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ABSITE 101 > Anus and Rectum (Makary Ch 23) > Flashcards

Anus and Rectum (Makary Ch 23) Flashcards

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1
Q

Where is the dentate line?

A

In the anal canal about 2cm from the anal verge

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2
Q

What is the anal verge?

A

the junction the anoderm and the perianal skin

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3
Q

What is the dentate line?

A

separates proximal columnar epithelium from the distal squamous epithelium

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4
Q

what drains at the dentate line?

A

anal glands (at the bottom of the columns of Morgagni) drain their secretions into the anal canal

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5
Q

What is the anoderm? (How are they innervated?)

A

the hairless squamous epithelium between the dentate line and the hair bearing perianal skin (anal margin)

Somatic innervation

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6
Q

What comprises the external anal sphincter?
What nerve innervates it?
Voluntary or involuntary?

A

Skeletal Muscle

Striated skeletal muscle has three parts: Deep, superficial and subcutaneous

All layers innervated by somatic sensory fibers from the pudendal nerve

VOLUNTARY

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7
Q

What comprises the internal anal sphincter?
What nerve innervates it?
Voluntary or involuntary?

A

Continuation of circular smooth muscle layer of the rectum

Visceral sympathetic and parasympathetic fibers from pre sacral nerves

INVOLUNTARY - constitutively contracted

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8
Q

What is the definition of a hemorrhoid?

A

Tufts of vascular and connective tissue that are normally present in the anal canal

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9
Q

Internal vs. External hemorrhoids - which one causes pain?

A

External hemorrhoids

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10
Q

What is a grade 1 internal hemorrhoid?

A

bleeding without prolapse

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11
Q

What is a grade 2 internal hemorrhoid?

A

prolapse with spontaneous reduction +/- bleeding

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12
Q

What is a grade 3 internal hemorrhoid?

A

Prolapse requiring manual reduction +/- bleeding

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13
Q

What is a grade 4 internal hemorrhoid?

A

prolapse that is not reducible

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14
Q

Treatments for Grade 1 internal hemorrhoids (3)

A

Dietary fiber supplements, avoidance of straining, rubber band ligation

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15
Q

Treatments for grade two hemorrhoids

A

Same as grade 1, but rubber band ligation required more frequently

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16
Q

What type of hemorrhoids are treated with a hemorrhoidectomy?

A

Grades 3 and 4

17
Q

What are the two ways to perform a hemorrhoidectoy?

A

Staple vs excisiononal

18
Q

What is the benefit and the risk of stapled hemorrhoidectomy?

A

Benefit - decreased post op pain

risk - rare, severe persistent anal pain

19
Q

What is a thrombosed external hemorrhoid?

A

A blood clot in an external hemorrhoid causing acute pain

20
Q

When do you operate on a thrombosed hemorrhoid?

A

If diagnosed within 1-2 days. If delay in diagnosis (2-4 days), pain caused by excision is greater than pain from resolving hemorrhoid

21
Q

What is the treatment for delayed presentation of thrombosed hemorrhoid? What is the timeline of “delayed presentation”?

A

Considered delayed if 2-4 days after onset of pain.

Sits baths, pain medications

22
Q

Where do 90% of anal fissures occur?

A

posterior midline

23
Q

What disease do you worry about with lateral or recurrent fissures?

A

IBD. Do not treat these surgically

24
Q

Conservative treatments - anal fissure?

A

Warm soaks (sitz baths), stook bulking agents, nifedipine ointment and topic anesthetics

25
Q

Two ointments used to treat anal fissures?

A

Nifedipine - a calcium channel blocker
Nitroglycerine

Goal is to relax sphincter muscle, increase blood flow to improve healing

26
Q

Option for treating chronic anal fissures?

A

Botox

27
Q

When does one consider a lateral internal sphincterotomy?

A

anal fissures refractory to conservative treatment

28
Q

What is the most common reason for persistent pain following a left internal sphincterotomy?

A

The sphincterotomy was inadequate

29
Q

intersphincteric fistula in ano (parks classification)

A

tracks between internal and external sphincter

most common kind

30
Q

transphincteric FIA (Parks classification)

A

tracks through through both internal and external sphincters

31
Q

Suprasphincteric Fistula in ano (parks classification)

A

Tracks up over the EAS

32
Q

Extra-sphincteric Fistula in ano (parks classification)

A

The internal opening is in the rectum, not at the dentate line

33
Q

Goodsall rule: Anterior or anterolateral external opening usually tracks …

A

directly radially into the anal canal (straight path)

34
Q

Goodsall rule: Posterior or posterior-lateral external openings typically track&raquo_space;>

A

curvilinearly into the anal canal

ABSITE 101 (4 decks)

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