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Y3R6: Surgery I 👨‍⚕️ > L16: Benign Anorectal Conditions > Flashcards

L16: Benign Anorectal Conditions Flashcards

1
Q

Examples of Benign Anorectal Conditions

A
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2
Q

Anal Canal anatomy

A
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3
Q

Def of Haemorrhoids (Piles)

A

Engorged displaced anal cushions.

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4
Q

Anal cushion showing Treitz’s muscle contribution to anal pressure and maintain continence.

A

…

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5
Q

Etiology of Haemorrhoids (Piles)

A
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6
Q

Primary piles

A

▪ Hereditary congenital weakness of vein walls.

▪ Disruption of Treitz muscles due to chronic staining at stool.

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7
Q

Secondary piles

A

▪ Pregnancy.

▪ Cancer rectum.

▪ Obstruction of venous return from anal cushions.
(It has no relation to portal hypertension)

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8
Q

CP of Haemorrhoids

A
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9
Q

Symptoms of Haemorrhoids

A

▪ Bright red bleeding at the end of defecation.

▪ Prolapse

▪ Mucoid discharge and pruritus

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10
Q

Bleeding in Haemorrhoids

A

Bright red bleeding at the end of
defecation.

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11
Q

Do Haemorrhoids Cause Pain?

A

Uncomplicated piles are painless

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12
Q

Do Haemorrhoids Cause Anemia?

A

Piles rarely cause anemia

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13
Q

Grades of Haemorrhoids

A
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14
Q

Complications of Haemorrhoids

A
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15
Q

Strangulation in Haemorrhoids

A

Piles are painful, purple, tender,
and tense.

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16
Q

Thrombosis in Haemorrhoids

A

(after 12 h): Pain decreases, becomes solid, and marked edema of the anal margin develops.

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17
Q

Gangrene in Haemorrhoids

A

Rarely complicated by severe anorectal sepsis and portal pyemia

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18
Q

Thrombosed external piles

A
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19
Q

Pain in Thrombosed external piles

A

Sudden severe pain that peaks within 48 hours.

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20
Q

Characters of Thrombosed external piles

A

Purple black, tender, and tense perianal swelling.

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21
Q

TTT of Haemorrhoids (Piles)

A
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22
Q

TTT of Grade I & II Haemorrhoids (Piles)

A

Medical treatment for grade I & II and secondary piles.

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23
Q

TTT of Garde II & III Haemorrhoids (Piles)

A

Rubber band ligation (RBL) for grade II & III piles.

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24
Q

TTT of Grade III & IV Haemorrhoids (Piles)

A

Excision haemorrhoidectomy (EH) for grade III & IV piles or piles with skin tags

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25
Q

Other Modalities in TTT of Haemorrhoids (Piles)

A
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26
Q

Medical TTT of Haemorrhoids (Piles)

A
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27
Q

RBL in TTT of Hemorrhoids

A
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28
Q

In RBL, The band is applied to ….. above the pile.

A

mucosa

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29
Q

In RBL, Two piles can be ligated at the same time (repeated after 2 weeks).

A

..

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30
Q

In RBL, Sloughing occurs within …. days with slight bleeding.

A

7

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31
Q

RBL is as effective as EH for grade …. piles has higher recurrence (50 % versus 20 %) for grade …. piles

A

II - III

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32
Q

RBL is Contraindicated in patients with ……

A

bleeding tendency

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33
Q

Revise Picture of Modalites used in TTT of Hemorrhoids

A

…

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34
Q

What is the gold standard in TTT of Piles?

A

Excision haemorroidectomy

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35
Q

RR in Excision haemorroidectomy

A

Lowest recurrence rate for grade III & IV piles (20%)

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36
Q

Pain & Excision haemorroidectomy

A

Associated with sever postoperative pain

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37
Q

Methods of Excision haemorroidectomy

A
38
Q

Complications of Excision haemorroidectomy

A

Bleeding, incontinence to flatus, anal stenosis, pain

39
Q

Algorithm of TTT of Piles

A
40
Q

Management of strangulated piles

A
41
Q

Managment of Thrombosed external piles

A

− < 48 h: Evacuation under local anesthesia.

− > 48 h: Hot sitz baths and stool softners.

42
Q

def of Anal Fissure

A

A longitudinal tear in the anoderm in the anterior or posterior midline.

43
Q

Types of Anal Fissure

A

Can be acute or chronic (recurrent or persisting for > 6 ws).

44
Q

Etiology of Anal Fissure

A
45
Q

Causes of Idiopathic anal fissure

A

▪ Forceful dilatation of the anal canal by a firm stool.

▪ It persists due to pain induced spasm of the internal sphincter leading to mucosal ischemia.

46
Q

Causes of Specific anal fissure

A

perianal Crohn’s disease and sexually transmitted diseases.

47
Q

CP of Anal fissure

A
48
Q

Incidence of Anal fissure

A
  • It is common in young adult females.
  • It is not rare in infants and children.
49
Q

Pain in Anal fissure

A

Pain: Sharp and lasts for few hours.

50
Q

Examination of Anal fissure shows ….

A
51
Q

Characters of Specific anal fissure

A

▪ Ulcers with little pain, or non-healing.

