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Surgery > Anorectal Diseases > Flashcards

Anorectal Diseases Flashcards

1
Q

Causes of perianal pain

A
  1. Anal fissure
  2. Hemorrhoids
  3. Colitis
  4. Perineal abscess
  5. Anorectal carcinoma
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2
Q

Classification of haemorrhoids

A

1˚ inside rectum
2˚ prolapsed through anus on defecation but spontaneously reduces
3˚ Prolapses during defecation and reduces with manual reduction
4˚ remains prolapsed

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3
Q

Pathology of Haemorrhoids

A

Straining –> vascular cushion engorges (cushion = vascular and CT form plexus of dilated veins) –> epithelial lining torn –> bleeding –> bright blood on wiping

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4
Q

Risk factors for haemorrhoids

A
  • Increased abdominal pressure (ascities, pregnancy, chronic cough)
  • Straining/constipation
  • Increased age
  • HTN
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5
Q

Investigations and management of haemorrhoids

A

Ix: Proctoscopy (confirm diagnosis), FBC (anaemia), Flexible sigmoidoscopy or colonscopy
Mx: Lifestyle modification (fibre diet, weight loss, laxatives), topical analgesia (avoid opioids - cause constipation)
- Rubber band ligation - cut blood supply
- Hemorrhoidectomy if not responding to other treatment

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6
Q

Conservative management of anal fissure

A
  1. high-fibre diet
  2. Adequate fluid intake
  3. Stiz baths
  4. Topical analgesia
  5. Glycerin trinitrate intra-anal
  6. Stool softeners
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7
Q

Surgical treatment of anal fissure

A

Lateral internal anal sphincterotomy - chronic anal fissure - prevent internal sphincter spasm. divide distal internal sphincter up to dentate line

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8
Q

Definition & etiology of anal fissure

A

Tear in mucosal lining of anal canal/superficial ulcer extending below dentate line.

Due to trauma of passing hard stool - repetitive injury cycle

  • Can be secondary to IBD.
  • Lack of blood supply to posterior midline of anal canal leads to poor healing and increased breakdown of skin –> anal fissure
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9
Q

Risk Factors for anal fissure

A

Dehydration
Constipation
IBD
Diarrhoea

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10
Q

Symptoms of anal fissure

A
  1. “Feels like passing glass” - severe pain with defecation. Tearing sensation
  2. PR bleeding
  3. Pruritis
  4. Constipation
  5. Discharge
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11
Q

Outcome of chronic anal fissure

A

Fissure + sentinal skin tag and hypertrophied anal papillae

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12
Q

Types/classification of anorectal abscess

A
  1. Perianal
  2. Suprasphincteric
  3. Intersphincteric
  4. Extrasphincteric .
  5. Schiorectal, transphincteric
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13
Q

Etiology of Abscess

A

Blocked anal gland –>infection

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14
Q

Clinical features of perianal abscess

A
  1. Throbbing
  2. Swollen
  3. Erythematous
  4. Discharge
  5. Fever
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15
Q

Management of perianal abscess

A
  1. Analgesia
  2. Start fluids->keep NBM, surgical consult
  3. Surgical drain
  4. Have warm baths/clean 2-3 day
  5. Consider antibiotics if polymicrobial, immunocompromised, DM, elderly ->Gentamicin, ampicillin + metronidazole
  6. Fluids, fibre, avoid hard stools
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16
Q

Risk factors for anorectal abscess and differential

A
  1. Fistula
  2. Chron’s
  3. Male

Differential

  1. Chrohns
  2. Infected sebaceous gland
  3. Hydradenitis suppurativa
17
Q

Management of high and low fistula

A
  1. Low(does not cross many spinchter muscles)->lay tract open with fistulotomy: can heal via secondary intention
  2. High (does cross sphincter muscles)->requires
    a. seton procedure, or else with have flow incontinence, allows drainage of fistula + healing
    b. Advancement flap->repair of internal gland with suture, then advancing skin to cover fistula
18
Q

Clinical features of anal cancer

A 
Pain 
Pruritis 
Bleeding 
Moisture 
Most commonly epidermoid type (SCC)
19
Q

Risk Factors for anal cancer

A 
Homosexual male 
HPV
Anal sex 
Syphillis 
Tobacco
20
Q

Define pilonidal sinus

A

Pilonidal sinus disease is a disease of the inter-gluteal region, characterised by the formation of a sinus in the cleft of the buttocks. Males aged 16-30 years.
Acquired chronic inflammatory condition - hair becomes embedded in midline pit between buttock and coccygeal region.

21
Q

Pathophysiology of pilonidal sinus

A
  1. Forceful insertion of hair into skin of natal cleft in sacrococcygeal area
  2. Promotes chronic inflammatory reaction
  3. Epithelialized sinus formed
  4. Sinus cause deep communication via deep cavity
  5. Chronic discharge and infection
  6. Abscess
22
Q

Symptoms of pilonidal sinus

A
  1. Sacrococcygeal discharge, pain and swelling
  2. offensive smell from natal cleft
  3. staining underwear
23
Q

Management of pilonidal sinus

A

Non-surgical: shaving/hair removal. Washed out. If infected antibiotics and drainage

Surgical: excising tract and laying open wound - close by secondary intension or primary closure.

24
Q

Common organisms causing anorectal abscess

A

E coli, strep cocci, staph cocci, bacteriods, anaerobes

25
Q

Definition of fistula-in-ano

A

Anal fistula from rectum to perianal skin

Inflammatory tract with internal os at dentate line, external os on skin.

26
Q

What is the dentate line

A

Pectinate line - Divides upper 2/3 and l ower 1/3 of anal canal at the hindgut - proctodeum junction

27
Q

What is Goodsall’s rule?

A

Fistulas originating anterior to transverse line will follow straight course and exit anteriorly. Fistulas originating posterior to transverse line will begin in midline and have curved tract.

28
Q

Treatment of fistula-in-ano

A

Identify internal opening
Fistulotomy: unroof tract, drain and heal by secondary intention.
- Low lying (doesn’t involve external sphincter)= primary fistulotomy
- High lying (involves external sphincter - staged fistulotomy with seton suture placed through tract to promote drainage and fibrosis (decreased incidence of incontinence.

Post op: sitz baths, irrigation and packing (help heal from inside out)

29
Q

Why do fistulas stay open

A 
FRENDO
Foreign body 
Radiation 
Infection 
Epithelialization 
Neoplasm 
Distal obstruction (most common) 
Others: increased flow, steroids

Surgery (9 decks)

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