Anorectal Fistula

Question 1

Pertinent Anatomy

Answer 1

(1) Anus
(a) Anal crypt gland
(2) Rectum

Question 2

What allow for secretion of excess mucus otherwise found in the rectum and anus.

Answer 2

Anal Crypts

Question 3

These crypts become problematic when an _______ persists

Answer 3

obstruction

Question 4

is the chronic manifestation of the acute perirectal process that forms
an anal abscess. When the abscess ruptures or is drained, an epithelialized track can form that connects the abscess in the anus or rectum with the perirectal skin .

Answer 4

anorectal fistula

Question 5

Anal fistulas are

sometimes also referred to as

Answer 5

“fistula-in-ano”.

Question 6

What would you suspect?
Symptoms
(1) “Nonhealing” anorectal abscess following drainage
(2) Chronic purulent drainage and a pustule-like lesion in the perianal or buttock area
(3) Intermittent rectal pain, particularly during defecation, but also with sitting
(4) Intermittent and malodorous perianal drainage and pruritus

Answer 6

Anorectal Fistula

Question 7

DDx for anorectal fistula

Answer 7

(1) Perianal Abscess
(2) Hemorrhoid
(3) Anal Fissure
(4) Pilonidal Cyst
(5) Colorectal Cancer

Question 8

Initial Care for anorectal fistula

Answer 8

(1) Given location of area, initial care will be based on vital signs and patient stability.
(2) If patient presents in pain, consider MEDEVAC and treat pain with appropriate medications

Question 9

True/False

Patients presenting with anal fistula require higher echelon care due to proximity of involved area.

Answer 9

True

Question 10

________ should be reserved for problematic patients

Answer 10

MECIVAC

Question 11

If patient is unstable, stabilize and prepare for

Answer 11

MEDEVAC