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MN ABSITE: FISER + TrueLearn + Decker > chapter 37: anal and rectal > Flashcards

chapter 37: anal and rectal Flashcards

1
Q

arterial supply to the anus

A

inferior rectal artery

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2
Q

venous drainage of the anus

A

above the dentate is internal hemorrhoid plexus and below the dentate is external hemorrhoid plexus

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3
Q

hemorrhoidal plexuses

A
  • left lateral
  • right anterior
  • right posterior
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4
Q
  • can pain when the thrombosis

- distal to the dentate line, covered by sensate squamous epithelium; can cause pain, swelling and itching

A

external hemorrhoids

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5
Q

cause bleeding or prolapse

A

internal hemorrhoids

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6
Q

internal hemorrhoids: slides below dentate with strain

A

primary

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7
Q

internal hemorrhoids: prolapse that reduces spontaneously

A

secondary

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8
Q

internal hemorrhoids: prolapse that has to be manually reduced

A

tertiary

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9
Q

internal hemorrhoids: not able to reduce

A

quaternary

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10
Q

tx: hemorrhoids

A

fiber and stool softeners (prevent straining); sitz baths

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11
Q

tx: thromboses external hemorrhoid

A

lance open (if > 72 hours) or elliptical excision (if

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12
Q

surgical indications for hemorrhoids:

A

recurrence, thrombosis multiple times, large external component

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13
Q

hemorrhoids: can be resected with elliptical excision

A

external hemorrhoids

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14
Q

type of internal hemorrhoids that can be banded

A

can band primary and secondary internal hemorrhoids

- do not band external hemorrhoids (painful)

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15
Q

surgery required for what type of internal hemorrhoids

A

surgery for tertiary and quaternary internal hemorrhoids - 3 quadrant resection
- need to resect down to the internal anal sphincter (do not go through it)

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16
Q

post op management of tertiary and quaternary internal hemorrhoids

A

sitz baths, stool softener, high-fiber diet

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17
Q

where does rectal prolapse start?

A

starts 6-7 cm form anal verge

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18
Q

what causes rectal prolapse?

A

secondary to pudendal neuropathy and laxity of the anal sphincters

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19
Q

risk factors for rectal prolapse

A

increased with female gender, straining, chronic diarrhea, previous pregnancy, and redundant sigmoid colons

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20
Q

what layers of the rectum are involved in rectal prolapse?

A

prolapse involves all layers of the rectum

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21
Q

medical treatment: rectal prolapse

A

high-fiber diet

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22
Q

surgical tx: rectal prolapse

A
  • perineal rectosigmoid resection (altemeier) transanally if patient is older and frail
  • low anterior resection and pexy of residual colon if good condition patient
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23
Q

caused by a split in the anodrem

  • 90% in posterior midline
  • causes pain and bleeding after defection; chronic ones will see a sentinel pile
A

anal fissure

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24
Q

medical tx: anal fissure

A

sitz baths, lidocaine jelly, and stool softeners (90% heal)

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25
surgical tx: anal fissure
lateral subcutaneous internal sphincterotomy
26
most serious complication of surgery for anal fissure
fecal incontinence
27
what do you worry about with lateral or recurrent anal fissures?
worry about inflammatory bowel disease
28
can cause severe pain | - risk factors: antibiotics, cellulitis, DM, immunosuppressed or prosthetic hardware
anorectal abscess
29
anorectal abscess: can be drained through the skill (all are below the elevator muscles)
perianal, intersphincteric, and ischiorectal abscesses
30
anorectal abscess: can form horseshoe abscess
intersphincteric and ischiorectal abscesses
31
anorectal abscess: need to be drained transrectally
supralevator abscesses
32
- sinus or abscess formation over the sacrococcygeal junction; increased incidence in men - tx?
pilonidal cysts tx: drainage and packing; follow-up surgical resection of cyst
33
do not need to excise the tract | - often occurs after anorectal abscess formation
fistula-in-ano
34
what is goodsall's rule for fistula-in-ano?
- anterior fistulas connect with anus/rectum in a straight line - posterior fistulas go toward a midline internal opening in the anus/rectum
35
tx: fistula-in-ano (lower 1/3 of the external anal sphincter)
fistulotomy (open tract up, curettage out, let it heal by secondary intention)
36
tx: fistula-in-ano (upper 2/3 of the external anal sphincter)
rectal advancement flap
37
most worrisome complication of treatment for fistula in ano
risk of incontinence - you want to avoid damage to the external anal sphincter so fistulotomy is not used for fistulas above the 1/3 of the external anal sphincter
38
tx -> rectovaginal fistulas: | - simple (low to mid-vagina)
tx: trans-anal rectal mucosa advancement flap | - many obstetrical fistulas heal spontaneously
39
tx -> rectovaginal fistulas: | - complex (high in vagina)
abdominal or combined abdominal and perineal approach usual; resection and reanastomosis of rectum, close hole in vagina, interpose omentum, temporary ileostomy
40
tx: neurogenic anal incontinence (gaping hole)
no good treatment
41
chronic damage to levator ani muscle and pudendal nerves (obesity, multiparous women) and anus falls below levators
abdominoperineal descent
42
tx: abdominoperineal descent
high-fiber diet, limit to 1 bowel movement a day; hard to treat
43
tx: obstetrical trauma leading to anal incontinence
anterior anal sphincteroplasty
44
what is anal cancer associated with?
xrt and hpv
45
above dentate line
anal canal
46
below dentate line
anal margin
47
what are the different types of squamous cell carcinoma in the anal canal?
epidermoid CA mucoepidermoid CA cloacogenic CA basaloid CA
48
anal cancer: | - symptoms: pruritus, bleeding, and palpable mass
squamous cell CA
49
tx: squamous cell CA - anal cancer
nigro protocol (chemo-XRT with 5FU and mitomycin), not surgery - cures 80% - APR for treatment failures or recurrent cancer
50
tx: adenocarcinoma - anal cancer
APR usual; WLE if
51
3rd most common site for melanoma
anal cancer (skin and eyes #1 and #2)
52
how does melanoma spread?
1/3 has spread to mesenteric lymph nodes | - hematogenous spread to the liver and the lung is early and accounts for most deaths
53
what is symptomatic melanoma of the anal cancer associated with?
significant metastatic disease
54
anal melanoma: most common symptom
rectal bleeding
55
anal melanoma: appearance
lightly pigmented or not pigmented at all
56
tx: anal melanoma
APR usual; margin dictated by depth of lesion standard for melanoma
57
anal cancer below dentate line - have better prognosis than anal canal lesions
anal margin lesions (below dentate line)
58
- ulcerating, slow growing; men with better prognosis | - metastases: go to inguinal nodes
squamous cell cancer - anal margin lesions
59
sx: anal margin lesions (squamous cell CA)
WLE for lesions
60
anal margin lesions: squamous cell CA - primary tx for lesions > 5cm, if involving sphincter or if positive nodes
chemo-XRT (5-FU and cisplatin) - try to preserve the sphincter here and avoid APR
61
anal cancer: central ulcer, raised edges, rare metastases
basal cell CA
62
tx: anal cancer - basal cell CA
WLE usually sufficient, only need 3-mm margins; rare need for APR unless sphincter involved
63
nodal metastases: superior and middle rectum
IMA nodes
64
nodal metastases: lower rectum
primarily IMA nodes, also to internal iliac nodes
65
nodal metastases: upper 2/3 of anal canal
internal iliac nodes
66
nodal metastases: lower 1/3 of anal canal
inguinal nodes

MN ABSITE: FISER + TrueLearn + Decker (45 decks)

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