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Section 9: Gastrointestinal Disorders > Chapter 85: Anorectal Disorders > Flashcards

Chapter 85: Anorectal Disorders Flashcards

1
Q

The rectum begins at

A

The S3 vertebral body and descends for about 13 to 15 cm becoming the anus, which is comprised of the anal canal, anal verge, and anal margin

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2
Q

True or False
The rectum narrows and traverses through the muscular pelvic floor, at the level of the levator ani and coccygeal muscles, and becomes the anal canal, 4 cm in length, surrounded by the anal sphincter muscle

A

True
The rectum narrows and traverses through the muscular pelvic floor, at the level of the levator ani and coccygeal muscles, and becomes the anal canal, 4 cm in length, surrounded by the anal sphincter muscle

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3
Q

The junction of rectum and anal canal is called

A

Dentate line

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4
Q

Rectal ampulla narrows to conform to the opening of the anal canal. A pleated appearance, forming 8 to 14 convoluted longitudinal folds

A

Columns of morgagni

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5
Q

True or False

Just proximal to the dentate line, the mucosa transitions from rectal columnar to cuboidal to squamous epithelium

A

True

Just proximal to the dentate line, the mucosa transitions from rectal columnar to cuboidal to squamous epithelium

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6
Q

Supplies the proximal 2/3 of the rectum

A

The superior hemorrhoidal artery, from the internal mesenteric artery

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7
Q

Supplies the distal 1/3 of the rectum

A

The middle hemorrhoidal artery, from the internal iliac artery

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8
Q

Supplies the anus

A

Inferior hemorrhoidal artery

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9
Q

True or False
The superior rectal vein drains into the portal system, whereas the middle rectal vein drains into the inferior vena cava

A

True
The superior rectal vein drains into the portal system, whereas the middle rectal vein drains into the inferior vena cava

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10
Q

The most common position for routine digital rectal examination and anoscopy

A

The lateral or Sims position

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11
Q

In debilitated patients, one may have to perform the examination with the patient in ____

A

In debilitated patients, one may have to perform the examination with the patient in a supine, lithotomy position

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12
Q

Skin tags covering anal crypts, fistulas, and fissures are called

A

Sentinel tags

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13
Q

True or False
Surgical referral for excision and/or biopsy is warranted because inflammatory bowel disease may be associated with sentinel tags

A

True
Surgical referral for excision and/or biopsy is warranted because inflammatory bowel disease may be associated with sentinel tags

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14
Q

Internal hemorrhoids originate from

A

Proximal to the dentate line

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15
Q

Location of internal hemorrhoids?

A
  • Right posterolateral
  • Right anterolateral
  • Left lateral positions
    (2, 5 (most common, and 9 o’clock)
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16
Q

True or False
Although the most common cause with sentinel tags.
of bright red rectal bleeding is hemorrhoids, tumors must be ruled out HEMORRHOIDS
as a cause of rectal bleeding in patients >50 years of age

A

False
Although the most common cause with sentinel tags.
of bright red rectal bleeding is hemorrhoids, tumors must be ruled out HEMORRHOIDS
as a cause of rectal bleeding in patients >40 years of age

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17
Q

A rare complication of hemorrhoidal banding is ____

A

A rare complication of hemorrhoidal banding is pelvic sepsis

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18
Q

Grading for internal hemorrhoids

A
  • Grade I (luminal protrusion above dentate line)
  • Grade II (prolapse with spontaneous reduction)
  • Grade III (prolapse needing manual reduction)
  • Grade IV (nonreducible prolapse)
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19
Q

The result of a superficial linear tear of the anal canal below the dentate line and extending distally to the anal verge

A

Anal fissures

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20
Q

True or False

Anal fissures are usually single and occur in the midline posteriorly in 80% to 90% of cases

A

True

Anal fissures are usually single and occur in the midline posteriorly in 80% to 90% of cases

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21
Q

Chronic anal fissures

A

> 6 weeks

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22
Q

True or False

Fissures due to Crohn’s disease are multiple, off midline, and asymptomatic more commonly than in the general population

A

True

Fissures due to Crohn’s disease are multiple, off midline, and asymptomatic more commonly than in the general population

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23
Q

Supportive treatment for anal fissure

A

Warm baths for at least 15 minutes three to four times a day and after each bowel movement along with stool softeners may suffice

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24
Q

Occurs when the pliable tissue is replaced by scarred fibrotic tissue

A

Anal stenosis

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25
Q

Most common cause of anal stenosis

A

Secondary cause

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26
Q

The common denominator for the development of fissure- in-ano, fistula-in-ano, and perirectal abscesses

A

Cryptitis

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27
Q

Cardinal signs of cryptitis

A

Anal pain, spasm, and itching with or without bleeding

28
Q

Fistula-in-ano originates from an ____

A

Fistula-in-ano originates from an infected crypt and tracks to the skin

29
Q

True or False

CT scan is more accurate than US in the evaluation of perirectal fistulas

A

False

US is more accurate than CT scan in the evaluation of perirectal fistulas

30
Q

True or False

Anorectal abscesses are typically monomicrobial

A

False

Anorectal abscesses are typically polymicrobial

31
Q

The most common anorectal abscess location ____

A

The most common anorectal abscess location is perianal

32
Q

The least common is ____

A

The least common is supralevator (pelvirectal)

