Anorectal Disorders Flashcards
What does the normal anatomy of the anorectal canal include?
- Structures
- Muscles
- Mucosa
- Blood vessels
- Nerves
What is important to understand about the physiology of the anorectal canal?
- Function
- Transit times
- Frequency
- Capacity
- Sensory control
- Motor control
How can anorectal abnormalities be characterised?
- Congenital/acquired
- Local/systemic
- Benign/malignant
- Early/late
What are the common presentations of anorectal disorders?
- Pain
- Haemorrhage
- Dysfunction
What are the 4 classifications of anorectal disorders?
- Inflammation
- Infection
- Malignancy
- Trauma
Give 3 examples of congenital anorectal abnormalities.
- Imperforate anus
- Uro-genital fistulae
- Hirschsprung’s myenteric plexus deficiency
Give examples of acquired anorectal abnormalities.
- Haemorrhoids
- Fissure
- Abscess
- Fistula-in-ano
- Ulceration
- Cancer
- Control of continence
What is stapled anoplexy a treatment for?
Procedure for prolapse and haemorrhoids
What is involved in ultrasound guided ligation of haemorrhoids?
- Trans anal haemorrhoid dearterialiastion
- Protoscopy USS guided
- Suture transfixion of haemorrhoid arteries
- No tissue resection
- Above denate line, no pain
What can medically be used to relax the anal sphincter?
- Topical nitric oxide
- 0.2% glyceryl trinitrate paste
- 2% diltiazem calcium blocker
How can the internal anal sphincter be relaxed surgically?
Internal lateral sphincterotomy
How is a perianal abscess treated?
- Incision and drainage
- Try to avoid complications
How is a fistula in ano superficial treated?
Lay open by fistulotomy
How is a fistula in ano trans-sphincteric treated?
- Seton suture
- Fistula plug/permacol paste
- Aim to close primary (internal) opening
What are the CRC sites in order from most common to least?
- Left colon
- Right colon
- Rectum
- Transverse colon
- Other
- Anus
What imaging is used for CRC?
- Videoscape view
- +/- X-ray screening
What is CT colonography?
- X-ray procedure
- Virtual video of colonic lumen
How does MRI guided colonoscopy work?
- EM transmission coils every 10cm and the colonoscope generates pulsed low voltage magnetic field
- External receiver coils locate and orientate the transmission coils on a 3D screen-Virtual 3D image on PC screen while direct viewing the videoscope image
How are anal squamous cancers treated?
Radiotherapy
How are rectal adenocarcinomas treated?
- Neo adjuvant chemoRad
- Laparoscopic resection
What is the CRC infiltration on the Duke’s staging?
- A: submucosa
- B1: muscle
- B2: wall
- C1: nodes not apical
- C2: nodes apical
- D: distant mets
What can result in anal ulceration?
- Crohn’s disease
- Malignancy
- Syphilis (Chancre)
- Nicorandil
How can incontinence be treated?
Sacral nerve root stimulator implant
What nerves are involved in the sacral nerve root stimulator implant?
S2
S3
S4
What is involved in the sacral nerve root stimulator implant?
-Objective anorectal manometry and endoanal ultrasound Somatic motor nerves to sphincters -Percutaneous access to sacral foreamena -Implant trial then permanent implant -Day case
