Noncancerous diseases of anus and rectum

Question 1

Surgical treatment that is first line for rectal prolapse:

Answer 1

sigmoidectomy with suture rectopexy

Question 2

Surgical treatment for patient’s with rectal prolapse who cannot tolerate an abdominal operation:

Answer 2

Altemeier (perineal rectosigmoidectomy) and Delorme

Question 3

The anal canal is lined by what cell type above the dentate line and receives blood supply from what? Where do lymphatics drain?

Answer 3

columnar epithelium

superior rectal artery (branch of the IMA); lymphatics drain to paraaortic nodes

Question 4

The anal canal is lined by what cell type below the dentate line and receives blood supply from what ? Where do lymphatics drain?

Answer 4

squamous epithelium

inferior rectal artery (branch of internal pudendal artery); lymphatics drain to inguinal nodes

Question 5

What is PAGET’s disease of the anus associated with?

Answer 5

hidden GI malignancy. should always get a colonoscopy

Question 6

Treatment of horeshoe abscess:

Answer 6

Modified Hanley procedure: posterior internal sphincterotomy with or without seton placement and counter incisions in the bilateral ischioanal fossa

Question 7

Anal margin squamous cell carcinoma management:

Answer 7

wide local incision with margin of 1 cm for lesions <2cm

Question 8

Combined rectal and uterine prolapse treatment:

Answer 8

combined rectopexy with sacrocolpopexy

Question 9

Treatment of pelvic sepsis after hemorrhoidal banding:

Answer 9

proceed to OR for debridement and drainage

Question 10

What study should be performed for a patient with rectal prolapse prior to considering surgery?

Answer 10

colonoscopy

Question 11

After Nigro protocol for anal cancer what is the surveillance pattern?

Answer 11

initial exam 8-12 weeks after chemo/rads then every 6-8 weeks until regression of suspicious lesions

Question 12

Where should the band be placed for rubber band ligation of a hemorrhoid?

Answer 12

mucosa only, 2 cm above dentate line

Question 13

First step in treatment of fecal incontinence:

Answer 13

lifestyle modification: bulking agents, biofeedback etc

Question 14

Innervation of internal anal sphincter:

Answer 14

L5-S4, involuntary

Question 15

Innervation of external anal sphincter:

Answer 15

internal pudendal nerve, voluntary

Question 16

Symptoms of gonococcal proctitis:

Answer 16

anal burning; anoscopy will show inflammation of anorectal mucosa with purulent discharge at dentate line

Question 17

Inclusion criteria for transanal excision of a rectal cancer:

Answer 17

T1 tumor, mobile, <3cm size, well to moderately differentiated, absence of lymphovascular or perineural invasion; no lymphadenopathy on pretreatment imaging; lesion within 8cm of anal verge, <30% circumferential involvement

Question 18

Lateral anal fissures unlike midline fissures are more likely to be associated with what?

Answer 18

malignancy; they should be biopsied

Question 19

Treatment of rectal prolapse in patient with multiple comorbidities at elevated risk of perioperative complications:

Answer 19

perineal rectosigmoidectomy

Question 20

treatment of rectal prolapse in good surgical candidates:

Answer 20

minimally invasive rectopexy with sigmoidectomy

Question 21

Next diagnostic test for patients with fecal incontinence who fail conservative management:

Answer 21

endoanal ultrasound or MRI to assess for anatomic sphincter defects

Question 22

Diagnosis of fecal incontinence in patients who fail conservative management:

Answer 22

endoanal ultrasound or MRI to assess for anatomic sphincter defects

Question 23

First step in management of a rectal prolapse:

Answer 23

attempt manual reduction

Question 24

Management of rectal varices:

Answer 24

treat portal hypertension; avoid hemorrhoidal procedures

Question 25

True or false. In draining a perirectal abscess, I&D should be performed as far from the anal verge as possible.

Answer 25

False. as close to the anal verge as possible to limit length of a developing fistula tract

Question 26

Where should a lateral sphincterotomy be performed?`

Answer 26

right lateral position between the anterior and posterior hemorrhoid columns

Question 27

Treatment of pelvic sepsis:

Answer 27

emergent debridement and drainage in OR; presents with delayed pain, urinary retention, and fever

Question 28

Topical treatment of anal condyloma that can be performed at home:

Answer 28

podofilox

Question 29

Most common complication of hemorrhoidectomy:

Answer 29

urinary retention

Question 30

Internal anal sphincter innervation:

Answer 30

L5-S4; involuntary

Question 31

Presentation of gonoccoccal or chlamydial proctitis:

Answer 31

severe anal pain with purulent discharge; anoscopy shows erythema, edema, purulence of rectal mucosa

Question 32

True or false. Lateral anal fissures are suspicious for malignancy and should be biopsied.

Answer 32

True

Question 33

When is anal sphincteroplasty contraindicated?

Answer 33

cases of fecal incontinence with intact sphincter mechanism

Question 34

Treatment of persistent anal cancer 6 months after Nigro protocol

Answer 34

PET scan and salvage APR

Question 35

True or false. Neoadjuvant chemoradiotherapy is indicated for all stage 2 and 3 rectal cancer

Answer 35

true

Question 36

Procedure of choice for fecal incontinence with sphincter defect

Answer 36

overlapping sphincteroplasty

Question 37

What can lead to a nonhealing fissure after treatment?

Answer 37

inadequate sphincter division

Question 38

Where does anal condyloma reside

Answer 38

epidermis

Question 39

treatment of high grade squamous intraepithelial neoplasia of anus:

Answer 39

SCC in situ; WLE with 4mm margin for small isolated lesions for larger lesions treatment with radiotherapy, photodynamic therapy, cryotherapy, currettage with cautery, laser or imiquimod

Question 40

True or false. stapled hemorrhoidectomy has a higher recurrence rate than open hemorrhoidectomy

Answer 40

true

Question 41

Treatment of anaphylaxis (medication):

Answer 41

intramuscular epinephrine 0.3 mg (1:1000) or intravenous epinephrine 0.05 (1:10000)