33
Q

True or False

Isolated perianal abscesses are generally the only type of anorectal abscess that can be adequately treated in the ED

A

True

Isolated perianal abscesses are generally the only type of anorectal abscess that can be adequately treated in the ED

34
Q

True or False
Perianal abscesses are easily palpable at the anal verge, whereas deeper perirectal abscesses may be palpated through the rectal wall or more lateral to the anal verge, on the buttocks

A

True
Perianal abscesses are easily palpable at the anal verge, whereas deeper perirectal abscesses may be palpated through the rectal wall or more lateral to the anal verge, on the buttocks

35
Q

Often painful on rectal examination and are lateral to the anal verge

A

Ischiorectal abscesses

36
Q

Painful with defecation, may be associated with rectal discharge and fever, and a tender mass may be palpable on digital examination of the rectal canal, often in the posterior midline

A

Intersphinteric abscesses

37
Q

Often an extension of an intersphincteric abscess, frequently present with few outward signs and palpable on vaginal examination

A

Supralevator abscesses

38
Q

Often a clue to these deeper abscesses

A

Tender inguinal adenopathy

39
Q

Is inflammation of the rectal mucosa

A

Proctitis

40
Q

Three types of rec- tal prolapse

A

(1) prolapse involving the rectal mucosa only
(2) prolapse involving all layers of the rectum (complete)
(3) intussusception of the upper rectum into and through the lower rectum so that the mucosal apex of the intussusception nearly extends to the anus (incomplete or internal)

41
Q

True or False

Rectal prolapse in children is generally mucosal and occurs more commonly in females less than 3 years old

A

False

Rectal prolapse in children is generally mucosal and occurs more commonly in males less than 3 years old

42
Q

True or False

Mucosal prolapse is believed to occur due to a lack of the natural sacral curve reducing the anorectal angulation

A

True

Mucosal prolapse is believed to occur due to a lack of the natural sacral curve reducing the anorectal angulation

43
Q

It is not a significant feature with complete prolapse, but abdominal or pelvic discomfort may be present

A

Pain

44
Q

A distinguishing feature between mucosal and complete prolapse

A

With complete prolapse, a sulcus may be palpated between the extruded bowel and anus, compared to no sulcus with a mucosal prolapse

45
Q

An effective technique for allowing for easier prolapse reduction

A

Application of granulated sugar over the entire prolapsed segment

46
Q

Where is the transitional zone seen?

A

At the level of the dentate line and extending approximately 1 cm proximal

47
Q

Malignancies of the portion proximal to the dentate line and including the transitional zone, which are referred to as

A

Anal canal neoplasms

48
Q

Tumors arising in the anoderm distal to the dentate line, which are referred to as

A

Anal margin neoplasms

49
Q

Anal margin neoplasms have a low-grade malignant potential and are slow to metastasize, with the exception of ____

A

Anal margin neoplasms have a low-grade malignant potential and are slow to metastasize, with the exception of melanoma

50
Q

The third most common site of malignant melanoma (after the skin and the eye)

A

Anal canal

51
Q

Arise from the rectal columnar epithelium, frequently produce clear, watery diarrhea and a profuse rectal discharge

A

Villous adenomas

52
Q

Any ulcer that fails to heal within ____ or any discrete skin lesion that fails to improve with appropriate therapy must be biopsied to rule out the presence of malignancy

A

Any ulcer that fails to heal within 30 days or any discrete skin lesion that fails to improve with appropriate therapy must be biopsied to rule out the presence of malignancy

53
Q

Most foreign bodies are in the ___

A

Ampulla

54
Q

Useful when the foreign body is radiolucent and for the detection of free air

A

CT scan

55
Q

The second most common anorectal condition after hemorrhoids

A

Pruritus ani

56
Q

Etiologic cause of pruritus

A

Staphylococci and Streptococci

57
Q

Common cause of anal pruritus in children

A

Pinworms (Enterobius vermicularis)

58
Q

True or False

Lumbosacral radiculopathy has been associated with idiopathic pruritus ani

A

True

Lumbosacral radiculopathy has been associated with idiopathic pruritus ani

59
Q

Provide a protective covering for the perianal skin and may promote healing in pruritus ani

A

Zinc oxide

60
Q

May be used as an effective bedtime sedative in patient with pruritus ani

A

Hydroxyzine hydrochloride may be used as an effective bedtime sedative

61
Q

An acquired problem formed by the penetration of the skin by an ingrown hair, which causes a foreign body granuloma reaction

A

Pilonidal sinus

62
Q

True or False

An abscessed pilonidal sinus is almost always located in the posterior midline over the sacrum and coccyx

A

True

An abscessed pilonidal sinus is almost always located in the posterior midline over the sacrum and coccyx

63
Q

True or False

Perineal disease is more common in females, whereas axillary disease is more common in males

A

False

Perineal disease is more common in males, whereas axillary disease is more common in females

64
Q

Fistulas that extend above the dentate line may suggest coexisting ____

A

Fistulas that extend above the dentate line may suggest coexisting cryptoglandular or Crohn’s disease

65
Q

Treatment for perianal hidradenitis suppurativa

A

Topical clindamycin or oral clindamycin with rifampin can be helpful

66
Q

Flatulence and/or malodorous vaginal discharge or gross stool ema- nating from the vagina

A

Rectovaginal fistula

Section 9: Gastrointestinal Disorders (17 decks)

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