Clinical Surgery Flashcards
What management options are there for haemorrhoids before surgery
Conservative, aka lifestyle advice. Increased fiber, more exercise and less straining.
Simple procedures. Banding, sclerotherapy and cauterisation.
What is the most common cause of painless PR bleeding
Haemorrhoids
At what level in the anal canal is pain sensation lost
Dentate line
Where are haemorrhoids typically found
Left lateral, right anterior and right posterior
What are haemorrhoids made up of
Connective tissues, vascular anastomoses and smooth muscle
What are the surgical options in the management of haemorrhoids
Haemorrhoidectomy +/- plasty
What options are there for the management of anal fissures before surgery
Analgesia and lifestyle advices (increased fibre)
Stool softners
Topical GTN or second line diltiazem (smooth muscle relaxants)
Describe a sphincterotomy and how it is effective in managing anal fissures
A small incision roughly 1/3 trough the external sphincter is made opposite the site of the fissure. This relieves tension through the fissure and so reduces pain and damage and allows it to heal
How big is the external anal sphincter in women
Very thin anteriorly (less than 0.5cm) spreading to ~1cm posteriorly
What’s is TME in the context of rectal cancer
Total mesorectal excision. Designed to remove local tissues and lymph nodes to reduce local recurrence
What plane is used for TME
The holy plane
Describe the rectal mesentery
It is circumferential, but very thin anteriorly
