Anorectal Disease

Question 1

what are haemorrhoids?

Answer 1

enlarged vascular cushions in the lower rectum and anal canal

Question 2

describe the bleeding associated with haemorrhoids

Answer 2

painless

fresh, bright red

Question 3

describe the presentation of haemorrhoids

Answer 3

bleeding
perianal itchiness
no change in bowel habit

Question 4

what four investigations are done for haemorrhoids?

Answer 4

PR exam
rigid sigmoidoscopy
flexible sigmoidoscopy
proctoscopy

Question 5

when is a flexible sigmoidoscopy done when investigating haemorrhoids?

Answer 5

in patients over 50

Question 6

what four procedures can be done to treat haemorrhoids?

Answer 6

sclerosation therapy
rubber band ligation
haemorrhoidectomy
HALO/THD procedure

Question 7

what two methods of haemorrhoidectomy can be done?

Answer 7

open and stapled

Question 8

what is used in sclerosation therapy?

Answer 8

5% phenol in almond oil

Question 9

what does HALO stand for?

Answer 9

haemorrhoidal artery ligation

Question 10

what two types of rectal prolapse are there?

Answer 10

partial and complete

Question 11

what is a partial rectal prolapse?

Answer 11

prolapse of only the anterior mucosa

Question 12

what is a complete rectal prolapse?

Answer 12

the full thickness prolapses

Question 13

how does rectal prolapse present?

Answer 13

protruding mass from the anus

bleeding/mucus PR

Question 14

what does PR examination in rectal prolapse show?

Answer 14

poor anal tone

Question 15

how is complete prolapse treated if patients are too frail for surgery?

Answer 15

bulking agent

education on manual reduction

Question 16

name four surgeries that can be done to treat complete prolapse?

Answer 16

delorme’s procedure
perineal rectopexy
abdominal rectopexy
anterior resection

Question 17

how is partial prolapse in children treated?

Answer 17

dietary advice

treatment of constipation

Question 18

how is partial prolapse in adults treated?

Answer 18

very similarly to haemorrhoids

Question 19

what is anal fissure?

Answer 19

a tear in the anal margin due to the passage of a constipated stool

Question 20

what disease may be associated with multiple fissures?

Answer 20

crohn’s disease

Question 21

how does anal fissure present?

Answer 21

acute onset of severe pain following constipation

bright rectal bleeding

Question 22

what conservative management of anal fissures can be done?

Answer 22

dietary advice
stool softeners
pharmacological sphincterotomy

Question 23

how long does pharmacological sphincterotomy take?

Answer 23

6 weeks

Question 24

what two chemicals are used in pharmacological sphincterotomy?

Answer 24

0.3% GTN ointment

2% diltiazem ointment

Question 25

what two procedures can be done to treat anal fissures?

Answer 25

lateral sphincterotomy

botox injections

Question 26

what is fistula in ano?

Answer 26

an abnormal communication between the anal canal and the perianal skin

Question 27

what three conditions rarely cause fistula in ano?

Answer 27

crohn’s disease
TB
carcinoma

Question 28

what four investigations can be done into fistula in ano?

Answer 28

EUA of anorectum
sigmoidoscopy
proctoscopy
MRI

Question 29

what is an EUA of the anorectum?

Answer 29

a PR exam under anesthesia