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Surgery > Benign anorectal disease > Flashcards

Benign anorectal disease Flashcards

1
Q

what is dentate/pectinate line

A

transition from colonic mucosa to squamous mucosa of the anus

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2
Q

what is hintons line

A

change from squamous mucosa of the anus to the perianal skin

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3
Q

symptoms of perianal disease

A
  • bleeding
  • pattern change in BMs
pain
protruding mass on straining
seepage and soilage
straining
urgency
incomplete evacuation
itching
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4
Q

signs of perianal disease

A 
*mass
tenderness
fluctuance
erythema
discharge
anal tone/squeeze
prolapse
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5
Q

how should yo evaluate patients with anorectal complaints

A

all should undergo some time of proctosigmoioscopy at some point during eval and treatment

rule out proximal malignancy

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6
Q

what are you looking for on anal palpation/exam

A

inspect anal argin and perianal margin

ID lesions/tags/hemorrhoids

ID rectal/pelvic masses, fistulae, abscesses

assess anal tone and squeeze

eval prostate

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7
Q

which is better for anal disease–CT or MRI

A

MRI though its less accessible

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8
Q

what causes hemorrhoids

A

hemorrhoidal tissue –> vascular cushions that are supposed to help reduce trauma to anal canal during defectation

increased intraabdominal pressure

pregnancy

constipation

weight lifting

chronic straining

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9
Q

what are external hemorrhoids

A

distal to dentate line

squamous epithelium, skin

have nerve endings and thus are PAINFUL

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10
Q

what are internal hemorrhoids

A

proximal to dentate line

columnar epithelium/mucosa

no nerve endings… PAINLESS

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11
Q

grade I hemorrhoid

A

no prolapsing

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12
Q

grade II hemorrhoid

A

spontaneously reduces

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13
Q

grade III hemorrhoid

A

reduce manually

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14
Q

grade IV hemorrhoid

A

irreducible

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15
Q

how do you do a physical exam for hemorrhoids

A

prep with fleet enema

position in left lateral decubitus

perianal inspection–> do valsalva to cause prolapse

DRE

anoscopy

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16
Q

what is the difference between hemorrhoids and anal prolapse

A

prolapse is a circumferential invagination of the bowel lining whereas hemorrhoids are the vascular cushions

17
Q

conservative therapy for internal hemorrhoids

A

**works for vast majority of people

high fibre diet (25-30 g/day)

plenty of fluids

stool lubricants

no reading on toilet

minimize straining

sitz bath

18
Q

indications for surgical tx of hemorrhoids

A

failure of conservative measures

continues symptoms--
bleeding
protrusion
pruritis/irritaiton
seepage and soilage 
difficulty with hygiene
19
Q

surgical procedures for internal hemorrhoids

A

excisional hemorrhoidectomy

stapled anoplexy

20
Q

officed based procedures for internal hemorrhoids

A

rubber band ligation–over time the hemorrhoid becomes ischemic and resolves/scars

injection sclerotherapy–try to get it to fibrose

infrared coagulation

21
Q

symptomatic relief of external hemorrhoids

A

sitz bath

stool softeners

pain meds

excision

thrombectomy if within 48-72 hours

22
Q

where are anal fissures found

A

distal to dentate line

23
Q

causes of anal fissures

A

trauma–large stool, diarrhea

hypertonic/hyperspastic internal sphincter

diminished blood flow/ischemia (inability to heal)

24
Q

symptoms of anal fissure

A

pain

spasm

bleeding

seepage/soilage

difficult evacuation

25
Q

management of anal fissure

A

most people will be treated conservatively

symptomatic–> sitz bath, stool softener, pain meds

topical–> nitroglycerin, calcium channel blockers

botox injection of hypertonic sphincter

26
Q

surgical tx of anal fissures

A

lateral internal sphincterotomy

  • -> portion of sphincter cut for patrial width to reduce its hypertonicity
  • ->worry about complications with incontinence

anoplasty–> strips of tissue excised and closed/reconstructed

27
Q

acute etiology of perianal absecess

A

*cryptoglandular

crohns
cancer
trauma
radiation
TB
actinomycosis
lymphogranuloma vereneum
28
Q

anorectal abscess sx

A 
pain
swelling
drainage
bleeding
constipation
urinary difficulties
systemic signs of infection
29
Q

what % of patients with abscesses develop anal fistulas

A

up to 50%

30
Q

tx for anal fistula

A

fistulotomy

fistula plug

fibrin glue injection

advancement flap

31
Q

what do ALL patients with an anorectal complaint need?

A

eval with DRE and proctoscopy/sigmoidoscopy

  • depending on age/risk factors, full screening colonoscopy may be indicated
  • -refer to BCCA for screening guidelines

Surgery (20 decks)

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