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GI > Anorectal Disorders > Flashcards

Anorectal Disorders Flashcards

1
Q

Do ano-rectal problems show up as malaena or haematochezia

A

No, they show up as dripping blood form back passage. Blood in stool in any form is associated with other parts of the GI tract

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2
Q

What are haemorrhoids also known as

A

Piles

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3
Q

What are haemorrhoids

A

Swellings comtaining engorged blood vessels found inside or around the bottom

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4
Q

Common presentation of haemorrhoids

A

Painless bleed
Perianal itch
Fresh, bright blood not mixed with faeces
No change in bowel habits, no weight loss

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5
Q

Examination of haemorrhoids

A

External inspection can be normal
Maceration of skin
Obvious if 3rd degree piles preset

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6
Q

What is maceration of skin

A

Softening and breaking down of skin resulting in prolonged exposrue to moisture

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7
Q

Investigation for haemorrhoids

A

PR examination
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy if patient > 50

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8
Q

Dreaded effect of surgery for haemorrhoids

A

Anal sphincters may be affected/damaged leading to incontinence

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9
Q

Management of haemorrhoids

A

Symptomatic
HALO - Haemmorhoid Artery Ligation Operation (or)
THD - Transanal Haemorrhoid Dearterialization

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10
Q

What does HALO/THD involve

A

A dopple is used to locate termiating branches of the haemorrhoidal arteries. Once the artery is located, surgeons use an absorbable suture to “tie-off” the arterial blood flow. Venous “out-flow” remains to shrink the cushion

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11
Q

Side effect of stapled haemorrhoidectomy

A

Can lead to a feeling of tenesmus and cause sepsis

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12
Q

Why is HALO procedure virtually painless

A

As the stitch is placed above the pectinate line where no sensory supply is present

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13
Q

Late stage stage anal cancer can often be mistaken for

A

3rd degree piles/haemorrhoides

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14
Q

Types of rectal prolapse

A

Partial - Anterior mucosal collapse

Complete - Full thickness

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15
Q

Prevalence of rectal prolapse

A

More common in females due to a wider girth of pelvis. Removal of uterus leads to more space available for prolapse.

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16
Q

Presentation of rectal prolapse

A

Protruding mass from anus especially during defaecation. Bleeding and passing mucus is common. May reduce spontaneously

17
Q

Examination of rectal prolapse

A

Reveals poor anal tone

18
Q

Perineal vs abdominal rectoplexy for rectal prolapse

A

Abdominal rectoplexy is preferred in younger patients as a perineal rectoplexy doesn’t last long.

19
Q

Management of complete rectal prolapse in frail patients

A

Bulking agents and education on manual reeduction

20
Q

Treatment for complete rectal prolapse

A

Derlome’s procedure
Perineal rectopexy
Abdominal rectopexy
Anterior resection

21
Q

What are anal fissures

A

Tear in anal margins due to passage of a constipated stool

22
Q

Cause of multiple fissures may be

A

Crohns

23
Q

Presentation of anal fissures

A

Feels like glass passing through back passage
Acute onset of severe anal pain usually following episodes of constipation
Bright rectal bleeding

24
Q

How can a sentinel pile be used clinicaly

A

Generally points in the directio of fissure

25
Q

Pectinate line is also known as

A

Dentate line

26
Q

Treatment for anal fissures

A

Dietary advice, stool softeners

Botox injection

27
Q

How do botox injections help anal fissures

A

Prevent muscle spasms. Injecting Botox causes anal muscles to relax and reduce muscle tension. This reduces pain and increases blood flow to the fissure encouraging natural healing.

28
Q

Why is lateral sphincterotomy not carried out now for anal fissures

A

As it may cause incontinence

29
Q

Fistula in ano maybe cause by what external conditions

A

Crohn’s disease, tuberculosis or carcinoma

30
Q

Management of incomplete rectal prolaspe

A

Children - Dietary advice and treat constipation

Adults - Symptomatic management

31
Q

Multiple fistulae and abscess can be a sign of what underlying autoimmune pathology

A

Crohn’s disease

32
Q

Investigation for fistula

A 
Examination under anaesthesia (EUA) of anorectum
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy
MRI
33
Q

Management of fistula in ano

A

Laying open and drain with a SETON
Glue back once cleared of fluid/pus
Might need defunctioning colostomy

34
Q

Complications of SETON for fistula in ano

A 
Bleeding
Pain
Incontinence of flatus or stool
Recurrence
Further surgery

GI (32 decks)

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