Anorectum

Question 1

What are haemorrhoids

Answer 1

Dilatations of anal veins surrounded by tissue

Question 2

Where do internal haemorrhoids originate

Answer 2

Above the dentate line

Question 3

Where do external haemorrhoids originate

Answer 3

Below the dentate line

Question 4

How much of the population have haemorrhoids

Answer 4

Over half

Question 5

What are first degree haemorrhoids

Answer 5

Internal haemorrhoids move into the anal canal

Question 6

What are second degree haemorrhoids

Answer 6

Haemorrhoids prolapsed out of the anus on straining but spontaneously reduce

Question 7

What are third degree haemorrhoids

Answer 7

Haemorrhoids prolapsed out of the anus on straining but need manual reduction

Question 8

What are fourth degree haemorrhoids

Answer 8

Haemorrhoids prolapsed out of the anus on straining but cannot be reduced

Question 9

What might be a typical presentation of haemorrhoids

Answer 9

Sensation of a lump at the anus with possible fresh rectal bleeding on the tissue paper

Question 10

How are haemorrhoids diagnosed

Answer 10

Usually on anal inspection and asking the patient to to gently strain

Question 11

What is the management for first and second degree haemorrhoids

Answer 11

Non-surgical as an outpatient

Question 12

What is the management for third and fourth degree haemorrhoids

Answer 12

Usually need haemorrhoidectomy

Question 13

What is an anal fissure

Answer 13

A tear of the skin of the anal canal

Question 14

Where do anal fissures occur

Answer 14

Posterior midline where anal blood flow is lowest and the anal skin is least supported

Question 15

In what 4 patients do the most commonly occur in

Answer 15

Constipated patients
Crohn’s disease patients
ANorectal infection
Haematological malignancy

Question 16

What are the clinical features of an anla fissure

Answer 16

Pain which begins with defaecation but continues afterwards

Possible blood

Question 17

How is the diagnosis of an anal fissure made

Answer 17

On inspection

Question 18

What is the managent for anal fissures

Answer 18

Correct constipation (diet alteration or bulk laxative)
Avoid straingin
Local anaesthetic
suppositories or creams

Question 19

What is a fistula

Answer 19

A pathological connection between the gut and skin

Question 20

Who is more likely to have an anal fistual. Men or women

Answer 20

Men

Question 21

What are the 4 at risk groups

Answer 21

Crohn’s disease
Prior anal surgery
Prior pelvic radiation
Prior pelvic trauma

Question 22

What are the clinical features of an anal fistula

Answer 22

Anal discomfort
itching
Loss of faecal material and pus

Question 23

Who are the at risk groups for anal carcinoma

Answer 23

HIV infection
HPV infection
Syphilis
People participating in anoreceptive intercourse
Prior perianal Crohn’s disease or fistulae
Prior pelvic irradiation
People who have received immunosuppression
Smokers

Question 24

Who is susceptible to rectal prolapse

Answer 24

Women over the age of 50 who have had children
Patients who chronically strain
Patients with CF 
Spina bifida
Congenital mesenchymal disorders

Question 25

What is the usual presentation

Answer 25

The sensation of a mass on wiping

Question 26

how is the examination carried out for rectal prolapse

Answer 26

With the patient straining - possibly needs to be done on the toilet

Question 27

What is the treatment for severe rectal prolapse

Answer 27

Surgery