IGNORE AFTER THIS [31] Anorectal Abscess Flashcards

1
Q

What is an anorectal abscess?

A

A collection of pus in the anal or rectal region

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2
Q

Which gender are anorectal abscesses more common in?

A

Men

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3
Q

What are anorectal abscesses thought to be caused by?

A

Plugging of the anal ducts

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4
Q

What are the anal ducts?

A

Structures found in the wall of the anal canal which drain the anal glands

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5
Q

What do the anal ducts do?

A

Secrete mucus into the anal canal to ease the passage of faecal matter

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6
Q

What does blockage of the anal ducts cause?

A

Stasis

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7
Q

What does stasis caused by the blockage of the anal ducts allow?

A

Normal bacterial flora to overgrow, leading to infection

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8
Q

What are the common causative organisms for infection in anorectal abscesses?

A

E. Coli
Bacteroides
Enterococcus

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9
Q

Where are the anal glands located?

A

In the intersphincteric space

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10
Q

What is the intersphincteric space?

A

The space between the internal and external anal sphincters

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11
Q

What can happen once infection has started in the anal glands?

A

Infection can spread to adjacent areas

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12
Q

What can anorectal abscesses be classified on the basis of?

A

Where they occur

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13
Q

What are the classifications of anorectal abscesses?

A

Perianal
Ischiorectal
Intersphincteric
Supralevator

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14
Q

What course do anorectal abscesses take?

A

They are typically intermittent in nature

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15
Q

How do anorectal abscesses present?

A

Pain in perianal region, which is exacerbated when sitting down
Localised swelling, itching, or discharge

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16
Q

What symptoms might be caused by severe anorectal abscesses?

A

Systemic features, such as fever, rigors, general malaise, or sepsis

17
Q

What will be found on examination in anorectal abscess?

A

The abscess will be red and tender, and may be discharging purulent or haemorrhagic fluid
Likely be some degree of surrounding cellulitis

18
Q

How is a diagnosis of superficial anorectal abscess made?

A

Clinically

19
Q

What will DRE often reveal in anorectal abscesses?

A

Fluctuant tender mass

20
Q

What is the limitation of DRE in anorectal abscess?

A

Many patients cannot tolerate this, and require examination under anaesthesia

21
Q

What investigation might complicated or chronic anorectal abscesses require?

A

Imaging, typically MRI

22
Q

Which anorectal abscess patients are systemic features more likely to occur in?

A

Patients who are immunocompromised

Those with ischiorectal abscesses

23
Q

Why is there little room for conservative management of anorectal abscesses?

A

As they have high rates of recurrence and the development of fistulae

24
Q

What is the role of antibiotics in anorectal abscesses?

A

Antibiotics may be utilised initially for acute infective states, especially in diabetes or immunocompromised patients, but should not be used routinely

25
Q

What is the main management of anorectal abscesses?

A

Surgical drainage

26
Q

Is surgical drainage of an anorectal abscess typically performed under local or general anaesthesia?

A

General

27
Q

Why should drainage of an anorectal abscess be performed in a timely manner?

A

To prevent tissue damage, including anal sphincter dysfunction

28
Q

How do anorectal abscesses heal following drainage?

A

Secondary intention

29
Q

Should there ever be an attempt for early closure of an anorectal abscess?

A

It is not advised

30
Q

What may be considered by experienced surgeons in anorectal abscesses?

A

The insertion of a seton

31
Q

When is the insertion of a seton performed in anorectal abscess?

A

Typically only if the tract is identifiable with minimal probing