Anorectal conditions Flashcards
What are the common presentations of anorectal conditions?
Pain
Haemorrhage
Dysfunction
What are the classifications of anorectal conditions?
Inflammation
Infection
Malignancy
Trauma
What are the congenital anorectal conditions?
Inperforate anus
Uro-genital fistulae
Hirschprung’s myenteric plexus deficiency
What are the causes of an imperforate anus?
Rectum may end in a pouch which does not connect with colon
Rectu may have openings to other structures
Stenosis of anus or no anus
What is the treatment of imperforate anus?
Surgery
What is Hirschsprung’s myenteric plexus deficiency?
Stool becomes stuck in anus as nerves supplying the end of the colon are missing/not working
What are the signs of Hirschsprung’s?
Failure to defaecate in first 48 hours of life
Vomiting
What is the treatment of Hirschsprung’s?
Surgery to remove uninnervated section and attach rectum to a section with innervation
What is done pre op in Hirschsprung’s?
IV nutrition
Bowel washouts
Possible antibiotics
What are the acquired anorectal abnormalities?
Haemorrhoids Fissure Abscess Fistula Ulceration Cancer Incontinence
What are haemorrhoids?
Painful, swollen veins that may bleed
What are the signs and symptoms of haemorrhoids?
Irritation, pain and extreme itching around anus
Itchy or painful lump or swelling around anus
Faecal leakage
Painful bpwel movements
Melaena
What is the treatment of haemorrhoids?
Pain relief
Fibre supplements
Rubber band ligation
Stapled anopexy
What are the complications of haemorrhoids?
Anaemia
Bleeding
What are the signs of an anal tissue?
Sharp pain when passing stool followed by a burning pain for several hours
Melaena
What are the causes of an anal tissue?
Constipation- straining can cause a tear in the lining
Persistant diarrhoea
IBD
Pregnancy and childbirth
What is the treatment of an anal fissure?
Should resolve itself Fibre Hydration Pain relief Possible laxatives
What is an anal abscess?
Collection of pus near anus, usually as a result of infection of small anal glands
What is the most common type of anal abscess?
Perianal abscess
What is a perianal abscess?
Painful, boil lie swelling ear the anus
Red in colour, warm to touch
What are the causes of anal abscesses?
Infected fissure
STI
Blocked anal glands
What are the symptoms of an anal fissure?
Constant throbbing pain, worse when seated
Skin irritation around anus
Discharhe of pus
Constipation or pain associated with bowel movements
What is the treatment of anal abscesses?
Surgical incision and drainage
Post drainage pain relief and possible antibiotics
What are the complications of an anal abscess?
Fistula formation
What is an anal fistula?
Narrow channel with internal opening in anal canal and external opening in skin near the anus
What are the causes of anal fistulae?
Abscess which, when draining away, leaves behind a tunnel
IBD
Diverticulitis
What are the symptoms of an anal fistula?
Skin irritation around anus Constant throbbing pain which is worse when seated, moving, having a bowel movement or coughing Smelly discharge from anus Melaena Pus in stool Swelling and redness around anus Bowel incontinence
What is the treatment of anal fistulae?
Fistulotomy
Seton suture
Fill fistula with glue, block with plug, or cover with a flap of tissue
What is a fistolotomy?
Cutting open length of fistula so it heals as a flat scar
What are the causes of anal ulceration?
Crohn’s
Malignancy
Syphilis
Nicorandil- angina drug
What are the symptoms of anal cancer?
Rectal bleeding Itching and pain around anus Small lumps around anus Discharge of mucus from anus Bowel incontinence
How is anal cancer diagnosed?
Examination
Colonoscopy
CT colonography
MRI guided colonoscopy
What is the classification system of anal cancer?
Dukes
What is Dukes A anal cancer and the 5 year survival?
Submucosal cancer
90%
What is Dukes B anal cancer and the 5 year survival?
B1- muscle invasion 80-85%
B2- wall invasion 70-75%
What is Dukes C anal cancer and the 5 year survival?
C1- lymph nodes not apical 50-65%
C2- lymph nodes apical 25-45%
What is Dukes D cancer and the 5 year survival?
Distant mets
<5%
What are the 2 types of anal cancer?
Squamous cell carcinoma
Rectal anenocarcinoma
How is anal squamous cell carcinoma treated?
Radiotherapy
How is rectal adenocarcinoma treated?
Neoadjuvant chemoradiation
Laprascopic resection
What are the types of incontinence?
Urge bowel incontinence
Passive incontinence
What is urge bowel incontinece?
Sudden urge to go to the toilet and are unable to make it in time
What is passive incontinence?
Experience no sensation before soiling themselves
What are the 3 causes of bowel incontinence?
Problems with rectum
Problems with sphincter muscles
Nerve damage
What are the rectal reasons for incontinence?
Constipation
Diarrhoea
Scarring of rectum
Severe haemorrhoids
How can constipation cause incontinence?
Bowel impaction can cause rectal wall muscles to weaken, allowing watery stools to leak around the impacted stools and out of the anus
What can cause the sphincter muscles to weaken or be damaged?
Childbirth
Injury
Rectal/bowel surgery
What nerves supply in the internal anal sphincter?
Sympathetic fibres of the inferior hypogastric plexus
What nerves supply the external anal sphincter?
Inferior rectal nerve and perineal branch of S4
What nerve ssupply the anal canal?
Upper 1/2- hypogastric plexus
Lower 1/2- inferior rectal nerves
What can cause damage to the nerves supplying the anal canal?
Diabetes
MS
Stroke
Spina bifida
