Chapter 37 - Anal and Rectal

Question 1

What hemorrhoids do we sclerose or band?

Answer 1

Internal - primary or secondary (if they come out, they pop back in on their own)

Question 2

Arterial supply to anus

Answer 2

Inferior rectal artery

Question 3

Venous drainage and dentate line

Answer 3

Internal and external hemorrhoid plexus

Question 4

How to treat thrombosed external hemorrhoids

Answer 4

<4 days, can remove in clinic

>4 days pain meds, Will likely resolve

Question 5

Surgical indications for hemorrhoids

Answer 5

Recurrence, thrombosis multiple times, large external component, skin tags (from resolved hemorrhoids) that get in the way of cleanliness.

Question 6

Describe surgery for tertiary or quaternary internal hemorrhoids

Answer 6

3 quadrant resection
Resect down to internal anal sphincter (not through)
Postop - sits baths, stool softener, high fiber, fluids

Question 7

Anal canal vs anal margin

And associated LNs

Answer 7

Canal = above dentate&raquo_space; internal
Iliac nodes
Margin = below dentate&raquo_space; inguinal nodes

Question 8

How to treat flat anal condylomas

Answer 8

Burning chemical - fulguration

Question 9

AIN

Answer 9

Caused by high risk HPV viruses
Could have condylomata or not
Turns into cancer, maybe not stepwise (1,2,3, cancer)

Question 10

AIN Surveillance per tsikitis

Answer 10

If immunocompromised, DM, cancer, HIV, etc&raquo_space; check every 3-4 months
Nothing for 2-3 years can go every 6 months to a year

If immunocompetent&raquo_space; every 6 months then

HRA is a way to treat - lasers - but it causes anal stenosis

Question 11

Anal cancer treatment

Answer 11

Perianal = excise

In the anal canal = nigra protocol (XRT w 5FU and mitomycin)

Cures 80% without surgery

Apr for treatment failure or recurrent cancer

Question 12

Posterior midline anal fissures

Answer 12

Normal - 90% are here

Question 13

Lateral fissures

Answer 13

Abnormal - worry about IBD