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Alimentary System: Pathology SA > Anorectal Disorders > Flashcards

Anorectal Disorders Flashcards

1
Q

What is the Blood vessel, and lymph innervation of the anal and rectal canal

A

Arterial
=Superior/inferior rectal artery

Venous
=Superior/inferior
rectal vein

Lymphatic
= para-rectal nodes + superficial inguinal nodes

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2
Q

What muscle later becomes the internal anal sphincter

A

Circular

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3
Q

What controls the voluntary external anal spinchter

A

Inferiori rectal nerve which is a branch of the Perineal branch of the 4th sacral nerve

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4
Q

What control the involuntary internal anal spinchter

A

Sympathetic fibres from the inferior hypogastric plexus

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5
Q

What is the common presentation of an-rectal disorders

A

Pain
haemorrhage
Dysfunction

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6
Q

What is the 4 classifications of an-rectal disorders

A

Inflammation
Infection
Malignancy
Trauma

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7
Q

What are 3 examples of congenital ano-rectal abnormalities

A

Imperforate anus

Uro-Genital Fistulae

Hirschprung’s Myenteric Plexus Deficiency

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8
Q

What is 7 examples of acquired an-rectal abnormalities

A

Haemorrhoids

Fissure

Abscess

Fistula-in-ano

Ulceration

Cancer

Control of Continence

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9
Q

What is the Haemorrhoids and where is it located

A

Painful, swollen veins that may bleed

Located internal and external to the anal canal

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10
Q

What is the presentation and symptoms of haemorrhoids

A

Extreme itching around anus

Irritation and pain around anus

Itchy or painful lump or swelling around anus

Faecal leakage

Painful bowel movements

Melaena

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11
Q

What is the treatment of Haemorrhoids

A

Pain relief

Fibre supplements

Rubber band ligation

Stapled anoplexy

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12
Q

What is stapled apoplexy

A

surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position

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13
Q

What does stapled anoplexy treat

A

Rectal prolapse and haemorrhoids

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14
Q

What is the complications of haemorrhoids

A

Bleeding

Anemia

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15
Q

What is the symptoms of anal fissure

A

Sharp pain when passing stool

Followed by burning pain lasting several hours

Melaena

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16
Q

What is the aetiology of anal fissures

A

Constipation
- Straining causes tear in lining

Persistent diarrhoea

IBD

Pregnancy and childbirth

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17
Q

How is the symptoms of anal fissures Managed

A

Should resolve independently

Pain relief

Hydration
Fibre
May be given laxatives by GP

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18
Q

What is the complications of anal fissures

A

Failure to heal:
chronic > 6 weeks

Recurrence - prone to having another one.

A tear that extends to surrounding muscles

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19
Q

What is the medical treatment of anal fissure

A
  • Topical nitric oxide
  • Glycerine trinate pasta
  • Diltiazem Calcium blocker
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20
Q

What is the mechanism of medical treatment of anal fissure

A

Relax internal anal spinchter

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21
Q

What is the surgical treatment of anal fissureand how does it work

A

Internal lateral spinchtereotomy

procedure helps by lowering the resting pressure of the internal anal sphincter, which improves blood supply to the fissure and allows faster healing

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22
Q

What is the presentation of perianal abscess

A

Painful, boil like swelling near anus

Red in colour, warm to touch

Pus near anus

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23
Q

What is the aetiology of perianal abscess

A

Fissure becomes infected

STI

Blocked anal glands

Infection of small anal glands

24
Q

What is the symptoms of perianal abscess

A

Constant, throbbing pain
- worse when seated

Skin irritation around anus

Discharge of pus

Constipation or pain associated with bowel movements

25
Q

What is the treatment of perianal abscess

A

Surgical incision and drainages

Post drainage relief

Antibiotics

26
Q

What is the complication of perianal abscess

A

Fistulas

- due to leaving channel behind from drainage

27
Q

What is the presentation of anal fistula

A

Narrow channel with internal opening in anal canal and external opening in skin near the anus

28
Q

What is the aetiology of anal fistulas

A

Most develop after an abscess

IBD

Diverticulitis

29
Q

What is the symptoms of anal fistulas

A

Skin irritation around anus

Constant throbbing pain

Worse pain when:

  • Seated
  • Moving
  • Bowel movement
  • Coughing

Smelly discharge from anus

Melaena

Pus in stool

Swelling and redness around anus

Bowel Incontinence

30
Q

What is the treatment of Fistulas

A

Fistulotomy

Seton sutures

Or Fill fistula:

