 - General Surgery (17 decks)

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