AnoRectal Disorders Flashcards

1
Q

Describe the nerve supply of the pelvic region?
Specifically the pelvic organs, pelvic floor muscles, puborectalis and external sphincter nerve supply.

A
  • Pelvic Organs are supplied by the sympathetic fibres of L1-L2 and parasympathetic fibres of S2-S4. (Lumbar and pelvic splanchnic nerves)
  • Pelvic floor uscles are supplied directly by ventral rami of sacral spinal nerves S2-4
  • Puborectalis and external sphincter are supplied by the ventral rami of s2-4 spinal nerves via the pudendal nerve.`
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2
Q

What are the categories of anorectal disorders?

A

Inflammatory
Infection
Malignancy
Trauma
Congenital

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3
Q

List some congenital anorectal abnormalities?

A
  • Imperforate Anus
  • Uro-genital Fistulae
  • Hirschprung’s Myenteric plexus deficiency
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4
Q

What are the types of imperforate anus?

A
  • Pouch shaped rectum fails to connect with colon
  • Anus stenosed or absent
  • Rectum opening to other structures e.g. urethra
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5
Q

What is hirschprung’s myenteric plexus deficiency?

A

The nerves suppling the end of the colon are missing leading to an inability to shit.
The baby fails to defecate in the first 48 hours of life and vomits bile

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6
Q

How do we treat hirschprungs myenteric plexus deficiency?

A

Pre-op:
IV nutrition, bowel washouts and antibiotics if necessary

Surgery:
Remove uninnervated bowel section and attach an innervated section to the rectum

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7
Q

List of the acquired anorectal conditions:

A
  • Haemorrhoids
  • Anal fissure
  • Abscess
  • Fistula in-ano
  • Ulceration
  • Cancer
  • Continence control
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8
Q

What is a haemorrhoid?

A

An inflamed and swollen vein in the anal canal causing enlarged anal cushions.

Associated with straining, constipation etc.

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9
Q

How does a haemorrhoid present?

A
  • Itching
  • Irritation/pain
  • Lumps/swelling
  • Faecal Leakage
  • painful bowel movements
  • haematochezia

Theres no pain if the haemorrhoid is above the dentate line

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10
Q

What is the dentate line?

A

A line which divides the upper two thirds and lower third of the anal canal.
This line represents the divide of feeling

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11
Q

How do we treat a haemorrhoid?

A

With
- pain relief
- Fibre supplements
- Ligation either by rubber banding the haemorrhoid or US guided ligation of the vessel
- Stapled anopexy

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12
Q

Explain the stapled anopexy procedure?

A

For haemorrhoids and prolapse.
Use a special device to cut out a doughnut shape of mucosa and stable the tissue above and below together

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13
Q

What causes an anal fissure and how does it present?

A
  • Straining e.g. constipation
  • Persistant diarrhoea
  • IBD
  • Pregnancy & Childbirth

Presents with sharp pain when passing stool and haematochezia. Followed by persistant burning pain,

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14
Q

How do we treat an anal fissure?

A

Most resolve independantly
Fibre & Hydration
Pain relief
~laxatives

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15
Q

What causes anal abcess in the ano-rectal region and how do they present?

A

Usually blocked small anal glands becomes infected, STI or an infected fissure.

A perianal abscess is most common, appearing like a painful boil like swelling near the anus, red an warm.
Also with constant, throbbing pain worse when seated, skin irritation, pus and constipation/pain with bowel movements.

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16
Q

How is an anal abscess complicated/treated?

A

Fistula formation

Treated with surgical incision and drainage followed by pain relief and antibiotics as necessary

17
Q

What is an anal fistula and how does it arise?

A

A narrow channel connecting anal canal externally to the skin near the anus.
Usually results from an abscess but also from IBD or diverticulitis

18
Q

How does an anal fistula present?

A
  • Skin irritation
  • Pain. Constant, throbbing, worse when seated moving shitting or coughing
  • Smelly discharge
  • Pus in stool
  • haematochezia
  • Incontinence
  • Swelling/redness
19
Q

How do we treat an anal fistula?

A

Fistulotomy:
- Cut open length of fistula
- Heals to a flat scar
- For superficial fistulas

Seton Suture:
- Suture loops through fistula to keep it open so the pus drains until it heals
- For trans-sphincteric fistulas (starts between the sphincters and crosses the external on its way out)

Glue Plug:
- Clean out fistula and drain pus
- Block fistula with glue and cover with a flap of tissue

20
Q

What could cause ulceration of the anorectal region?

A
  • IBD, mostly crohn’s
  • Malignancy
  • Syphilis
  • Nicorandil (angina vasodilator)
21
Q

How does a cancer in the anorectal region present and how would we investigate it?

A

Rectal bleeds, itching and pain, small lumps, bowel incontinence, mucous from anus.

  • Rectal exam
  • Colonoscopy
  • CT Colonography
  • MRI guided colonoscopy
22
Q

How do we classify colonic and anorectal cancer?

A

Dukes classification
A - Submucosa
B - Muscle wall
C - Lymph nodes
D - Metastases

23
Q

Hwo do we treat anorectal cancer?

A

If its squamous cell carcinoma use radiotherapy

If its rectal adenocarcinoma neoadjuvant chemo and a laprascopic resection

24
Q

What are the 2 types of incontinence?

A

Urge bowel - sudden need to go and not enough time

Passive - No sensation prior to soiling themselves

25
Q

What causes incontinence?

A
  • Rectal problems such as constipation - fistula-in-ano - bowel impaction (weakens rectal wall muscles) - rectal prolapse -
    Diarrhoea - Scarring of the rectum - Haemorrhoids
  • Problems with the sphincter muscles due to trauma, childbirth, surgery or congenital disorders (e.g. hirschprungs)
  • Nerve damage to the hypogastric plexus (upper 1/2 of anal canal) or inferior rectal nerves (lower 1/2)
    OFten caused by diabetes, MS, stroke or spina bifida