Anorectal Disorders Flashcards
What are present at the anorectal junction and what is the epithelium change here?
Teeth
Columnar inside the external anal sphincter and then squamous on the outside of the junction leading round to the buttocks
What must the sphincter pressure be for it at rest to be continent?
50mmHg
What types of anorectal abnormalities are there?
Congenital e.g. Imperforate Anus/Acquired e.g. Fissure
Local/Systemic
Benign/Malignant
Early/Late
What are the common presentations of anorectal disorders?
Pain
Haemorrhage
Dysfunction
What are the classifications of anorectal disorders?
Inflammation
Infection
Malignancy
Trauma
What are haemorrhoids?
Swollen blood vessels found in the anus and rectum
How do you treat haemorrhoids and how do they feel?
Stapled anoplexy
Not painful to touch
Where is stapled anoplexy done?
Above the dentate line
What is an anal fissure?
A tear or ulcer that develops in the lining of the anal canal
What are the causes of an anal fissure? (5)
Persistent diarrhoea IBD Pregnancy STI Tight anal sphincter muscles
What is the treatment for anal fissures?
Plenty fibre
Hydrated
Not ignoring an urge to pass stool
Exercise
What can be done to relax an internal anal sphincter?
Medical drugs
Surgery - Internal Lateral Sphincterotomy
What is a peri-anal abscess?
A collection of pus that develops near the anus
What is the treatment for a peri-anal abscess?
Incision drainage Avoid complications
How does a peri-anal abscess come about?
Most are a result of infection from small anal glands
What is a fistula-in-ano?
Chronic abnormal communication between the epithelialised surface of the anal canal and (usually) the perianal skin
What is the appearance of a fistula-in-ano?
Has two holes
Secondary to an abscess
Hole on outside and one on the inside
Where are anal glands situated and what do they drain into?
Between the internal and external anal sphincters
Anal canal
What are causes of a fistula-in-ano?
CD
HIV
Anal abscess
What is the treatment for a fistula-in-ano?
Surgery as they rarely heal
What complications are there for a fistula-in-ano?
Infection
Bowel incontinence
Anal fistula returning
What are the sites of anorectal cancer?
Asc/Trans/Des colon
Rectum
Anus
Other - 3% of cases
What does a CT colonography give you?
A virtual video of the colonic lumen
What treatment is given for anal squamous cancer?
Radiotherapy
What treatment is given for rectal adenocarcinoma?
Neo-adjuvant chemo/rad & Laparoscopic resection
What is Duke’s Classification for Anorectal cancer?
A - Submucosa B1 - Muscle B2 - Wall C1 - Nodes not apical C2 - Apical D - Distant mets
