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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

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2
Q

scoring that can be used for incontinence on defectation

A

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

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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

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4
Q

evacuation constipation vs transit

A 
evauction= obstructive so pelvic floor wont relax
transit= when there isn't enough propulsion
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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
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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
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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)

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8
Q

how are haemorrhoids graded

A

internal or external
size of prolapse
bleeding

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9
Q

what is an external haemorrhoid

A

swollen venous plexus that runs into the normal skin of anoderm

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10
Q

what is a fibroepithelial anal polyp

A

benign also called an anal skin tag

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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
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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

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13
Q

haemorrhoids management

A
  • high fibre diet
  • stop straining
  • rubber band ligation
  • open haemorrhoidectomy
  • stapled haemorrhoidectomy
  • doppler guided haemorrhoid artery ligation HALO
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14
Q

which surgical option is gold standard for haemorrhoids and why

A

open haemorrhoidectomy

pain for a fornight but good long term results

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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

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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

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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
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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
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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
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20
Q

what causes a chronic anal fissure

A

due to ischaemia secondary to internal sphincter spasm

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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

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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

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23
Q

what is anal sepsis

A

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

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24
Q

treatment of anal sepsis

A

antibiotics if minor but mostly surgical

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25
what is a fistula in ano
a neglected perianal sepsis causing an abnormal connection between anal canal and perianal skin
26
pathophysiology of anal sepsis
- 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
what is a perianal abscess and treatent
perianal=swelling on anal margin | -external incision and drainage
28
what is a ischioanal abscess and treatment
- between anal sphincter and ischium ie along - external red swelling next to anal canal - external incision and drain
29
what is an intersphincteric abscess
-submucosal of anal passagenext to internal sphincter -intense pain -temp and septic -need anaesthetic for exam -treatment drain into bowel
30
supraevator abscess
origin from pelvis or abdomen not assoc. to anorectal sepsis
31
what is an anal fistula
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
definition of a fistula
abnormal connection between 2 epithelised surfaces
33
symptoms of a fistula
- persistent intermittent swelling - discharge - red spot that weeps fluid a couple of cm from anal opening
34
surgery for fistula in ano
-CTONE insert rubber band tied externally to allow drainage and prevent abscess forming
35
what is a pilonidal sinus
hair nest infection - infection of a pilonidal sinus at the top of bottom cheeks possibly by a hair that gets stuck
36
who does pilonidal disease affect
- young males - jeep drivers - barbers/hairdressers
37
surgery for pilonidal disease
- 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
causes of rectal bleeding
- haemorrhoids - benign rectal polyps in older - ibd-uc - infection food poisoning
39
rectal prolapse m:f ratio
1:6
40
who are rectal prolapse assoc. too
pelvic floor problems uterine prolapse, obstetric trauma, previous hysterectomy -difficult labour causing damage to anal sphincter complex
41
clinical features of rectal prolapse
50% also have faecal incontince due to weak anal sphincter
42
2 types of rectal prolapse
-mucosal or -full thickness
43
what is a mucosal rectal prolapse
- big haemorrhoid - eccentric or circumferential - looks like small lumps - partial to the rectal mucosa
44
what is a full thickness rectal prolapse- who is more common in
- all the layers of the bowel wall - looks smoother - harder to pop back in and maintain continence - more common in elderly ladies
45
surgical treatment for complete prolapse
- abdominal rectopexy | - perineal rectopexy
46
reccurrnece vs operative risk for abdominal vs perineal rectopexy
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
definition of pneumoperitoneum and cause
air bubbles under the diaphragm | -perforated diverticular abscess
48
what is diveritculosis
presence of mucosal pouches/ herniation of colonic mucosa through muscle layers of colonic wall -no inflammation
49
what is diverticulitis
inflammation of these pouches
50
where does diverticular disease usually affect
between the taenia coli where vessels pierce the muscle to supply the mucosa
51
cause of diverticula
uknown | -constipation due to low fibre can increase pressure??
52
clinical presentation of diverticular and where does it normally affect
- left iliac fossa pain and tenderness= insidious onset | - systemic inflammatory response-high CRP
53
what does complicated vs uncomplicated diverticular mean
uncomplicated=inflammation of a segment usually of sigmoid colon complicated=perforated, abscess, fistula, stricture
54
diagnosis of diverticular
- CT | - endoscopic but risk of perforation
55
left iliac fossa pain think
diverticula??
56
treatment of diverticula
-fluid -antibiotics -fibre surgical
57
who with diverticula needs surgery
-infected and generalised peritonitis or septic shock if perforated possibly
58
what are the 4 hinchley classifications of diverticula
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
which hinchley classification definitely needs surgery
type IV
60
what operation is often used for diverticula
- 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
other operation that can be used for diverticula
laprascopic peritoneal lavage=wash out
62
what to do for an acute admission of diverticula
- exclude cancer so endoscopy 6-8 weeks after | - ct or flexible sigmoidoscopy
63
complications of diverticular disesae
- 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)

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