Anorectal Disorders

Question 1

What does the normal anatomy of the anorectal canal include?

Answer 1

• Structures
• Muscles
• Mucosa
• Blood vessels
• Nerves

Question 2

What is important to understand about the physiology of the anorectal canal?

Answer 2

• Function
• Transit times
• Frequency
• Capacity
• Sensory control
• Motor control

Question 3

How can anorectal abnormalities be characterised?

Answer 3

• Congenital/acquired
• 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 4 classifications of anorectal disorders?

Answer 5

• Inflammation
• Infection
• Malignancy
• Trauma

Question 6

Give 3 examples of congenital anorectal abnormalities.

Answer 6

• Imperforate anus
• Uro-genital fistulae
• Hirschsprung’s myenteric plexus deficiency

Question 7

Give examples of acquired anorectal abnormalities.

Answer 7

• Haemorrhoids
• Fissure
• Abscess
• Fistula-in-ano
• Ulceration
• Cancer
• Control of continence

Question 8

What is stapled anoplexy a treatment for?

Answer 8

Procedure for prolapse and haemorrhoids

Question 9

What is involved in ultrasound guided ligation of haemorrhoids?

Answer 9

• Trans anal haemorrhoid dearterialiastion
• Protoscopy USS guided
• Suture transfixion of haemorrhoid arteries
• No tissue resection
• Above denate line, no pain

Question 10

What can medically be used to relax the anal sphincter?

Answer 10

• Topical nitric oxide
• 0.2% glyceryl trinitrate paste
• 2% diltiazem calcium blocker

Question 11

How can the internal anal sphincter be relaxed surgically?

Answer 11

Internal lateral sphincterotomy

Question 12

How is a perianal abscess treated?

Answer 12

• Incision and drainage

- Try to avoid complications

Question 13

How is a fistula in ano superficial treated?

Answer 13

Lay open by fistulotomy

Question 14

How is a fistula in ano trans-sphincteric treated?

Answer 14

• Seton suture
• Fistula plug/permacol paste
• Aim to close primary (internal) opening

Question 15

What are the CRC sites in order from most common to least?

Answer 15

• Left colon
• Right colon
• Rectum
• Transverse colon
• Other
• Anus

Question 16

What imaging is used for CRC?

Answer 16

• Videoscape view

- +/- X-ray screening

Question 17

What is CT colonography?

Answer 17

• X-ray procedure

- Virtual video of colonic lumen

Question 18

How does MRI guided colonoscopy work?

Answer 18

• 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

Question 19

How are anal squamous cancers treated?

Answer 19

Radiotherapy

Question 20

How are rectal adenocarcinomas treated?

Answer 20

• Neo adjuvant chemoRad

- Laparoscopic resection

Question 21

What is the CRC infiltration on the Duke’s staging?

Answer 21

• A: submucosa
• B1: muscle
• B2: wall
• C1: nodes not apical
• C2: nodes apical
• D: distant mets

Question 22

What can result in anal ulceration?

Answer 22

• Crohn’s disease
• Malignancy
• Syphilis (Chancre)
• Nicorandil

Question 23

How can incontinence be treated?

Answer 23

Sacral nerve root stimulator implant

Question 24

What nerves are involved in the sacral nerve root stimulator implant?

Answer 24

S2
S3
S4

Question 25

What is involved in the sacral nerve root stimulator implant?

Answer 25

-Objective anorectal manometry and endoanal ultrasound
Somatic motor nerves to sphincters
-Percutaneous access to sacral foreamena
-Implant trial then permanent implant
-Day case