Anorectal Disorders

Question 1

What are the common presentations of anorectal disorders? (3)

Answer 1

Pain
Haemorrhage
Dysfunction

Question 2

What are some common acquired anorectal disorders? (6)

Answer 2

Haemorrhoids
Fissure
Abscess
Anal Fistula
Ulceration
Cancer

Question 3

Where are the anal cushions when viewed from a lithotomy position?

Answer 3

3, 7 and 11 O’clock

Question 4

Why can the anal cushions become bulky and loose? (3)

Answer 4

Gravity
Straining at stool
Increased anal tone

Question 5

Why do haemorrhoids become painful?

Answer 5

They become thrombosed

Question 6

What are the common presentations of haemorrhoids? (4)

Answer 6

Bleeding after passing stool
Pruritus ani
A lump hanging down after defecation
Mucus discharge after defecation

Question 7

What are the 4 stages of haemorrhoids?

Answer 7

1. No prolapse, prominent blood vessels
2. Prolapse upon bearing down, spontaneous reduction
3. Prolapse upon bearing down requiring manual reduction
4. Prolapse with inability to be manually reduced

Question 8

Treatment for Stage 1 haemorrhoids (4)

Answer 8

Increased fibre and fluids
+/- Topical analgesics
Stool softener.
Topical steroids for a short period of time only.

Question 9

Treatment for Stage 2 haemorrhoids (or refractory stage 1) (3)

Answer 9

Rubber band ligation
Sclerosants (1 or 2) – injecting phenol in almond oil
Infrared coagulation

Question 10

What surgical options are available for haemorrhoids? (2)

Answer 10

Excisional haemorrhoidectomy

Stapled haemorrhoidopexy

Question 11

What are the rarer causes of anal fissures? (6)

Answer 11

Syphilis
Herpes 
Trauma
Crohn’s 
Anal cancer 
Psoriasis

Question 12

What is the most common cause for anal fissures?

Answer 12

Hard stools

Question 13

What lifestyle advice will be offered to patients with anal fissures? (3)

Answer 13

More fibre
More fluid
Hygiene Advice

Question 14

What are the medical options to treat anal fissures? (4)

Answer 14

• Topical nitric oxide
• 0.2% Glycerol Trinitrate paste
• 2% Dilitazem Calcium blocker
• Stool softener

Question 15

What diseases are associated with peri-anal abscesses? (3)

Answer 15

Crohn’s
Malignancy
Fistulae.

Question 16

What can cause an anal fistula? (7)

Answer 16

Peri-anal sepsis
Abscesses
Crohn’s 
TB 
Diverticular disease
Rectal carcinoma 
Immuno-compromise

Question 17

How do you treat peri-anal abscesses? (2)

Answer 17

Antibiotics

Surgical drainage

Question 18

How do you treat a superficial anal fistula?

Answer 18

Laid open by fistulotomy

Heals by second intention

Question 19

How do you treat a trans-sphincter anal fistula?

Answer 19

May need a Seton suture to maintain continence

Question 20

What are the risk factors for anal cancer? (3)

Answer 20

Syphillis
Anal Warts
Ano-receptive homosexuals

Question 21

What is the histological type that accounts for 85% of anal cancer?

Answer 21

Squamous

Question 22

What can cause anal ulceration? (5)

Answer 22

Syphillis chancre
Anal cancer
Crohn's disease
TB
Treatment with Nicorandil

Question 23

What are some pathological causes of pruritus ani? (6)

Answer 23

Incontinence
Threadworm
Fistula
Dermatoses (skin condition)
Lichen sclerosus (a long term skin condition)
Anxiety