butt stuff

Question 1

what is colorectal cancer

Answer 1

cancer in colon or rectum
usually adenocarcinoma
arises from polyps

Question 2

what are risk factors for colorectal cancer

Answer 2

male 
age 
smoking 
IBD 
red meat diet 
family history

Question 3

how may colorectal cancer present

Answer 3

ascending colon - occult bleeding, iron deficiency anaemia, non-obstructive
descending colon - ring shaped tumour, abdominal pain, obstructive, constipation
abdominal pain
weight loss
fatigue

Question 4

what investigations could you do for colorectal cancer

Answer 4

barium enema
colonoscopy
bowel cancer screening program
bloods - iron deficiency, CEA

Question 5

how could you treat colorectal cancer

Answer 5

TNM staging
chemotherapy
radiotherapy
surgical resection

Question 6

what are haemorrhoids

Answer 6

enlarged vessels in the anus that can be seen on the exterior

Question 7

what causes haemorrhoids

Answer 7

usually constipation and straining

Question 8

how can haemorrhoids present

Answer 8

pruritis 
blood or mucous on stool 
pain 
anaemia
painless

Question 9

what investigations could you do for haemorrhoids

Answer 9

examine abdomen and anus
sigmoidoscopy
colonoscopy

Question 10

how could you treat haemorrhoids

Answer 10

advice - hydration, paracetamol, cut out alcohol and coffee, keep anus clean and dry, bath etc
normally resolves in a week
rubber band ligation - base of haemorrhoid is tied off to stop it’s blood supply
HALO
remove haemorrhoid
treat underlying cause - constipation

Question 11

what is an anal fissure

Answer 11

a tear in the lining of the anus

Question 12

what can cause an anal fissure

Answer 12

usually due to passing hard stools and constipation

Question 13

how may an anal fissure present

Answer 13

pain while passing stools - ‘like passing glass splinters’
itching
blood on tissue/stool
lump, skin tag, visible tear

Question 14

what investigations could you do for anal fissures

Answer 14

sigmoidoscopy - rule out cancer

Question 15

how could you treat an anal fissure

Answer 15

manage constipation 
topical NO paste 
GTN/diltiazem 
botox to relax the sphincter 
clean the fissure 
sphincterotomy - take some of the internal sphincter away

Question 16

what is an anal fistula

Answer 16

abnormal connection between anal canal and skin

Question 17

what can cause a fistula

Answer 17

trauma 
perianal abscess 
chron's disease 
diverticular disease 
rectal carcinoma

Question 18

how may a fistula present

Answer 18

pain/swelling 
fever 
weight loss
diarrhoea
sepsis 
pus discharge

Question 19

how could you treat a fistula

Answer 19

it is difficult to treat
clean and drain it
can do a fistulotomy but risk of incontinence especially in women

Question 20

what is anorectal cancer

Answer 20

squamous cancer in the anus or rectum

usually arises from pre-existing polyps - tubular or villous

Question 21

what are risk factors for anorectal cancer

Answer 21

anal intercourse 
HIV
HPV
family history 
age 
male 
low fibre, high red meat and alcohol diet 
obesity 
smoking 
DM

Question 22

how may anorectal cancer present

Answer 22

change in bowel habit 
iron deficiency anaemia 
fatigue 
weight loss 
bleeding 
pruritis 
pain 
anal mass/stricture on examination

Question 23

what investigations could you do for anorectal cancer

Answer 23

colonoscopy with biopsy = 1st line 
CT 
sigmoidoscopy 
MRI 
FIT test - positive 
rectal exam

Question 24

how could you treat anorectal cancer

Answer 24

chemotherapy
radiotherapy
palliate

Question 25

what is a perianal abscess

Answer 25

large collection of pus/fluid in perianal area

Question 26

how does a perianal abscess present

Answer 26

extreme pain

signs of sepsis

Question 27

how do you treat a perianal abscess

Answer 27

antibiotics if needed

drain

Question 28

what is pelvic floor dysfunction

Answer 28

spectrum of symptoms related to defecation

can be related to child birth, surgery, abuse, sepsis