Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

gastrointestinal > diverticulitis and anorectal disease > Flashcards

diverticulitis and anorectal disease Flashcards

1
Q

difference between melena and bright red rectal bleeding

A

melena=foul smelling & dark from upper GI bleed

bright red=lower GI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

scoring that can be used for incontinence on defectation

A

wexner score
-urgency
passive: soiles themselves
constipation/ overflow diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does digitation mean

A

if have a problem with evacuation so put a finger anally or vaginally to try and support pelvic floor to help them go

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

evacuation constipation vs transit

A 
evauction= obstructive so pelvic floor wont relax
transit= when there isn't enough propulsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is prolapse

A

when something comes out of the anal canal so ask if

  • can be pushed back in
  • will go back on its own
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how should the anus be examined

A
  • at rest and on straining for prolapse
  • scars and distortion
  • discharge
  • prolapse
  • blood
  • anal fissure
  • dre
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are haemorrhoids

A

internal venous plexus above and below the dentate line

-dilation of the venous plexus causing prolapse of the anal canal (outside the body)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how are haemorrhoids graded

A

internal or external
size of prolapse
bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is an external haemorrhoid

A

swollen venous plexus that runs into the normal skin of anoderm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is a fibroepithelial anal polyp

A

benign also called an anal skin tag

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

clinical features of haemorrhoids

A
  • bleeding: bright red on toilet paper
  • discomfort
  • prolapse
  • mucous discharge causing pruritus
  • thrombosis if strain excessively, acute pain and swollen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what would be suspected in an >50 year old with new bleeding vs <30 and no phx of haemorrhoids

A

> 50 with no phx of haemorrhoids exclude possible lesion

<30 probably haemorrhoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

haemorrhoids management

A
  • high fibre diet
  • stop straining
  • rubber band ligation
  • open haemorrhoidectomy
  • stapled haemorrhoidectomy
  • doppler guided haemorrhoid artery ligation HALO
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

which surgical option is gold standard for haemorrhoids and why

A

open haemorrhoidectomy

pain for a fornight but good long term results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how does a doppler guided haemorrhoid artery ligation work

A

works out where feeding vessels are and over sew above the area of skin sensation
-less painful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

issues with rubber band ligation

A

-opd
-simple put a band over
-common
but not effective unless for minor bleeding and can get severe pain if put on too low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

complictions of haemorrhoids

A
  1. prolapsed thrombosed haemorrhoid
    - bleeding and engorged vessels
    - tissue thrombosed outside
    - pain
    - analegesia, ice and bed rest
  2. perianal haematoma
    - injection local anaesthetic and evacuation of clot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is an anal fissure

A

a linear tear in the anoderm often follows an episode of constipation/ defecation

  • knife like pain
  • prolonged pain
  • bright red bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

clinical diagnosis of an anal fissure

A

diff dx if haemorrhoids but if above symptoms and no lump

  • don’t tolerate dre so get patient to strain and part buttocks to see
  • or use an anaesthetic to do this
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what causes a chronic anal fissure

A

due to ischaemia secondary to internal sphincter spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

treatment of anal fissure

A
  • aim to reduce sphincter tone due to spasm in internal sphincter which can reduce healing
  • GTN glyceryl trinitrate-headache se
  • dilatiazem cream: muscle relax
  • botox injection

surgical
-lateral internal spincterotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how does a lateral internal spincterotomy work and adverse and who is it effective and not effective in

A

reduces tone but cutting the internal sphincter
-once cut can alter continence as loose control

effective in young males with chronic scarring but not in women with narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is anal sepsis

A

acute onset of perianal pain assoc. to swelling arising from the anal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

treatment of anal sepsis

A

antibiotics if minor but mostly surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is a fistula in ano

A

a neglected perianal sepsis causing an abnormal connection between anal canal and perianal skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

pathophysiology of anal sepsis

A
  • anal glands lie between the internal and external sphincter
  • ducts open to anal canal
  • ducts get blocked leading to sepsis and infection in the anal canal
  • cause formation of abscesses
27
Q

what is a perianal abscess and treatent

A

perianal=swelling on anal margin

-external incision and drainage

28
Q

what is a ischioanal abscess and treatment

A
  • between anal sphincter and ischium ie along
  • external red swelling next to anal canal
  • external incision and drain
29
Q

what is an intersphincteric abscess

A

-submucosal of anal passagenext to internal sphincter
-intense pain
-temp and septic
-need anaesthetic for exam
-treatment
drain into bowel

30
Q

supraevator abscess

A

origin from pelvis or abdomen not assoc. to anorectal sepsis

31
Q

what is an anal fistula

A

residual abnormality left in some patients in which the perianal sepsis has been drained

