Noncancerous diseases of anus and rectum Flashcards
Surgical treatment that is first line for rectal prolapse:
sigmoidectomy with suture rectopexy
Surgical treatment for patient’s with rectal prolapse who cannot tolerate an abdominal operation:
Altemeier (perineal rectosigmoidectomy) and Delorme
The anal canal is lined by what cell type above the dentate line and receives blood supply from what? Where do lymphatics drain?
columnar epithelium
superior rectal artery (branch of the IMA); lymphatics drain to paraaortic nodes
The anal canal is lined by what cell type below the dentate line and receives blood supply from what ? Where do lymphatics drain?
squamous epithelium
inferior rectal artery (branch of internal pudendal artery); lymphatics drain to inguinal nodes
What is PAGET’s disease of the anus associated with?
hidden GI malignancy. should always get a colonoscopy
Treatment of horeshoe abscess:
Modified Hanley procedure: posterior internal sphincterotomy with or without seton placement and counter incisions in the bilateral ischioanal fossa
Anal margin squamous cell carcinoma management:
wide local incision with margin of 1 cm for lesions <2cm
Combined rectal and uterine prolapse treatment:
combined rectopexy with sacrocolpopexy
Treatment of pelvic sepsis after hemorrhoidal banding:
proceed to OR for debridement and drainage
What study should be performed for a patient with rectal prolapse prior to considering surgery?
colonoscopy
After Nigro protocol for anal cancer what is the surveillance pattern?
initial exam 8-12 weeks after chemo/rads then every 6-8 weeks until regression of suspicious lesions
Where should the band be placed for rubber band ligation of a hemorrhoid?
mucosa only, 2 cm above dentate line
First step in treatment of fecal incontinence:
lifestyle modification: bulking agents, biofeedback etc
Innervation of internal anal sphincter:
L5-S4, involuntary
Innervation of external anal sphincter:
internal pudendal nerve, voluntary
Symptoms of gonococcal proctitis:
anal burning; anoscopy will show inflammation of anorectal mucosa with purulent discharge at dentate line
Inclusion criteria for transanal excision of a rectal cancer:
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
Lateral anal fissures unlike midline fissures are more likely to be associated with what?
malignancy; they should be biopsied
Treatment of rectal prolapse in patient with multiple comorbidities at elevated risk of perioperative complications:
perineal rectosigmoidectomy
treatment of rectal prolapse in good surgical candidates:
minimally invasive rectopexy with sigmoidectomy
Next diagnostic test for patients with fecal incontinence who fail conservative management:
endoanal ultrasound or MRI to assess for anatomic sphincter defects
Diagnosis of fecal incontinence in patients who fail conservative management:
endoanal ultrasound or MRI to assess for anatomic sphincter defects
First step in management of a rectal prolapse:
attempt manual reduction
Management of rectal varices:
treat portal hypertension; avoid hemorrhoidal procedures
True or false. In draining a perirectal abscess, I&D should be performed as far from the anal verge as possible.
False. as close to the anal verge as possible to limit length of a developing fistula tract
Where should a lateral sphincterotomy be performed?`
right lateral position between the anterior and posterior hemorrhoid columns
Treatment of pelvic sepsis:
emergent debridement and drainage in OR; presents with delayed pain, urinary retention, and fever
Topical treatment of anal condyloma that can be performed at home:
podofilox
Most common complication of hemorrhoidectomy:
urinary retention
Internal anal sphincter innervation:
L5-S4; involuntary
Presentation of gonoccoccal or chlamydial proctitis:
severe anal pain with purulent discharge; anoscopy shows erythema, edema, purulence of rectal mucosa
True or false. Lateral anal fissures are suspicious for malignancy and should be biopsied.
True
When is anal sphincteroplasty contraindicated?
cases of fecal incontinence with intact sphincter mechanism
Treatment of persistent anal cancer 6 months after Nigro protocol
PET scan and salvage APR
True or false. Neoadjuvant chemoradiotherapy is indicated for all stage 2 and 3 rectal cancer
true
Procedure of choice for fecal incontinence with sphincter defect
overlapping sphincteroplasty
What can lead to a nonhealing fissure after treatment?
inadequate sphincter division
Where does anal condyloma reside
epidermis
treatment of high grade squamous intraepithelial neoplasia of anus:
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
True or false. stapled hemorrhoidectomy has a higher recurrence rate than open hemorrhoidectomy
true
Treatment of anaphylaxis (medication):
intramuscular epinephrine 0.3 mg (1:1000) or intravenous epinephrine 0.05 (1:10000)
