Anorectal and Pelvic Floor Disorders Flashcards
What is the function of the anorevtum?
To maintain continence
To control defaecation
What is the main presentation of haemorrhoids?
Bleeding PR which is painless, usually caused by straining
Surgery is often not required in the treatment of haemorrhoids but what can be done if surgery is required in an outpatient setting?
Rubber band ligation
Which other surgeries can be performed which do not occur in an out-patient setting?
HALO- haemorrhoid artery ligation operation
Haemorrhoidectomy
How will people with anorectal fissures present?
Little bleeding upon wiping, pain present.
What is the underlying cause of an anorectal fissure?
Constipation
What is the medical management of an anorectal fissure?
GTIN ointment
Ligocaine
What is the surgical management for anorectal fissure?
Botox
Sphincterotomy (not the full sphincter is removed or the patient will be fully incontinent).
What is the presentation of perianal abscess?
Excruciating pain
Signs of systemic sepsis
What are the risk factors for perianal abscesses?
BMI
Diabetes
Immunosuppressants
Trauma
What is the treatment if the perianal abscess is septic?
Antibiotics
What is the treatment if the perianal abscess is not septic?
Incision and drainage of abscess
What causes a fistula in ano?
Peri-anal sepsis
What is the presentation for a fistula in ano?
Persisting pus discharge with each flair-up
How can fistulas in ano be treated?
Very difficult to treat- 50% surgery failure
-Can use Seton to drain sepsis/mature tract
-Sphincter preseveration
What is the presentation for anal cancer?
-Painful/painless
-Bleeding
-Indurated (firm or hard)
-Red flag symptoms
-Positive FIT test
Which investigations can be used to diagnose anorectal disroders?
PR examination
Proctoscopy
Rigid sigmoidoscopy
Colonoscopy/ flexi sigmoidoscopy
Which investigation can be do if colonoscopy fails or you can get a good colonoscopy for someone with an anorectal disorder?
CT colonscopy
Which investigation can be used to rule out sepsis in the anrectum?
MRI
When would you give a patient with an anorectal disorder a CT scan?
If they are frail and cannot have a CT colonoscopy.
However, this will probably mean they are unable to undergo any surgical procedures.
Which investigation is useful for staging of rectal cancers?
MRI
What can Colonic Transit Studies be used for?
Constipation
What can anorectal manometry be used for?
Assessing anal sphincter function
What can endoscopic ultrasound be useful for in anorectal disorders?
Outlines anatomy of sphincter so can show abnormalities
What can anoscopy be useful for?
Surveillance of anal carcinomas
What is pelvic floor dysfunction?
Wide range of symptoms relating to defaecation
In those with pelvic floor dysfunction, what is important to think about in terms of history?
Patient may have a history of abuse
What are the causes of pelvic floor dysfunction?
Child-birth related
All others causes e.g. surgery, abuse, perianal sepsis.
What happens to the pelvic floor muscles after childbirth?
Become thinner and weakened
Who is usually affected by pelvic floor disorders?
Usually women but can affect men.
What is chronic constipation?
Difficulty or reduced frequency of defaecation
What can cause chronic constipation?
-Diet
-Drugs
-Organic
-Functional
Name two conditions which can cause organic chronic constipation.
Ehrler’s Danlos (!!!)
Hirschsprung
How would chronic constipation be assessed?
Exclude sinister pathology
Detailed history
Colonic Transit Studies
Defecating portogram
How can chronic constipation be treated?
-Irrigation (the process of washing out an organ or wound with a continuous flow of water or medication).
-Some surgical options e.g. sigmoid colectomy, subtotal colectomy with ileostomy/ ileorectal anastomosis.
What are the types of faecal incontinence?
Passive
Urge
Mixed
Overflow
What is passive incontinence related to?
Internal sphincter defect
What is urge incontinence related to?
Rectal pathology/ functional issues
What is mixed incontinence related to?
Prolapse
What is overflow incontinence related to?
Constipation
How is faecal-incontinence assessed?
Detailed history to determine type
Clinical examination
Anorectal physiology
Endo-anal ultrasound
Defaecatory programme
Anal manometry assesses the function of the anal sphincter. How does this happen?
-Measures resting pressure, squeeze increment, duration of squeeze.
-Estimates length of anal canal
What is the management for Figure Incontinence of the pelvic floor?
Low fibre diet
Pelvic floor exercises
Irrigation
Anal plug
