Benign conditons of the ano-rectal area Flashcards

1
Q

What is a haemorrhoid?

A

Enlarged vascular cushions in the lower rectum and anal canal

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2
Q

What is the classic presentation of haemorrhoids?

A

Painless bleeding
Fresh, bright red blood, not mixed with stool, usually on the paper
Perianal itchiness
No change in bowel habit, no weight loss or other associated symptoms

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3
Q

What is the classical positioning of haemorrhoids?

A

corresponds to the branches of the superior haemorrhoidal artery occuring at 3 , 7 and 11 o’clock position

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4
Q

What are the investigations for heamorrhoids?

A

PR examination
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy in patients above age of 50

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5
Q

What is the best procedure for symptomatic haemorrhoids?

A

HALO (haemorrhoidalartery ligation operation) or

THD (transanal haemorrhoidal dearterialisation)

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6
Q

Describe the HALO procedure?

A

Miniature Doppler ultrasound device locates branches of arteries supplying the haemorrhoids.
These blood vessels are tied off, and the haemorrhoid shrinks

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7
Q

What is a rectal prolapse?

A

Protruding mass from anus especially during defecation - bleeding and mucus

Examination usually shows poor anal tone

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8
Q

What are the two kinds of rectal prolapse?

A

Partial

Complete

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9
Q

What is the best treatment for complete rectal prolapse?

A

Abdominal rectopexy

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10
Q

What is the best treatment for complete rectal prolapse in a frail patient?

A

bulking agent and education on manual reduction

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11
Q

Describe anal fissures?

A

Tear in the anal margin due to passage of a constipated stool
Usually in the midline posteriorly but may be occasionally anterior

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12
Q

What may multiple fissures be due to?

A

Crohn’s disease

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13
Q

What is the clinical presentation of anal fissures?

A

Acute onset of severe anal pain usually following episode of constipation
“Glass passing through the back passage”
Pain lasts for up to ½ h after defecation
Bright rectal bleeding

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14
Q

What is the treatment anal fissures?

A

Dietary advice, stool softeners
Pharmacological sphyncterotomy (0.3% GTN ointment, 2% Diltiazem ointment)
Lateral sphyncterotomy
Botox injection

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15
Q

What is a fistula in ano?

A

Abnormal communication between two epithelial surfaces

There is an internal opening in the anal canal and one or more external openings on the peri-anal skin

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16
Q

What conditions can cause a fistula in ano?

A

Crohn’s disease
tuberculosis
carcinoma

17
Q

How do fistulas in ano arise?

A

Majority arise from delay in treatment, or inadequate treatment of anorectal abscess

18
Q

What are the recommended investigations and treatmetns for fistulas in ano?

A
MRI
Insertion of Seton (draining, cutting)
LIFT procedure
Glue/permacol
Defunctioning colostomy