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GI Anatomy > Anorectal disorders - NOT PRIORITY > Flashcards

Anorectal disorders - NOT PRIORITY Flashcards

1
Q

Epithelium of rectum/anus

A

Rectum - columnar

Anal canal - stratified squamous

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2
Q

Defaecation is controlled by what nerves

A

Parasympathetic fibres of S2-S4

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3
Q

What line divides the anal canal into upper and lower parts

A

Pectinate line

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4
Q

Arterial supply above pectinate line (rectum and upper anal canal)

A

Superior rectal artery (branch of IMA)

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5
Q

Arterial supply below pectinate line (lower anal canal) (2)

A

Inferior rectal artery (branch of internal iliac artery)

Middle rectal artery

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6
Q

What is the inferior rectal artery a branch of

A

Internal iliac artery

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7
Q

Venous drainage above pectinate line

A

Superior rectal vein

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8
Q

Venous drainage below pectinate line

A

Inferior rectal vein

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9
Q

Nerve supply above pectinate line

A

Inferior hypogastric plexus (parasympathetic)

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10
Q

Nerve supply below pectinate line

A

Inferior anal nerves (sensory + motor)

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11
Q

Function of anal canal

A

Faecal continence

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12
Q

Capacity of rectum

A

200-300ml faecal contents

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13
Q

Anorectal disorders are divided into what 2 categories

A

Congenital

Acquired

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14
Q

Anorectal disorders usually present with what 3 things

A

Pain
Haemorrhage
Dysfunction

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15
Q

Name 3 congenital anorectal disorders

A

Hirschprung’s disease - baby can’t defaecate because no myenteric plexus

Imperforate anus

Uro-genital fistulae

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16
Q

Name acquired anorectal disorders (7)

A 
Peri-anal haematoma
Rectal prolapse 
Haemorrhoids
Anal fissure
Peri-anal abscess
Fistula-in-ano
Anal cancer
17
Q

What are haemorrhoids

A

Swellings contains swollen blood vessels within the anal canal

Normal anatomical and functional component of the anal canal; they become pathological only when they cause symptoms

18
Q

Symptoms (2) /signs (2) of haemorrhoids

A

Rectal bleeding
Perianal pain/discomfort
Anal pruritus
Anal mass/ perianal lesion

19
Q

Treatment of haemorrhoids (8)

A

Diet + lifestyle change - more fibre, fluids, exercise
Steroid cream

Grade 2/3 haemorrhoids:

  • Rubber band ligation
  • Sclerotherapy - injecting something to numb and harden the haemorrhoid
  • infrared photocoagulation
  • haemorrhoid arterial ligation (blood vessels supplying haemorrhoid are stitched closed)
  • stapled haemorrhoidopexy

Grade 4
-haemorrhoidectomy

20
Q

What is a stapled haemorrhoidopexy

A

Part of the anorectum [last section of the LI], is stapled, so haemorrhoids are pulled back into rectum; reduces the supply of blood to the haemorrhoids, which causes them to gradually shrink

21
Q

How does infrared photocoagulation treat haemorrhoids

A

passing electric current to cause the blood supplying the haemorrhoid to coagulate so haemorrhoid can shrink

22
Q

What is an anal fissure

A

Split in the skin of the distal anal canal characterised by pain on defecation and rectal bleeding

Much worse than haemorrhoids

23
Q

Symptoms/signs of an anal fissure (3)

A

Pain on defaecation
Blood in stool/toilet paper
Anal spasm

24
Q

Risk factors of anal fissure (2)

A

Hard stool

Pregnancy

25
Q

Treatment of anal fissure (4)

A

Topical glyceryl trinitrate
Topical diltiazem

If resistant to above:
botulinum toxin injection
surgical sphincterotomy - cutting some of sphincter muscle to relax it

26
Q

What is a peri-anal abscess

A

Collection of pus near the anus usually due to infection of small anal glands

27
Q

Treatment of perianal abscesses

A

Surgical incision and drainage

28
Q

What may be underlying if perianal abscesses persistently fail to heal after incision and drainage

A

Fistula formation

29
Q

How can fistulas result from abscesses

A

Abscesses can extend to the skin surface forming a tract (FISTULA) between the anal gland and the skin (internal opening in anal canal and external opening in skin) if the abscess doesn’t heal properly

30
Q

Anal fistula treatment (3)

A

Fistulotomy - cutting open fistula so it heals as a flat scar
Seton suture - to keep fistula open and allow pus to drain
Fistula plug after seton suture

31
Q

Anal ulcer could be a feature of what GI disease

A

Crohn’s

32
Q

Anorectal cancer is usually what type of tumour

A

Squamous cell carcinoma

33
Q

Definitive diagnosis of anorectal cancer

A

Biopsy

34
Q

Investigations of anal cancer (4)

A

Anoscopy + biopsy
Anal ultrasound
CT abdo/pelvis - to look for metastases

35
Q

Treatment of anal cancer

A

fluorouracil (CHEMO) + mitomycin (CHEMO) + radiotherapy

so CHEMORADIOTHERAPY

36
Q

Treatment of rectal adenocarcinoma (2)

A

Neoadjuvant chemoradiotherapy

Surgical resection

GI Anatomy (21 decks)

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