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Gastrointestinal > 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

Give examples of acquired ano-rectal abnormalities

A

Haemorrhoids

Fissure

Abscess

Fistula-in-ano

Ulceration

Cancer

Control of Continence

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3
Q

What is the cause of haemorrhoids?

A

Venous plexus congestion around the anal canal

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4
Q

What is the aetiology of haemorrhoids?

A

Unknown

Associated with straining or constipation

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5
Q

What are the symptoms of haemorrhoids?

A

Bright red rectal bleeding

Pruritis ani

Mucus discharge

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6
Q

What is the treatment of haemorrhoids?

A

Band ligation (if above the dentate line)

Injection scleropathy

Stapled anopexy (https://www.youtube.com/watch?v=Xv2y8XtGCCY)

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7
Q

What is the cause of anal fissures?

A

Trauma or ischaemia

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8
Q

What is an anal fissure?

A

Superficial mucosal tear most commonly in the midline posteriorly

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9
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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10
Q

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

A

Medical: Topical nitric oxide, diltiazem calcim bocker

Surgical: Internal lateral sphincterotomy

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11
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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12
Q

Where do perianal abscesses develop?

A

Inbetween the internal and external anal sphincters and may point at the perianal skin

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13
Q

Where do ischiorectal abscess occur?

A

Lateral to the sphincters in the ischiorectal fossa

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14
Q

How do ischiorectal abscesses usually develop?

A

Infection of the anal glands by normal intestinal bacteria

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

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16
Q

What can happen as a result of rupture of anorectal abscess?

A

Development of fistulae

May be superficial or may track through the anal sphincters to reach the rectum

17
Q

How are abscesses treated?

A

Surgical incision and drainage

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 complications associated with anal fistula?

A

Painful

Irriitating because of the drainage of pus - formed stools can also pass through the fistula

Starting point for systemic infection

21
Q

What are the symptoms of anal fistula?

A

pain

swelling

tenderness

fever

unpleasant odor

Pus / serous fluid / faeces discharge

22
Q

Describe the lay - open surgical procedure indicated for superficial fistulae

A

Fistula is cut open

Packed on a daily basis for a short period of time to ensure that the wound heals from the inside out.

May cause problems with continence depending on where the fistula lies in terms of the sphincter muscles.

Not indicated in patients with fistula that span the full distance between the internal and external sphincters

23
Q

What is a seton stitch?

A

It is a thread that is placed through the fistula and out the anus - allows the infection to drain and heal, without damaging the sphincter muscles

24
Q

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

A

Rectum: 16%

Anus: 3%

25
Q

What are the possible imaging modalities for the colorectum?

A

Colonoscopy with or without x-ray screening

Colonography (x-Ray procedure)

MRI guided colonoscopy, MRI component allows the shape of the endoscope to be displayed on screen in real time

26
Q

What is treatment for anal squamous cancer?

A

Radiotherapy

27
Q

What is the treatment for rectal adenocarcinoma?

A

Neo adjuvant ChemoRad

Laparoscopic Resection

28
Q

What are the causes of anal ulceration?

A

Crohn’s Disease

Malignancy

Syphilis “Chancre”

Nicorandil

29
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

30
Q
A

Gastrointestinal (38 decks)

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