Anorectal Disease

Question 1

what are 1y anorectal lesions?

Answer 1

fissures, ulcers

Question 2

what are 2y anorectal lesions?

Answer 2

abscess, tags, fistula

Question 3

incidental anorectal lesions?

Answer 3

piles, hidradenitis

Question 4

key hx qs for anorectal lesions?

Answer 4

symptoms?
first episode? 
bleeding-fresh or dry?
dripping or on paper?
pain- sharp? dull?
anything protruding through back passage?
discharge?

Question 5

are haemorrhoids common?

Answer 5

yes

Question 6

what are haemorrhoids?

Answer 6

enlarged vascular cushions in lower rectum and anal canal

Question 7

presentation of haemorrhoids?

Answer 7

painless fresh bleeding on paper, perianal itching, maceration of perianal skin

Question 8

sites of haemorrhoids?

Answer 8

correspond to branches of superior haemorrhoidal artery occurring at 3,7,11 o’clock of pr in lithotomy position

Question 9

ix for haemorrhoids

Answer 9

PR exam, sigmoidoscopy, protoscopy

Question 10

Mx for haemorrhoids?

Answer 10

sclerosation therapy, rubber band ligation, haemerrhoidectomy (open/ stapled), HALO/THD procedure (cutting off vascular supply to haemorrhoids)

Question 11

what are the classes of rectal prolapse?

Answer 11

partial (anterior or mucosal prolapse)

complete (full thickness)

Question 12

presentation of rectal prolapse?

Answer 12

protruding mass from anus during defaecation, rectal bleeding/discharge, poor anal tone

Question 13

Mx for rectal prolapse?

Answer 13

partial: dietary advice, tx for constipation (kids), haemorrhoids tx (adults)
complete: bulking agent, Delorme’s procedure, rectopexy

Question 14

what are anal fissures?

Answer 14

tear in anal margin due to passage of constipated stool

Question 15

aetiology of anal fissures?

Answer 15

constipates stool, Crohn’s (multiple fissures)

Question 16

presentation of anal fissures?

Answer 16

acute onset of severe sharp anal pain following episode of constipation, fresh rectal blood

Question 17

what is anal fissure pain often likened to?

Answer 17

glass passing

Question 18

tx for anal fissures?

Answer 18

dietary advice, stool softeners, sphincterotomy (GTN or botox injection)

Question 19

what is a fistula in ano?

Answer 19

abnormal communication between 2 epithelial surfaces- 1 internal, 1 external opening on peri-anal skin

Question 20

aetiology of fistula in ano?

Answer 20

Crohn’s, TB, carcinoma or due to inadequate/delayed tx for anorectal abscess

Question 21

ix for fistula in ano?

Answer 21

EUA of anorectum, rigid/flexible sigmoidoscopy, proctoscopy, MRI

Question 22

Mx for fistula in ano?

Answer 22

staged fistulotomy, glue

Question 23

complications of fistula in ano?

Answer 23

pain, bleeding, incontinence, recurrence