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2ND YEAR SYSTEMS: GI > Anorectal disorders > Flashcards

Anorectal disorders Flashcards

1
Q

Give examples of congenital ano-rectal abnormalities

A

Imperforate anus

Uro-Genital Fistulae

Hirschprung’s Myenteric Plexus Deficiency

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2
Q

Common presentations of an ano-rectal disorder?

A

pain
haemorrhage
dysfunction

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3
Q

What are 4 common root causes of ano-rectal disorders?

A

Inflammation
Infection
Malignancy
Trauma

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4
Q

Examples of acquired ano-rectal abnormalities? (7)

A 
Haemorrhoids
Fissure
Abscess
Fistula-in-ano
Ulceration
Cancer
Control of Continence
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5
Q

What causes heamorrhoids

A

Increased pressure/congestion in the blood vessels around the anal canal

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6
Q

What is the aetiology of haemorrhoids?

A

Unknown

Associated with straining or constipation

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7
Q

What are the symptoms of haemorrhoids?

A

Bright red rectal bleeding - painless

Pruritis ani

Mucus discharge

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8
Q

What is the treatment of haemorrhoids?

A

Treat underlying cause ie constipation

Out patient - Rubber band ligation - internal hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid

Surgical:-
HALO - haemarroidal artery ligation op

Anopexy - staple - done if patient has prolapse (pushing out the rectum) and haemorrhoids

Haemorrhoidectomy

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9
Q

What is the cause of anal fissures?

A

Trauma or ischaemia

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10
Q

What is an anal fissure?

A

Superficial mucosal tear of the anus most commonly in the midline posteriorly

can be sign of anal cancer

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11
Q

What are the symptoms of anal fissures?

A

Pain on defacation

Minor bleeding

Mucus discharge and pruritis

Odematous skin tag / ‘sentinal pile’ may be present next to the fissure

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12
Q

Treatment for anal fissures requires relaxing the internal anal sphincter, how is this done?

A

Underlying cause - constipation

Medical
GTN/diltiazem + Lignocaine

Surgical
Sphincterotomy
Botox

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13
Q

What happens as a result of the tension of the internal anal sphincter being too high?

A

The internal anal sphincter is always under tension, also known as resting pressure. If that pressure becomes too high, a fissure may form or an existing one may not heal.

In surgical anal sphincterectomy - an incision reduces the resting pressure, allowing the fissure to heal.

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14
Q

Where do ischiorectal abscess occur? and how do they normally develop?

A

Lateral to the sphincters in the ischiorectal fossa

Infection of the anal glands by normal intestinal bacteria or
Crohn’s disease is sometimes responsible

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15
Q

What are the symptoms of perianal fistulae?

A

Extreme perianal pain, fever and discharge of pus

signs of sepsis

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16
Q

Risk factors of perianal abscess

A

diabetes
BMI
immunosuprression
trauma

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17
Q

How are abscesses treated?

A

Antibiotics if septic

Surgical incision and drainage

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18
Q

What is a fistula in ano?

A

An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus

19
Q

Where do anal fistula form?

A

Anal fistulae originate from the anal glands, which are located between the internal and external anal sphincter and drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually extend to the skin surface. The tract formed by this process is a fistula

20
Q

What are the symptoms/complications associated with anal fistula? (4)

A

Painful

Peri-anal sepsis

Persisting pus discharge with flare up

+/- fecal soiling - formed stools can also pass through the fistula

21
Q

Treatment of fistula in ano

A

very difficult to treat

surgical - 50% failure rate

seton - drain sepsis/mature tract

sphincter preservation techniques

Lay open - Simple fistulas can be ‘laid open’ by cutting a small amount of the anal skin and muscle to open up the tract. Risk of impairment of continence is particularly worrying in women

22
Q

What percentage of colorectal cancers are in the rectum and anus?

A

Rectum: 16%

Anus: 3%

23
Q

What is treatment for anal squamous cancer?

A

Radiotherapy

24
Q

What is the treatment for rectal adenocarcinoma?

A

Neo adjuvant ChemoRad (chemo and radiotherapy)

Laparoscopic Resection

25
Q

What are the causes of anal ulceration?

A

Crohn’s Disease

Malignancy

Syphilis “Chancre”

Nicorandil - used for angina

26
Q

What are common causes of faecal incontinence?

A

Severe diarrhoea

Anorectal disease - haemorrhoids, rectal prolapse, Crohn’s

Neurological conditions - spinal cord/cuada equina legions

Dementia

27
Q

What does the function of the anorectum require? (3)

A

Pelvic floor
rectal compliance
intact pelvic neurology

28
Q

What does the anorectum do? (2)

A

controls defaecation

maintenance of continence

29
Q

What is anopexy

A

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

30
Q

Symptoms/signs of Anal/rectal cancer (5)

A

Painful/painless

Bleeding

Indurated - hardened mass/formation

Red flag signs

FIT test +ve - screening - fecal immunochemical test

31
Q

Routine investigations for anal/rectal cancer (7)

A

PR examination - rectal

Proctoscopy - camera up rectum

Rigid sigmoidoscopy - light and glass window

Colonoscopy/flexi sigmoidoscopy

CT colonoscopy

CT scan

MRI rectum

32
Q

What is pelvic floor dysfunction

A

Collection of wide spectrum of symptoms related to defecation

Obscure symptomatology

Often a fear of more serious illnesses

Embarrassment and hesitation to come up with real issues

May have a history of abuse

Social limitation

33
Q

What are the 2 broad categories of causes of pelvic floor dysfunction

A

child-birth related

all other causes - surgery, abuse, perianal sepsis, low anterior resection syndrome (LARS)

34
Q

Who can get pelvic floor dysfunction?

A

predominantly women - either parous (having had children)

also men and non-parous women due to things like surgery, neurological/Connective Tissue disorders or psychological/behavioural issues

35
Q

Chronic constipation types (4)

A

Dietary (commonest)

Drugs

Organic - Hirshsprung or EDS

Functional - Slow transit (infrequent), Evacuation related (Common) or Combination (slow transit as a result of evacuatory dysfunction)

36
Q

Drugs causing constipation

A

aluminium antacids

antidepressants - tricyclic

antiepileptics

antipsychotics

opioids

37
Q

How to assess chronic constipation

A

Colonoscopy/ CT colon

baseline bloods to exclude anaemia

symptomatic FIT test

coeliac serology

colonic transit studies

detailed history

38
Q

What is Hirshsprung

A

Birth defect

absence of particular nerve cells (ganglions) in bowel of an infant

39
Q

How to treat chronic constipation

A

Start with regular baseline laxatives

Ensure compliance

Consider combination therapy

surgical options for slow transit - colectomy etc

40
Q

Faecal incontinence types (4)

A

Passive: Internal sphincter defect
Urge: Rectal pathology, functional
Mixed: Prolapse
Overflow: Constipation

41
Q

What is anal manometry used for?

A

to test rectal function

42
Q

what is the best modality to assess anatomy and dynamic function of

A

defaecating proctogram - uses X-ray

provides info on Pelvic floor mobility, Pathological function of the musculature etc

43
Q

Aggressive conservative measures to manage FI

A 
Low fibre diet
Loperamide
Pelvic floor exercises
EMG if required
Irrigation
Anal plug
44
Q

Surgery options for FI

A

Sphincter repair

Correct anatomical defect

Sacral nerve stimulator

Anal bulking agent for passive FI

  • Permacol
  • GateKeeper
  • SphinKeeper

2ND YEAR SYSTEMS: GI (38 decks)

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