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MD2 GIT > Perianal Disease > Flashcards

Perianal Disease Flashcards

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1
Q

List 5 symptoms of perianal disease

A 
Pain
Bleeding
Prolapsed anal lumps and swelling
Itchiness
Discharge
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2
Q

What components make up the examination for perianal disease?

A 
Inspection
Palpation of perineum
DRE
Sigmoidoscopy
Proctoscopy
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3
Q

Indications for flexible sigmoidoscopy

A

??

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4
Q

Indications for rigid sigmoidoscopy

A

??

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5
Q

What kind of cancers can occur in the anus?

A

SCC
BCC
Melanoma

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6
Q

What kind of cancers can occur in the rectum?

A

Adenocarcinoma

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7
Q

What kind of cancers can occur at the anorectal junction?

A

SCC
BCC
Melanoma
Adenocarcinoma

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8
Q

List 7 common non-malignant perianal conditions

A 
Anal fissure
Haemorrhoids
Anal skin tags
Anal fibrous polyps
Anal fistula
Anal warts
Rectal prolapse
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9
Q

What perianal conditions are usually painless?

A 
Perianal skin tags
Haemorrhoids (1st, 2nd and 3rd degree)
Rectal prolapse
Anal fistula
Cancer (anal margin, low rectal)
Anal fibrous polyps
Anal warts
Pruritis ani
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10
Q

When can anal/rectal cancers cause pain?

A

When they invade nerves, bones and/or sphincters

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11
Q

When do haemorrhoids usually cause pain?

A

When strangulated or prolapsed

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12
Q

What is proctalgia fugax?

A

Sudden, severe episodes of pain
Sporadic and resolves
Not related to defecation

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13
Q

What other perianal conditions cause pain?

A

Anal fissure
Perianal haematoma
Anal abscess

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14
Q

30 year old woman, 3 months post-partum, presents with anal pain on defecation for several weeks
Associated symptoms include bright red bleeding per rectum
DDx?

A

Anal fissure
Strangulated or prolapsed haemorrhoid
Perianal haematoma
Exclude abscess, fistula, cancer

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15
Q

What are the 3 principles of treatment of anal fissure?

A

Simple measures
Chemical sphincterotomy
Surgical sphincterotomy

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16
Q

What causes proctalgia fugax?

A

Spasm of the levator ani (typically the pubococcygeus muscle)

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17
Q

What simple measures are used to treat anal fissure?

A

Topical anaesthetic ointment
Stool softeners, coloxyl and senna
Sitz bath

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18
Q

What agents can be used to achieve a chemical sphincterotomy?

A 
Rectogesic ointment (0.2% GTN; can give headache)
Nifedipine 0.5%/lignocaine 5% gel
Botulinum toxin injection (40-60U into intersphincteric space)
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19
Q

What are the aims of a chemical sphincterotomy?

A

To relax pressure on sphincter and reduce spasm

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20
Q

What is the rationale underlying botox for treatment of anal fissure? What are some of the risks?

A

Relaxes anal sphincter to allow fissure to heal (does reverse but provides a 60-day window for healing)
Risk of poor bowel control

21
Q

How may a surgical sphincterotomy be achieved?

A

Lateral sphincterotomy

Fissurectomy or mucosal flap repair

22
Q

What is the risk with surgical sphincterectomy?

A

Most effective but has risk of minor flatus incontinence (esp in females)
Reserved for intractable cases and in males

23
Q

What is the typical presentation of perianal haematoma?

A

Acutely painful perianal swelling

24
Q

Mx of perianal haematoma

A

Conservative

Incisional drainage under LA

25
Q

What are perianal skin tags a sequelae of?

A

Perianal haematoma

26
Q

What is the typical presentation of perianal skin tag?

A

Painless

Perianal itch

27
Q

Mx of perianal skin tags

A

Conservative

Excision

28
Q

25 year old man presents with painful perianal swelling, unable to sit down, with associated fever
Likely Dx?

A

Perianal abscess

29
Q

Describe the different classifications of perianal abscess

A

Superficial perianal

Deep, ischiorectal or supralevator abscess

30
Q

Describe the different classifications of anal fistula

A

Low, perianal

High and complex: intersphincteric, transphincteric, extra-sphincteric, supra-levator

31
Q

What are the Sx of perianal abscess and anal fistula?

A

Chronic discharge of pus
Bleeding
Irritation

32
Q

Mx of complex anal fistula

A

Insertion of Seton to eradicate fistula and preserve sphincter function
Provides drainage and guides subsequent surgery, fistulotomy or repair

33
Q

Sx of haemorrhoids

A

Bleeding
Prolapse
Mucus discharge

34
Q

Describe the classification of haemorrhoids

A

First degree: internal, bleeds
Second degree: prolapse and reducible spontaneously
Third degree: non reducible
Fourth degree: thrombosed, painful

35
Q

How are first degree haemorrhoids treated?

A

High fibre diet to regulate bowel habit
Avoiding constipation and straining
Injection sclerotherapy for bleeding
5% Phenol in almond oil

36
Q

How are second degree haemorrhoids treated?

A

Diet
Rubber band ligation
Injection sclerotherapy for symptomatic cases

37
Q

How are third degree haemorrhoids treated?

A

Diet

Surgery by haemorrhoidectomy

38
Q

How are fourth degree haemorrhoids treated?

A

Analgesia followed by surgery

39
Q

What are the standard and newer ops available for haemorrhoidectomy?

A

Standard: Milligan-Morgan excision ligation
New: stapled haemorrhoidectomy, Doppler-guided haemorrhoidal artery ligation

40
Q

What are the different types of rectal prolapse?

A

Full thickness

Internal mucosal

41
Q

Sx of rectal prolapse

A 
Anal lump
Bleeding
Discharge
Incontinence
Unable to sit
42
Q

Sx of anal warts (condyloma acuminata)

A

Bleeding
Discharge
Anal lumps

43
Q

Sx of anal cancer

A

Bleeding
Pain
Lump
Discharge

44
Q

Mx of anal cancer

A

If in doubt, perform biopsy

Treatment depending on staging: local excision if small and clear of sphincter, usually chemo-irradiation therapy

45
Q

Sx of low rectal carcinoma

A

Bright red bleeding
Mucus discharge
Tenesmus

46
Q

What factors are important to assess on DRE if you are concerned about a low rectal carcinoma?

A

Soft or hard rectal mass

Assess position and distance from anal verge

47
Q

Sx of pruritis ani

A

Common, mild to severe intractable itch

Bleeding

48
Q

Causes of pruritis ani

A

Moisture from soiling or discharge
Infestations
Dermatological

49
Q

Mx of pruritis ani

A 
Dependent on underlying cause but may include:
Topical steroid
Anti-fungal
Oral anti-histamine
Avoiding excessive wiping
Diet
Excision of skin tags

MD2 GIT (14 decks)

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