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Gastroenterology > Anorectal disorders > Flashcards

Anorectal disorders Flashcards

1
Q

Which muscle is responsible for being able to squeeze on a finger during a PR exam?

A

external sphincter

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2
Q

Anus epithelium type

A

stratified squamous epithelium

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3
Q

Rectum epithelium type

A

columnar epithelium

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4
Q

What does the dentate line indicate?

A

junction of hindgut and proctodenum

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5
Q

Venous drainage above dentate line

A

superior rectal vein + portal vein (portal circulation)

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6
Q

Venous drainage below dentate line

A

IVC (systemic circulation)

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7
Q

What are haemorrhoids?

A

varicose veins of anal canal

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8
Q

Haemorrhoids symptoms

A

bleeding
prolapse
irritation
pain - less common

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9
Q

Describe the grading of haemorrhoids

A

grade 1 = no prolapse
grade 2 = prolapse but reduce spontaneously
grade 3 = prolapse, stay reduced if pushed back manually
grade 4 = irreducible (intero-external haemorrhoid)

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10
Q

Haemorrhoids differential diagnosis

A

anal fissure
anorectal polyps
mucosal prolapse
bleeding from higher source - usually mixed with faeces
anorectal carcinomas

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11
Q

What investigation would you perform on a 45yM who has red rectal bleeding and itching, no altered bowel habit and no FH?

A

flexible sigmoidoscopy

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12
Q

How far can a flexible sigmoidoscopy view?

A

up to splenic flexure

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13
Q

Haemorrhoids management options

A

conservative (reassurance, diet)
injection or rubber band ligation
surgical - HALO, haemorrhoidectomy, stapled haemorrhoidopexy

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14
Q

Complications of haemorrhoid surgery

A

pain
haemorrhage
infection
stenosis
incontinence
recurrence
impacted faeces
retention of urine

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15
Q

What is an anal fissure?

A

tear causing a painful linear ulcer at the margin of the anus

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16
Q

Anal fissure symptoms

A

pain during and after bowel motion
bleeding
itching

17
Q

What conditions should you think of if someone has a lateral anal fissure?

A

Crohn’s
lymphoma
leukaemia
anal cancer
syphilis/STD
trauma
TB

18
Q

Most common location of anal fissure

A

posterior midline

19
Q

How is an anal fissure diagnosed?

A

physical examination is diagnostic

sentinel skin tag (externally), fissure, hypertrophied papilla (internally)

20
Q

What is a sentinel pile?

A

oedematous skin tag at the lower end of chronic anal fissure

21
Q

A patient presents to clinic with posterior anal fissure, what is the most commonly used treatment?

A

diltiazem cream

22
Q

Chronic anal fissure treatment

A

ointments - nitro-glycerine ointment, diltiazem ointment

botulinum toxin A injection

surgery - lateral internal sphincterotomy

23
Q

Perianal abscess symptoms

A

pain - increased on walking and straining
fever
malaise
inflammation signs - calor, rubor, dolor, tumour, function laesse

24
Q

Name some locations of anal abscessed

A

perianal
ischiorectal
supralevator, intersphincteric, submucous
ischiorectal post-anal space

25
Q

Abscesses treatment

A

surgical drainage - cruciate incision, sometimes a drain may be left

26
Q

What is an anal fistula?

A

abnormal communication between the interior of the anal canal or rectum and the skin surface

(rarer forms may communicate with the vagina, large bowel and bladder)

27
Q

What is the difference between a fistula and a sinus?

A

A fistula is an abnormal pathological pathway between two anatomic spaces or a pathway that leads from an internal cavity or organ to the surface of the body. A sinus tract is an abnormal channel that originates or ends in one opening

28
Q

Anal fistula symptoms

A

discharge
pain and swelling when fistulas become blocked and abscesses recur
irritation causes itching and discomfort

29
Q

Describe Goodsall’s rule for anal fistulas

A

if perianal skin opening is posterior to the transverse anal line, the fistulous tract will open into the anal canal in the midline posteriorly, sometimes taking a curvilinear course
a perianal skin opening anterior to the transverse anal line is usually associated with a radial fistulous tract

helps locate site of internal opening

30
Q

Fistula treatment

A

seton
fistulotomy
fibrin glue
fistula plugs
LIFT procedure
advancement flap

31
Q

Why is there reluctance in performing fistulotomy for fistula in ano despite high success rate?

A

risk of incontinence

32
Q

What is a pilonidal sinus?

A

a small hole or ‘tunnel’ in the skin. It usually develops in the area where the buttocks divide

33
Q

Pruritis ani symptoms and signs

A

itching
burning
irritation
worse at night
reddened, oedematous, ulcerations and excoriations
skin atrophic or hypertrophic with associated nodularity and scarring

34
Q

What causes anal warts?

A

HPV

Gastroenterology (43 decks)

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