▪ Ulcers off the midline or not related to the dentate line.

52
Q

TTT of anal fissure

A
53
Q

Aim in TTT of anal fissure

A

Complete relaxation of the internal
sphincter.

54
Q

Medical TTT of anal fissure

A
55
Q

Botox in TTT of anal fissure

A

temporary paralysis for internal
sphincter to allow healing.

56
Q

Partial internal sphincterotomy in TTT of Anal Fissure

A

When medical treatment fails or for recurrent or chronic anal fissure.

57
Q

def of Chronic anal fissure

A

persistent for > 1 month or with sentinel pile

57
Q

Complications of Partial internal sphincterotomy

A

Can cause permanent incontinence to flatus in 5 % of cases.

58
Q

Algorithm in TTT of Anal Fissure

A
59
Q

Types of Rectal Prolapse

A

1- Internal rectal prolapse.
2- External (complete) rectal prolapse.

60
Q

Def of Internal rectal prolapse

A
  • Prolapse of the proximal rectum into rectal lumen during straining at defecation.
61
Q

Grades of rectal prolapse

A
62
Q

CP of Internal rectal prolapse

A
63
Q

Investigations for Internal rectal prolapse

A
64
Q

TTT of Internal rectal prolapse

A
  1. Stapled transanal rectal resection (STARR).
  2. Ventral mesh rectopexy
65
Q

Def of Complete rectal prolapse

A
  • Protrusion of all layers of the rectal wall outside the
    anus.
  • Considered the end stage of rectal intussusception or internal rectal prolapse.
66
Q

Pathological Anatomy of Complete rectal prolapse

A

− It is more common in old females usually associated with uterine prolapse.

− In the Middle East it is more common in young males.

67
Q

Symptoms of Complete rectal prolapse

A
68
Q

Findings of Complete rectal prolapse on Examination

A
69
Q

Compare between Partial & Complete Rectal Prolapse in terms of

  • Incidence
  • Age
  • Layers
  • Length
  • Muscosa
  • Thickness
  • Contents
  • Continence
A
70
Q

TTT of Rectal Prolaspse

A
71
Q

TTT of Rectal Prolaspse

  • Abdominal Procedure
A

a) Posterior rectopexy:
1) Well’ operation.
2) Repstein operation.
3) Suture rectopexy.
4) Resection rectopexy.

b) Ventral mesh rectopexy

72
Q

TTT of Rectal Prolaspse

  • Perineal Procedure
A

a) Delorme`s operation.

b) Altemeier’s operation (perineal rectosigmoidectomy).

c) Stapled transanal rectal resection (STARR).

d) Thiersch’s operation.

73
Q

Adv & Disadv of Abdominal procedures for rectal prolapse

A

Less recurrence but risk of injury to pelvic nerves and higher postoperative complication.

74
Q

Adv & Disadv of Perineal procedures for rectal prolapse

A

More safe but have more recurrence.

75
Q

What are other perineal procedures for rectal prolapse?

A

− STARR: Perineal proctectomy using staplers.

− Thiersch’s operation: Purse string narrowing of the anus around the index finger.

76
Q

Procedure of Posterior rectopexy

A
  1. Complete mobilization of the rectum.
  2. Rectum fixed to the sacrum by a mesh (e.g. Well s operation & Repstein s operation) or sutures (suture rectopexy).
  3. Sigmoid resection can be added to suture rectopexy (resection rectopexy).
77
Q

SE of Posterior rectopexy

A

▪ Recurrence: 5%

▪ Constipation: 70%

▪ Incontinence: improves in 70% of cases after several methos.

78
Q

Procedure of Ventral mesh rectopexy

A
  1. Anterior dissection of the rectum till the pelvic floor.
  2. A mesh strip is fixed to the rectum and sacral promontory.
79
Q

Advantages of Ventral mesh rectopexy

A

Avoids lateral dissection of the rectum so there is no postoperative constipation

80
Q

Procedure of Delorme`s operation

A
  1. Excision of the mucosa covering the prolapsed part.
  2. Longitudinal plication of the muscular rectal wall.
  3. Mucosa to mucosa sutures.
81
Q

Disadvantages of Delorme`s operation

A

Recurrence: At least 20%.
▪ Safe operation.
▪ Constipation and incontinence improve.

82
Q

Procedure of Altemeier`s operation

A
  1. Full thickness excision of the prolapsed rectum.
  2. Coloanal anastomosis.
83
Q

SE of Altemeier`s operation

A

▪ Recurrence: 10%.
▪ Mortality: < 5%.

▪ Patient complains of low anterior resection syndrome. (Frequency − Urgency)

84
Q

The gold standard was ……

A

was posterior rectopexy then ventral mesh rectopexy

85
Q

Resection rectopexy: when there is associated slow transit

A

..

86
Q

Perineal procedures reserved for elderly patients with comorbidities, young males, and children.

A

..

87
Q

STARR: in small rectal prolapse or internal rectal prolapse.

A

..

88
Q

Thiersch’s operation: For frail patients.

A

..

89
Q

Postanal repair for patients with incontinence.

A

..

90
Q

Done

A

..

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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