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MD2 Surgery and Anaesthesia > Perianal Disease > Flashcards

Perianal Disease Flashcards

1
Q

What are the common symptoms of perianal disease?

A 
Bleeding
Pain
Prolapsed anal lumps - swellings
Itchiness
Discharge
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2
Q

What does a perineal examination involve?

A 
Inspection
Palpation of perineum - use KY/lignocaine gel
DRE
Sigmoidoscopy
Proctoscopy
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3
Q

What is sigmoidoscopy?

A

Scope that reaches 1/2-2/3 of sigmoid colon

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4
Q

What is proctoscopy?

A

Can do with lubricant alone, without anaesthesia

See in colorectum

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5
Q

What are malignant conditions of the perineum?

A 
Anal cancers
- SCC
- BCC
- Melanoma
Low rectal adenocarcinoma
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6
Q

What are non-malignant conditions of the perineum?

A 
Anal skin tags
Anal fissure
Haemorrhoids
Anal fibrous polyps
Anal fistula
Anal warts
Rectal prolapse
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7
Q

What are painful perianal conditions?

A 
Anal fissure
Strangulated and prolapsed haemorrhoids
Perianal haematoma
Anal abscess
Anal cancer invading sphincter
Low rectal cancer invading sphincter
Proctalgia fugax
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8
Q

What are painless perianal conditions?

A 
Perianal skin tags
1st, 2nd, and 3rd degree haemorrhoids
Rectal prolapse
Anal fistula
Anal margin cancer
Low rectal cancer
Anal fibrous polyps
Anal warts
Pruritis ani
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9
Q

What is an anal fissure?

A

Tear/ulcer of anal junction

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10
Q

What is the difference between an acute and chronic anal fissure?

A

Acute - no induration

Chronic - induration

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11
Q

What is the treatment for anal fissure?

A 
Topical anaesthetics ointment
Stool softeners
- Coloxyl and senna
Sitz bath
Chemical sphincterotomy
Surgical sphincterotomy
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12
Q

What is a sitz bath?

A

Sit in bowl with water and soap/salt for 10-15 min > dry area well

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13
Q

What is the treatment for a perianal haematoma?

A

Conservative - will resolve in a few days

Incisional drainage under local anaesthetic > don’t need to stitch

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14
Q

Of what are perianal skin tags a sequelae?

A

Perianal haematoma

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15
Q

Why can perianal skin tags be itchy?

A

May ooze mucus

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16
Q

What is the treatment for perianal skin tags?

A

Conservative

Excision

17
Q

What are the different types of anal abscesses?

A 
Superficial
- Perianal
Deep
- Intersphincteric
- Ischiorectal
18
Q

Which anal abscesses cause fever?

A

Ischiorectal

19
Q

What is the treatment for an anal abscess?

A

Drainage

May not need Abx, unless signs of spread or immunocompromise

20
Q

What is the surgical procedure for an anal fistula?

A

Seton insertion
- Eradicate fistula
- Preserve sphincter function
Guides subsequent surgery/fistulotomy/repair

21
Q

What is the most common cause of haemorrhoids?

A

Constipation

22
Q

What is the classification of haemorrhoids?

A

1st degree = internal - seen only with endoscope
2nd degree = prolapse > reduce spontaneously
3rd degree = non-reducible
4th degree = thrombosed and painful

23
Q

What is the treatment for first degree haemorrhoids?

A

High fibre diet > regulate bowel habit
Avoid straining
Injection sclerotherapy for bleeding
5% phenol in almond oil

24
Q

What is the treatment for second degree haemorrhoids?

A

Diet

Rubber band ligation/injection sclerotherapy for symptomatic cases

25
Q

What is the treatment for third degree haemorrhoids?

A

Diet

Haemorrhoidectomy

26
Q

What is the treatment for fourth degree haemorrhoids?

A

Analgesia

Surgery

27
Q

What is the treatment for partial rectal prolapse?

A

Do nothing

28
Q

What is the treatment for complete rectal prolapse?

A

Sedate
Pack with sugar crystals > reduces oedema
Gently reduce

29
Q

What are the symptoms of anal warts?

A

Bleeding
Discharge
Anal lumps

30
Q

What causes anal warts?

A

HPV

31
Q

What are the symptoms of anal cancer?

A

Bleeding
Pain
Lump
Discharge

32
Q

What is the principle of management for anal cancer?

A

If in doubt, biopsy

33
Q

What is the treatment for anal cancer?

A

Depends on staging

  • Local excision if small and clear of sphincter
  • Usually chemoradiotherapy
34
Q

What are the symptoms of low rectal carcinoma?

A

Bright red bleeding
Mucous discharge
Tenesmus

35
Q

What should be assessed on digital rectal exam in suspected low rectal carcinoma?

A

Soft/hard rectal mass

Position and distance from anal verge

36
Q

What are the causes of pruritis ani?

A

Many
Moisture from soiling/discharge
Infestations
Dermatological

37
Q

What is the treatment for pruritis ani?

A 
Topical steroid
Anti-fungals
Oral antihistamine
Avoid excessive wiping
Diet
Excise skin tags

MD2 Surgery and Anaesthesia (31 decks)

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