  • Advancement flap procedure
  • Bioprosthetic plug
  • Firbin glue
31
Q

What happens in the procedure of a fistulomy

A

cutting along the whole length of the fistula to open it up so it heals as a flat scar

32
Q

When is fistulomy not recommended

A

Not suitable for fistulas that pass through much of the sphincter muscles
as can cause incontinence

Carry out other procedures

33
Q

What happens in the procedure of seaton suture

A

A seton is a piece of surgical thread that is left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles

34
Q

What is the benefit of loose or tight fit seton

A

Can be done loosely to avoid infection or pain

Can be done tightly to cut through tissue and allow the fistula to heal flat

35
Q

What is the aetiology of anal ulceration

A

Crohn’s

Malignancy

Syphilis

Nicorandil (Angina drug)

36
Q

Where is the locations and prevalence of the colorectal cancer sites

A 
Right Colon 27%
Transverse 10%
Left Colon 36%
Rectum 16%
Anus 3%
Others 8%
37
Q

What is the symptoms of anorectal cancer

A

Rectal bleeding

Itching and pain around anus

Small lumps around anus

Discharge of mucus from anus

Bowel incontinence

38
Q

What procedures are used for the diagnosis of colorectal cancer

A

Examination

Colonoscopy

CT colonography

MRI guided colonoscopy

39
Q

What is the dukes stages (A-D) classification of anorectal cancer

A

A= submucosa

B1= Muscle

B2= Wall

C1= lymph nodes not apical

C2= apical

D= Distant metastasises

40
Q

What is the treatment of anorectal cancer

A

Anal squamous cell carcinoma
- Radiotherapy

Rectal adenocarcinoma

  • Neoadjuvant chemoradiation
  • Laprascopic resection
41
Q

What is the two types of incontinence

A

Urge Bowel incontinence - express sudden urge to go to the toilet and don’t make it on time

Passive incontinence - experience no sensation before soiling themselves

42
Q

What are the problems of the rectum that result in incontinence

A

Constipation
Diarrhoea
Scarring of rectum
Haemorrhoids

43
Q

How does Constipation (the leading cause) result in bowel incontinence

A

Bowel impaction can cause rectal wall muscles to weaken, allowing watery stools to leak around the impacted stool and out of the anus
(can cause rectal prolapse)

44
Q

What is the overall aetiology of incontinence

A

Problems with rectum

Problems with spinchter muscle

weakened or damaged muscle

Childbirth

Injury

Bowe//rectal surgery

45
Q

What is the nerve innervation of the anorectal canal

A

Upper half:
Sympathetic and parasympathetic innervation from hypogastric plexus

Lower Half:
somatic motor and sensory innervation from inferior rectal nerve

46
Q

What is the aetiology of nerve damage

A

Diabetes
MS
Stroke
Spina Bifida

47
Q

What does the therapy of Sacral nerve root stimulator implant treat

A

Treats bladder and bowel problems

  • nerve damage
  • faecal incontinence
  • overreactive bladder
  • urge incontinence
  • chronic anal fissures
48
Q

How does the therapy of sacral nerve root stimulator work

A

Implantation of a programmable stimulator subcutaneously access via the S3 foremen which delivers low amplitude electrical stimulation to the sacral nerve allowing the somatic motor nerves to control spinchters

49
Q

What are investigations for anorectal disorders

A

AnoRectal Manometry

EndoAnal Ultrasound

50
Q

What happens first in a sacral nerve root stimulator

A

Initial test with implant trial for a day

then if effective receive permanent implant

51
Q

What does the sacrum nerves control function over

A

Pelvic floor

stimulate sacral nerve promotes contraction in pelvic floor

52
Q

What is the causes on congenital abnormality imperforate anus

A
  • Rectum may end in a pouch and not connect to colon
  • Rectum has opening to other structures
  • stenosis of anus
  • No anus
53
Q

What is the presentation of hirshprungs mesenteric plexus deficiency

A

congenital disorder of the colon in which ganglion cells, are absent in myenteric plexus causing chronic constipation as are responsible for moving food in the intestine.

54
Q

What is the signs of Hirschprungs myenteric plexus deficiency

A

Failure to defecate in first 48 hours of life

Vomiting bile

55
Q

What is the treatment and management ofHirschprungs myenteric plexus deficiency

A

Surgery to remove uninnervated section of bowel and attach the rectum to a section innervated

Pre op:

  • Give direct IVnutrition
  • Bowel washouts
  • possible antibiotics

Alimentary System: Pathology SA (27 decks)

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