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The Alimentary Canal > Anorectal and Pelvic Floor Disorders > Flashcards

Anorectal and Pelvic Floor Disorders Flashcards

1
Q

What is the function of the anorectum?

A

Control of defaecation
Maintenance of continence

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2
Q

What does the anorectum need for function?

A

Pelvic floor
Rectal compliance
Intact pelvic neurology

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3
Q

Describe the anorectum

A

Has 3 rectal folds - superior, middle and inferior
There are anal columns
Pectinate line

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4
Q

What are haemorrhoids?

A

Swellings containing enlarged blood vessels that are found inside or outside of bottom
They are painless and can cause bleeding

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5
Q

What are haemorrhoids caused by?

A

Straining - constipation

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6
Q

What is the treatment for haemorrhoids?

A

Laxatives for constipation
Rubber band ligation
Surgical - HALO, Anopexy, haemorrhoidectomy

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7
Q

Explain an anal fissure

A

A tear or ulcer that develops on lining of large intestine near the anus
Pain, bleeding and feels like passing glass splinters

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8
Q

What is the treatment for anal fissure?

A

Laxatives for constipation
GTN/Diltiazem and Lignocaine
Surgical - botox which relaxes sphincter so blood supply can heal the fissure
Sphincterotomy

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9
Q

What should you be aware of in chronic anal fissure?

A

Anal cancer

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10
Q

What is a perianal abscess?

A

Cavity in the anus fills with pus
Excruciating pain and signs of sepsis

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11
Q

What are the risk factors for perianal abscess?

A

DM, BMI, immunosuppression and trauma

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12
Q

What is the treatment for perianal abscess?

A

Antibiotics if septic
Incision and drainage of pus
Do not go looking for fistulas

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13
Q

Describe a fistula in ano

A

Small tunnel that develops between the end of the bowel and the skin near the opening of the anus
Peri-anal sepsis, pus discharge and faecal soiling

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14
Q

What are the types of anal fistulas?

A

Extrasphincteric, suprasphincteric, trans-sphincteric, intersphincteric and submucosal

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15
Q

What is the treatment for anal fistulas?

A

Difficult to treat
Seton - drain sepsis in fistula tract
Sphincter preservation techniques
Lay open - beware in women

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16
Q

Explain anal cancer

A

Is painless, causes bleeding, indurated
Reg flag signs
FIT test positive

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17
Q

What are routine investigations for anorectal disorders?

A

PR exam, proctoscopy, rigid sigmoidoscopy, colonoscopy, CT colonoscopy, CT scan and MRI rectum

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18
Q

What are special functional investigations for anorectal disorders?

A

Colonic Transit studies, anorectal manometry, endoanal USS, defecating proctogram, anoscopy and EUA

19
Q

What are pelvic floor disorders?

A

Collection of symptoms related to defaecation
Obscure symptomatology
Social limitation

20
Q

What are the causes for pelvic floor disorders?

A

Child birth related
Other causes - surgery, abuse, perianal sepsis, LARS - low anterior resection syndrome

21
Q

Who does pelvic floor disorders affect?

A

Predominantly women
2 groups - parous women which is largest group and symptoms related to pregnancy
All other patients including men

22
Q

What are the other reasons for pelvic floor disorders that are not parous women?

A

Surgical misadventure
Neurological/ CT disorders
Psychological/ behavioural issues

23
Q

What are some broad disorders?

A

Chronic constipation
Faecal incontinence
Mixed disorders
Chronic pelvic pain

24
Q

Explain chronic constipation

A

Difficulty or reduced frequency of evacuation
Types - dietary, drugs, organic, functional

25
Q

What are some drugs causing constipation?

A

Aluminium antacids, antimuscarinics, antidepressants, antiepileptics, antipsychotics, antispasmodics, calcium and iron supplements, diuretics, opioids and verapamil

26
Q

How is chronic constipation assessed?

A

Exclude sinister pathology by colonoscopy/CT, bloods, qFIT, coeliac serology and faecal calprotectin
Colonic transit studies, defaecating proctogram

27
Q

When should chronic constipation be treated?

A

Most want sinister pathology excluded
Aggressive dietary management, ensure adequate water intake, life style optimisation

28
Q

How is chronic constipation treated?

A

Start with regular laxatives
Ensure compliance
Consider combination therapy
Other - peristeen irrigation system and Qufora irrigation

29
Q

What are second line drugs in chronic constipation?

A

Prucalopride for women only
Lubiprostone for all adults
Linaclotide for IBS

30
Q

What are the surgical options for slow transit?

A

Subtotal colectomy with end ileostomy
Subtotal colectomy with ileorectal anastomosis

31
Q

What are the types of faecal incontinence?

A

Passive - Internal sphincter defect
Urge - Rectal pathology, functional
Mixed - prolapse
Overflow - constipation

32
Q

How is faecal incontinence assessed?

A

Clinical exam, anorectal physiology, endo-anal USS and defaecatory proctogram

33
Q

What is looked at in PR exam?

A

Peri-anal skin, resting anal sphincter tone, rectocoel, paradoxical contraction pubirectalis, haemorrhoids, prolapse

34
Q

Explain an anal manometry

A

Tests anal muscles by inserting balloon inflated with air or water to test rectal function

35
Q

What does an anal manometry measure?

A

Anal sphincter function, functional length of anal canal, pressure in response to cough and during defaecation, recto-anal inhibitory reflex

36
Q

Explain EAUS of high anal canal

A

In men thin arc of muscle from deep part of EAS can be seen anteriorly
In females deep part not seen, not be taken for rupture

37
Q

Describe a defaecating proctogram

A

Best modality
Provides info on pelvic floor motility, muscles, morphology, compensated or decompensated function and internal hernias
MRI proctogram is more time

38
Q

What is the management of faecal incontinence?

A

Aggressive conservative measures - low fibre diet, loperamide, pelvic floor exercises, EMG, irrigation and anal plug

39
Q

What are surgical interventions for faecal incontinence?

A

Sphincter repair and correct anatomical defect
Sacral nerve stimulator
Anal bulking agent for passive FI - permacol, gatekeeper, sphinkepper

40
Q

What are some mixed disorders?

A

Rectocoel - passive loss of stool from being trapped due to incomplete evacuation
Internal rectal prolapse - symptoms of obstructive defaecation and FI

41
Q

Explain chronic pelvic pain

A

Multiple behavioural/ psychological issues
Determine cause of pain
EUA, pudendal nerve block, regular enemas

42
Q

Should we use mesh or not?

A

No - stringent patient selection
Biological mesh if required
Absorbable sutures and tissue glue

43
Q

What is treatment for rectal prolapse?

A

Rectopexy if fit and active patient
Do not attempt repair without training

The Alimentary Canal (33 decks)

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