Anorectal Disorders

Question 1

What are present at the anorectal junction and what is the epithelium change here?

Answer 1

Teeth
Columnar inside the external anal sphincter and then squamous on the outside of the junction leading round to the buttocks

Question 2

What must the sphincter pressure be for it at rest to be continent?

Answer 2

50mmHg

Question 3

What types of anorectal abnormalities are there?

Answer 3

Congenital e.g. Imperforate Anus/Acquired e.g. Fissure
Local/Systemic
Benign/Malignant
Early/Late

Question 4

What are the common presentations of anorectal disorders?

Answer 4

Pain
Haemorrhage
Dysfunction

Question 5

What are the classifications of anorectal disorders?

Answer 5

Inflammation
Infection
Malignancy
Trauma

Question 6

What are haemorrhoids?

Answer 6

Swollen blood vessels found in the anus and rectum

Question 7

How do you treat haemorrhoids and how do they feel?

Answer 7

Stapled anoplexy

Not painful to touch

Question 8

Where is stapled anoplexy done?

Answer 8

Above the dentate line

Question 9

What is an anal fissure?

Answer 9

A tear or ulcer that develops in the lining of the anal canal

Question 10

What are the causes of an anal fissure? (5)

Answer 10

Persistent diarrhoea
IBD
Pregnancy
STI
Tight anal sphincter muscles

Question 11

What is the treatment for anal fissures?

Answer 11

Plenty fibre
Hydrated
Not ignoring an urge to pass stool
Exercise

Question 12

What can be done to relax an internal anal sphincter?

Answer 12

Medical drugs

Surgery - Internal Lateral Sphincterotomy

Question 13

What is a peri-anal abscess?

Answer 13

A collection of pus that develops near the anus

Question 14

What is the treatment for a peri-anal abscess?

Answer 14

Incision drainage Avoid complications

Question 15

How does a peri-anal abscess come about?

Answer 15

Most are a result of infection from small anal glands

Question 16

What is a fistula-in-ano?

Answer 16

Chronic abnormal communication between the epithelialised surface of the anal canal and (usually) the perianal skin

Question 17

What is the appearance of a fistula-in-ano?

Answer 17

Has two holes
Secondary to an abscess
Hole on outside and one on the inside

Question 18

Where are anal glands situated and what do they drain into?

Answer 18

Between the internal and external anal sphincters

Anal canal

Question 19

What are causes of a fistula-in-ano?

Answer 19

CD
HIV
Anal abscess

Question 20

What is the treatment for a fistula-in-ano?

Answer 20

Surgery as they rarely heal

Question 21

What complications are there for a fistula-in-ano?

Answer 21

Infection
Bowel incontinence
Anal fistula returning

Question 22

What are the sites of anorectal cancer?

Answer 22

Asc/Trans/Des colon
Rectum
Anus
Other - 3% of cases

Question 23

What does a CT colonography give you?

Answer 23

A virtual video of the colonic lumen

Question 24

What treatment is given for anal squamous cancer?

Answer 24

Radiotherapy

Question 25

What treatment is given for rectal adenocarcinoma?

Answer 25

Neo-adjuvant chemo/rad & Laparoscopic resection

Question 26

What is Duke’s Classification for Anorectal cancer?

Answer 26

A - Submucosa
B1 - Muscle
B2 - Wall
C1 - Nodes not apical 
C2 - Apical
D - Distant mets