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FFP Abdominal pain and PR bleeding > Perianal disease > Flashcards

Perianal disease Flashcards

1
Q

What is the dentate line

A

When the mucosa gathers into longitudinal folds which contain anal glands (Secrete mucus)

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2
Q

What is above the dentate line derived from

A

Embryological hindgut

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3
Q

What is below the dentate line derived from

A

Ectoderm

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4
Q

What is the epithelium above the dentate line

A

Columnar epithelium

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5
Q

What is the epithelium below the dentate line

A

Non keratinising squamous epithelium

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6
Q

What is the epithelium in the anal verge

A

Keratinizing squamous epithelium

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7
Q

Blood supply above dentate line

A

Superior rectal artery/vein (derived from IMA)

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8
Q

Blood supply below dentate line

A

Inferior rectal artery/vein (derived from internal pudendal artery)

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9
Q

Lymphs above dentate line

A

Internal iliac lymph nodes

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10
Q

Lymphs below dentate

A

Superficial inguinal lymph nodes

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11
Q

Nervous innervation above dentate line and presentation

A

Inferior hyper gastric plexus (stretch ulnae)

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12
Q

Nervous innervation below dentate line and presentation

A

Pudendal nerve (pain, temp, touch and pressure)

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13
Q

Lications of anal cushions

A

3 o clock
7 o clock
11 o’clock

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14
Q

What is a haemorrhoid

A

Abnormal swelling and vascular engorgement of normal anal cushions

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15
Q

Investigations with presentations

A

DRE exam

Protoscopy (for internal haemorrhoids)

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16
Q

What is a anal fissure

A

Longitudinal tear in the anal canal mucosa

17
Q

Where do anal fissures usually present

A

6 o’clock

12 oclock

18
Q

What are anal fissures associated with

A

Constipation

Crohns

19
Q

Symptoms of anal fissures

A

Severe pain post defecation
Fresh red bleeding
Itching
PR excruciation

20
Q

Exam findings of anal fissure

A

Break or ulcer in the mucosa

21
Q

Acute management of anal fissure

A

Dietery modification

Laxatives, instillagel and topical diltiazem or GTN cream

22
Q

Chronic management of anal fissure

A

Examination under anaesthesia and injection of botox (relaxes)

Lateral sphincterotomy

23
Q

What is a peri anal abscess

A

Collection of pus in anal region

24
Q

Pathology of peri anal abscess

A

Cyryptoglandular infection

Bacterial overgrowth

Usually e.coli, bactericides spp. And enterococcus spp

25
Q

Presentation of perianal abscess

A

Painful, hot, red lump in perianal region

Discharging pf pus

Sepsis

26
Q

What investigations may some patients require with PA abscess

A

CT or MRI

27
Q

Management of perianal abscess

A

surgical incision and drainage of abscess

Antibiotics not good because can’t penetrate into it

28
Q

What is a fistula in and

A

Abnormal connection between the anal canal and peri-anal skin

29
Q

Risk factors of fistula in ano

A

IBS
Systematic disease - HIV, TB, diabetes
Trauma
Pelvic radiation

30
Q

Presentation of fistula in ano

A

Peri-anal abscess

Intermittent or continuous discharge of pus, blood or mucuous from the perineum

31
Q

On examination of fistula in ano

A

Small opening in perineum
Some granulation tissue that may discharge on palpation
Thickening fibrous tract palpable in the skin

32
Q

What is the Goodsall’s rule

A

Where the fistula is decides on treatment

e.g.
If patient lying down and you drew a line going through middle of the anus going horizontally-

  • External opening above (anterior) to the line is connected through the internal opening by a short straight line
  • External opening below (posterior) to the line has a curved or horseshoe tract
33
Q

Investigation of a fistula in ano

A

Exam using proctoscopy or exam under anaesthesia

Curved tracts usually get gluteal or pelvic MRI

34
Q

Managemt of fistula in ano

A

Drain abscess

Seton- an elastic band put through external opening into internal opening and tied to make a loop that allows sepsis to drain, preventing abscess.

Fistulotomy- laying open of the tract including the overlying skin and/or muscle.

FFP Abdominal pain and PR bleeding (5 decks)

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