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Fiser ABSITE Review + Decker + TrueLearn > Chapter 37 - Anal & Rectal > Flashcards

Chapter 37 - Anal & Rectal Flashcards

1
Q

What is the arterial supply to the anus?

A

Inferior rectal artery

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2
Q

What is the venous drainage above the dentate line? Below?

A

Above: Internal hemorrhoid plexus
Below: External hemorrhoid plexus

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3
Q

Hemorrhoid plexus locations?

A

Left lateral, right anterior, right posterior

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4
Q

Symptoms of external hemorrhoids?

A

Pain when they thrombose, swelling, itching

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5
Q

Symptoms of internal hemorrhoids?

A

Bleeding or prolapse

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6
Q

Grades of prolapse of internal hemorrhoids?

A

Primary: slides below dentate w/ strain
Secondary: prolapse that reduces spontaneously
Tertiary: Prolapse that has to be manually reduced
Quaternary: not able to reduce

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7
Q

Treatment for hemorrhoids?

A

Stool softeners, fiber, sitz baths

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8
Q

Surgical indications for hemorrhoids?

A

Recurrent disease (bleeding), thrombosis, large external component

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9
Q

Banding for internal or external hemorrhoids?

A

Internal only

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10
Q

Rectal prolapse begins how far from the anal verge?

A

6-7cm

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11
Q

What causes rectal prolapse? Risk factors?

A

Pudendal neuropathy and laxity of the anal sphincters; increased with females, straining, diarrhea, previous pregnancy, redundant sigmoid colons

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12
Q

Treatment for rectal prolapse?

A

High-fiber diet
Rectosigmoid resection (Altmier) transanally
LAR or rectopexy

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13
Q

Virus associated with condylomata acuminata?

A

HPV

Laser surgery

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14
Q

What causes anal fissure?

A

Split in the anoderm

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15
Q

Where are anal fissures located?

A

90% in posterior midline

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16
Q

Symptoms of anal fissure?

A

Pain and bleeding after defecation; chronic ones will see a sentinel pile

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17
Q

Medical treatment for anal fissure? Surgical?

A

Medical: sitz baths, bulk, lidocaine jelly, stool softeners
Surgical: lateral subcu internal sphincterotomy

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18
Q

Most serious complication of anal fissure surgery?

A

Fecal incontinence

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19
Q

What disease processes are contraindications to surgery for anal fissure?

A

If secondary to Crohn’s or UC

20
Q

Drainage procedure for perianal, intersphincteric, and ischiorectal abscesses?

A

Through skin (all below the levator muscles)

21
Q

Drainage for supralevator abscesses?

A

Transrectally

22
Q

Treatment for pilonidal cyst?

A

Drainage and packing; follow up surgical resection of cyst

23
Q

Treatment for fistula in ano?

A

Unroof fistula and eliminate the primary opening with rectal advancement flap; do not need to excise the tract

24
Q

What is Goodsall’s rule?

A

Anterior fistulas connect with rectum in straight line; posterior fistulas go toward midline with internal opening in rectum

25
Q

Definition of simple rectovaginal fistula?

A

Secondary to infection or obstetrical trauma, low to midvagina, <2.5cm

26
Q

Treatment for simple rectovaginal fistula?

A

Many heal spontaneously; transanally unroof and place rectal mucosa advancement flap

27
Q

Definition of complex rectovaginal fistula?

A

Secondary to inflammatory bowel disease, XRT, neoplasm, or high in vagina, or >2.5cm

28
Q

Treatment for complex rectovaginal fistula?

A

Abdominal or combined approach; resection and reanastomosis with placement of colostomy, need good tissue for anastamosis

29
Q

Types of anal incontinence? Treatment?

A

Neurogenic: no good treatment
Abdominoperineal descent: damage to levator ani muscle and anus falls below levators, stretches the pudendal nerves; high fiber diet, limit to 1 bm/day, sphincteroplasty if related to trauma (childbirth)

30
Q

Anorecatal problems associated with AIDS? Characteristics?

A

Kaposi’s sarcoma: nodule with ulceration
CMV: shallow ulcers, similar presentation as appendicitis
HSV: #1 rectal ulcer
B cell lymphoma: can look like abscess or ulcer

31
Q

What type cancer found in the anal canal (above dentate line)?

A

Squamous cell CA, basaloid, mucoepidermoid, adenocarcinoma, melanoma

32
Q

Treatment for squamous cell CA of anal canal?

A

Nigro protocol - 5FU and mitomycin, XRT

33
Q

Cure rate for anal squamous cell CA?

A

80%

34
Q

Treatment for adenocarcinoma of the anal canal?

A

APR; WLE if <1/3 circumference, limited to submucosa, well differentiated, no vascular/lymphatic invasion; needs 1cm margin; postop chemo/XRT

35
Q

Treatment for melanoma of the anal canal?

A

APR; margin dictated by depth of lesion standard for melanoma

36
Q

What accounts for most deaths due to anal canal melanoma?

A

Hematogenous spread to the liver and lung early

37
Q

Most common symptom of melanoma of anal canal?

A

Rectal bleeding

38
Q

What type of cancers are found in anal verge (below dentate line)?

A

Squamous cell CA, basal cell CA, Bowen’s disease, Paget’s disease

39
Q

What is the treatment for squamous cell CA of the anal verge?

A

WLE for lesions <3cm, can get 0.5cm margin; APR for larger lesions or if sphincter involved

40
Q

Treatment for basal cell CA of anal verge?

A

WLE usually sufficient; need 3mm margins; rare need for APR

41
Q

What is Bowen’s disease?

A

Intraepidermal squamous cell CA

42
Q

Associated conditions with Bowen’s disease?

A

1 or more primary internal malignancy or primary cancer of the skin with internal mets

43
Q

Treatment for Bowen’s disease?

A

Local therapy, WLE with clear margins

44
Q

What is Paget’s disease of anal verge?

A

Intraepidermal apocrine gland CA, slow growing, positive PAS stain

45
Q

Treatment for Paget’s disease?

A

WLE with clear margins; groin dissection for positive nodes

46
Q

Where do nodal mets from anal/rectal cancer go?

A

Superior and middle rectum: IMA nodes
Lower rectum: primarily IMA nodes, internal iliac nodes
Upper 2/3 of anal canal: internal iliac and pelvic nodes
Lower 1/3 of anal canal: inguinal nodes

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