Anorectal Disorders

Question 1

What are the common symptoms of patients with anorectal disorders?

Answer 1

• Pain
• Haemorrhage
• Dysfunction

Question 2

What are the different classifications of anorectal disorders?

Answer 2

• Inflammation
• Infection
• Malignancy
• Trauma

Question 3

List some congenital anorectal disorders?

Answer 3

Imperforate anus (opening to the anus is missing or blocked)

Uro-Genital Fistulae

Hirschprung’s Myenteric Plexus Deficiency (disorder of the colon in which nerve cells are absent, causing chronic constipation)

Question 4

List some acquired anorectal abnormalities

Answer 4

Haemorrhoids
Fissure
Abscess
Fistula-in-ano
Ulceration
Cancer

Question 5

What are haemorrhoids? What is the commonly used surgical treatment for them?

Answer 5

• enlarged blood vessels that you can get inside or around your anus
• Stapled anopexy (circular stapled haemorrhoidectomy)

Question 6

What is the stapled anopexy procedure used to treat?

Answer 6

• Anal prolapse

- Haemorrhoids

Question 7

What is an anal fissure? Treatment?

Answer 7

• a small tear in the thin, moist tissue (mucosa) that lines the anus
• Don’t usually require treatment. CCB ointment can relax sphincter muscles to help healing, hydrocortisone cream + topical painkillers can help too
• Surgical: Internal Lateral Sphincterotomy

Question 8

What is a perianal abscess? Treatment?

Answer 8

• A perianal abscess is a localised collection of infected fluid in the perianal space
• Incision and Drainage

Question 9

What is a fistula-in-ano (anal fistula)? Treatment?

Answer 9

• a small tunnel that develops between the end of the bowel and the skin near the anus
• Fistulotomy for treatment: cutting open the whole length of the fistula so it heals into a flat scar
• Seton suture

Question 10

What is a seton suture? What is it used to treat?

Answer 10

• Treatment of anal fistulas
• nonabsorbable nylon or silk suture that is guided through the fistula tract and tied exteriorly. Local inflammatory reaction initiates fibrosis to heal wound

Question 11

What are the most common sites for colorectal cancers to occur?

Answer 11

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

Question 12

What are the symptoms of anorectal cancer?

Answer 12

• bleeding
• itching
• anal pain

Question 13

What are the two most common types of anorectal cancers? Treatment for each?

Answer 13

1. Anal squamous cancer: radiotherapy to treat

2. Rectal adenocarcinoma: Neoadjuvant chemo, laparoscopic resection

Question 14

What are some risk factors for anal ulceration?

Answer 14

Crohn’s Disease / UC

Malignancy

Syphilis “Chancre”

Nicorandil (vasodilator for angina)

Question 15

What is sacral nerve root stimulation used to treat? What does it involve?

Answer 15

• Used to treat urinary and bowel incontinence
• involves inputting a programmable stimulator subcutaneously, which delivers low amplitude electrical stimulation via a lead to the sacral nerve.