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Year 3 Surgery block > Gen Surg: Anal fistulas, abscesses, fissures and cysts > Flashcards

Gen Surg: Anal fistulas, abscesses, fissures and cysts Flashcards

1
Q

What isa perianal fistula?

A

Abnormal connection between the anal canal and perianal skin

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2
Q

What is the relationship between anorectal abscess and perianal fistula

A

Around 25-40% of abcesses lead to fistular formation

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3
Q

What is an anorectal abscess?

A

Collection of pus in the anal or rectal region

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4
Q

Who is most affected by anorectal abscesses

A

20-60 y/o
Men

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5
Q

What are the causes of anorectal abscess?

A

Infection in cyrptoglandular epilithelium
Crohns

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6
Q

How would a patient with anorectal abscess present

A

Severe throbbing or stabbing pain, localised swelling, itching or discharge
fever, malaise, constipation , bleeding

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7
Q

What are the sites for anorectal abcesses

A

Supralevator
Ischiorectal
Ischiosphincteric
Perianal

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8
Q

What is the most common site of an anorectal abcess

A

Perianal

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9
Q

What would you find on examination of a perianal abscess

A

Erythematous, fluctuant, tender perianal mass.

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10
Q

How do you a treat a perianal abscess?

A

Incision and draining, either using a cruciate or elliptical incision. Then proctoscopy should be performed to check for fistula

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11
Q

When would you prescribe IV antibiotics for an anorectal abscess

A

I.v antibiotics indicated in the following situations:
Immunosuppressants
Valvular heart disease
Prosthetic devices
Sepsis or extensive cellulitis
Crohns disease

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12
Q

What are the risk factors for perianal fistula ?

A

IBD
Systemic diseases
History of trauma
Previous radiation therapy

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13
Q

What is a complex perianal fistula?

A

above or passing through the external sphincter, involving > 30%

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14
Q

How does a perianal fistula present?

A

Hx of recurrent abscess
leaking faeces
Pain

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15
Q

What would you see on examination of an anorectal fistula

A

External opening visible
Erythema
Proctoscopy–> internal opening

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16
Q

What is the Goodsall rule?

A

If the external opening is posterior to the transverse anal line, the fistula tract will follow a curved course to the posterior midline

If the external opening is anterior to the transverse anal like, the fistula tract will be in a straight line to the denate line

17
Q

Where are the sites of anorectal fistula?

A

Extrasphincteric
Suprasphincteric
Transsphincteric
Intersphincteric
Submucosal

18
Q

What sites of anorectal fistula are simple and which are complex

A

Simple- intersphincteric and low-lying transsphincteric, submucosal

Complex- Suprasphincteric
Extrasphincteric or high fistulas
Fistulas with multiple tracts
Recurrent fistulas
Fistulas related to IBD, infection or radiation

19
Q
A
19
Q

What is a simple anorectal fistula

A

minimal or no involvement of external sphincter or puborectalis

20
Q

How do you treat a simple anorectal fistula?

A

Fistulotomy (laying it open)

21
Q

How do you treat a complex anorectal fistula?

A

Placement of a seton through the fistula attempts to bring together and close the tract

22
Q

What are the risk factors for anal fissures?

A

Constipation and pregnancy (particularly in 3rd trimester and delivery)

23
Q

How do you manage anal fissures?

A

Treatment of constipation- laxatives/fibre in diet
Topical analgesics- lidocaine cream/jelly
Topical vasodilators- nifedipine or nitroglycerine

Second line treatment incl topical CCB (diltiazem)

24
Q

What conditions increase risk of anal carcinoma?

A

HPV, Chrons, HIV

25
Q

Why is opiate analgesia a RF for anal fissures?

A

Opiates cause constipation —> stool is hard and patient will strain —> increases the risk of tearing skin of anal canal

26
Q

How do anal fissures present?

A

Pain on defecation - passing shards of glass. Bleed bright red on loo roll.

27
Q

How des anal cancer present?

A

Pain, bleeding, anal discharge, pruritus, palpable mass, increasing pt age, incontience or tenesmus

28
Q

What may you ask a pt about if you suspect anal cancer? (RF)

A

HPV infection in past - 16 and 19. Smoking. Immunosuppresision. Immunosuppressive drugs, hx of cancer, older age, many sexual partners, Chrons

29
Q

Treatment of chronic anal fissure?

A

Topical glyceryl trinitrate

Year 3 Surgery block (66 decks)

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