  • origin anal canal ducts
  • internal opening and then fistula from whole draining
32
Q

definition of a fistula

A

abnormal connection between 2 epithelised surfaces

33
Q

symptoms of a fistula

A
  • persistent intermittent swelling
  • discharge
  • red spot that weeps fluid a couple of cm from anal opening
34
Q

surgery for fistula in ano

A

-CTONE insert rubber band tied externally to allow drainage and prevent abscess forming

35
Q

what is a pilonidal sinus

A

hair nest
infection
- infection of a pilonidal sinus at the top of bottom cheeks possibly by a hair that gets stuck

36
Q

who does pilonidal disease affect

A
  • young males
  • jeep drivers
  • barbers/hairdressers
37
Q

surgery for pilonidal disease

A
  • simple drainage of abscess
  • elective surgery
  • excision and healing
  • exicion and primary closure
  • karydakis flap
  • limberg flap
  • cleft closure

none have great success rate

38
Q

causes of rectal bleeding

A
  • haemorrhoids
  • benign rectal polyps in older
  • ibd-uc
  • infection food poisoning
39
Q

rectal prolapse m:f ratio

A

1:6

40
Q

who are rectal prolapse assoc. too

A

pelvic floor problems
uterine prolapse, obstetric trauma, previous hysterectomy
-difficult labour causing damage to anal sphincter complex

41
Q

clinical features of rectal prolapse

A

50% also have faecal incontince due to weak anal sphincter

42
Q

2 types of rectal prolapse

A

-mucosal
or
-full thickness

43
Q

what is a mucosal rectal prolapse

A
  • big haemorrhoid
  • eccentric or circumferential
  • looks like small lumps
  • partial to the rectal mucosa
44
Q

what is a full thickness rectal prolapse- who is more common in

A
  • all the layers of the bowel wall
  • looks smoother
  • harder to pop back in and maintain continence
  • more common in elderly ladies
45
Q

surgical treatment for complete prolapse

A
  • abdominal rectopexy

- perineal rectopexy

46
Q

reccurrnece vs operative risk for abdominal vs perineal rectopexy

A

abdominal

  • low recurrence rate
  • high operative risk as either open or laparscopic using mesh

perineal

  • high recurrence rate
  • low operative risk
  • delorme’s/ altemeier’s
47
Q

definition of pneumoperitoneum and cause

A

air bubbles under the diaphragm

-perforated diverticular abscess

48
Q

what is diveritculosis

A

presence of mucosal pouches/ herniation of colonic mucosa through muscle layers of colonic wall
-no inflammation

49
Q

what is diverticulitis

A

inflammation of these pouches

50
Q

where does diverticular disease usually affect

A

between the taenia coli where vessels pierce the muscle to supply the mucosa

51
Q

cause of diverticula

A

uknown

-constipation due to low fibre can increase pressure??

52
Q

clinical presentation of diverticular and where does it normally affect

A
  • left iliac fossa pain and tenderness= insidious onset

- systemic inflammatory response-high CRP

53
Q

what does complicated vs uncomplicated diverticular mean

A

uncomplicated=inflammation of a segment usually of sigmoid colon
complicated=perforated, abscess, fistula, stricture

54
Q

diagnosis of diverticular

A
  • CT

- endoscopic but risk of perforation

55
Q

left iliac fossa pain think

A

diverticula??

56
Q

treatment of diverticula

A

-fluid
-antibiotics
-fibre
surgical

57
Q

who with diverticula needs surgery

A

-infected and generalised peritonitis or septic shock if perforated possibly

58
Q

what are the 4 hinchley classifications of diverticula

A

1.=abscess confined to small pericolic abscess ie on outside of colon
2.=intra-abdominal means large abscess stretch into abdomen
3=free intra-peritoneal pus
4=faecal peritonitis

59
Q

which hinchley classification definitely needs surgery

A

type IV

60
Q

what operation is often used for diverticula

A
  • Hartman’s operation so take out the sigmoid colon and/or the rectum
  • bring out part of bowel to make a colostomy
  • can later do a reversal colostomy but often incontinence
  • or a primary anastomosis but unusual due to leak risk
61
Q

other operation that can be used for diverticula

A

laprascopic peritoneal lavage=wash out

62
Q

what to do for an acute admission of diverticula

A
  • exclude cancer so endoscopy 6-8 weeks after

- ct or flexible sigmoidoscopy

63
Q

complications of diverticular disesae

A
  • diverticulitis
  • haemorrhage
  • development of a fistula eg colovesical bubbles in urine
  • perforation and faecal peritonitis
  • perforation and development of an abscess
  • development of diverticular phlegmon

gastrointestinal (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions