Anorectal Conditions Flashcards
What are the 2 broad categories of ano-rectal abnormalities?
Congenital
Acquired
What is the common presentation of ano-rectal abnormalities?
Pain
Haemorrhage
Dysfunction
What is a haemorrhage?
Escape of blood from a ruptured blood vessel
What are the different classifications of ano-rectal abnormalities?
Inflammation
Infection
Malignancy
Trauma
What are examples of ano-rectal congenital abnormalities?
Imperforate anus
Uro-Genital Fistulae
Hirschprung’s Myenteric Plexus Deficiency
What are examples of acquired ano-rectal abnormalities?
Haemorrhoids
Fissure
Abscess
Fistula-in-ano
Ulceration
Cancer
Control of continence
What should be considered when investigating haemorrhoids?
History
Site
Stage
Treatment
Complications
What is the treatment for haemorrhoids?
Stapled anopexy
What is stapled anopexy?
Procedure for Prolapse and Haemorrhoids (PPH), circular stapling instrument is inserted through the anus into the rectum which pulls the swollen and prolapsed blood vessels of the haemorrhoids back into their normal position
What is an anal fissure?
Break or treat in the skin of the anal canal
When investigating an anal fissure what should be considered?
History
Site
Stage
Treatment
Complications
How can the internal anal sphincter be relaxed?
Medical
Surgical
What medicine can be given to relax the internal anal sphincter?
Topical nitric oxide
0.2% glyceryl trinitrate paste
2% diltiazem calcium blocker
What surgical procedure can be done to relax the internal anal sphincter?
Internal lateral sphincterotomy
What is a peri-anal abscess?
Collection of pus develops near the anus
What are most peri-anal abscess’ the result of?
Infection from small anal glands
What should be considered when investigating peri-anal abscess’?
History
Site
Category
Treatment
Complications
What is the treatment for peri-anal abscess?
Incision and drainage
Try to avoid complications
What is fistula-in-ano?
Abnormal communications between the epithelialised surface of the anal canal and usually the perianal skin
What should be considered when investigating fistula-in-ano?
History
Site
Category
Treatment
Complications
What is the treatment for fistula-in-ano?
Lay open by fistulotomy (if superficial)
Trans-sphincteric, aim to close primary opening
What is anorectal cancer?
Malignant (cancer) cells form in the tissues of the anus
What should be considered when investigating anorectal cancer?
History
Site
Category/stage
Treatment
Complications
Follow up
Genetics
Screening
What are different colorectal cancer sites?
Left colon (36%)
Right colon (27%)
Rectum (16%)
Transverse colon (10%)
Anus (3%)
Others (8%)
What is the most common site of colorectal cancer?
Left colon
What are different kinds of imaging used to investigate colorectal cancer?
Colonoscopy
CT colonoscopy
MRI guided colonoscopy
What is a colonoscopy?
Videoscope (flexible thin tube with camera at the end) view with or without x-ray screening
What does anorectal cancer treatment depend on?
The histology (anal squamous cancer or rectal adenocarinoma)
What are the 2 main histological types of anorectal cancer?
Anal squamous cancer
Rectal adenocarcinoma
What is the treatment for anal squamous cancer?
Radiotherapy
What is the treatment for rectal adenocarcinoma?
Neo-adjuvant chemotherapy and radiotherapy
Laparoscopic resection
What is used to stage anorectal cancer?
Duke’s stage
What does each Duke’s stage correspond to?
What can anal ulceration be caused by?
Crohn’s disease
Malignancy
Syphilis
Nicrorandil
What is continence?
The ability to control movements of the bowels and bladder
What can control of continence be impacted by?
Congenital and acquired conditions
What is the treatment of lack of continence?
Sacral nerve root stimulator implant
What does a sacral nerve root stimulator implant do?
Stimulates the actions of the sacral nerve to alleviate faecal and/or urinary incontinence
How is a sacral nerve stimulator implant inserted?
Objective anorectal manometry and endoanal ultrasound
What is done before a sacral nerve root stimulator implant is permenently inserted?
Implant trial
