Perianal disease

Question 1

Pruritis ani causes

Answer 1

Moist/soiled anus

threadworm

others

Question 2

Pruritis ani rx

Answer 2

hygiene

anaesthetic cream,

moist wipe post-defecation,

avoid spicy food, steroid/antibiotic cream.

capsaicin

Question 3

Fissure-in-ano def

Answer 3

tear in squamous cell lining of lower anal canal

mostly posterior

Question 4

Fissure-in-ano cause

Answer 4

hard faeces

Question 5

Fissure in ano 1st line rx

Answer 5

lidocaine+GTN ointment

or topical diltiazem

diet: high fibre, fluids

stool softner

Question 6

Fissure in ano 2nd line

Answer 6

botox + diltiazem

Question 7

Surgical rx of fissure in ano

Answer 7

lateral partial internal sphincterotomy

Question 8

Fistula in ano pathophysiology

Answer 8

intramuscular gland ducts block

abscess formation

fistula

Question 9

Causes of fistula in ano

Answer 9

perianal sepsis/abscess

crohns

TB

diverticular disease

Question 10

Ix for fistula in ano

Answer 10

MRI

Endoanal US scan

Question 11

Rx of fistula in ano

Answer 11

Fistulotomy + excision

If high (sphincter): seton suture tightened over time to maintain continence

If low: laid open to heal by secondary intention

Question 12

Perianal haematoma def

Answer 12

thrombosed external pile

2-4 mm dark blueberry looking thing

Question 13

Perianal haematoma rx

Answer 13

evacuated under LA or left to resolve spontaneously

Question 14

Pilonidal sinus

Answer 14

obstruction of natal cleft hair follicles (6 cm above anus)

inflammation and secondary tracks opening laterally, d/c puss

Question 15

Pilonidal sinus rx

Answer 15

excision of sinus tract + primary closure

hair removal advice

Question 16

Rectal prolapse types

Answer 16

Type 1: Mucosa

Type 2: all layers

protruding through anus

Question 17

Rx of rectal prolapse

Answer 17

Rectopexy (rectum fixed to sacrum) ± mesh insertion ± rectosigmoidectomy

Question 18

Perianal warts types

Answer 18

Condylamata acuminata (viral)

Condylamata acuminata of Bushke & Loewenstein (low-grade, non-mets verrucous cancer)

Condylamata lata (2ndary to syphillis)

Question 19

Condylomata acuminata rx

Answer 19

Podophyllotoxin

Imiquimod

Cryotherapy

Question 20

Proctalgia fugax

Answer 20

Idiopathic, intense, brief, stabbing/crampy rectal pain, often worse at night

Question 21

Proctalgia fugax rx

Answer 21

reassurance

inhaled salbutamol

topical GTN or diltiazem

Question 22

RFs for anal cancer

Answer 22

Syphillis

Warts (HPV 6,11,16,18,31,33)

Homosexual receptive sex

Question 23

Anal cancer cell type

Answer 23

mostly squamous cell

Question 24

Differentiation of anal cancer

Answer 24

above dentate line: poorly differentiated, poor prognosis

Below dentate line/anal margin: well diff, good prognosis

Question 25

Anal ca rx

Answer 25

Radiotherapy + chemo (2nd line: anorectal excision+colostomy)

Question 26

Haemorroids aka

Answer 26

piles

Question 27

Haemorroids def

Answer 27

disrupted and dilated anal cushions

Question 28

Anal cushion def

Answer 28

Three anal cushions at 3,7,11 o clock Discontinuous masses of spongy vascular tissue that line the anus Contribute to anal closure

Question 29

Pathophysiology of haemorroids

Answer 29

Constipation -\> vascular cushions protrude through tight anus -\> congested -\> hypertrophy -\>protrude even more

Question 30

Classification of haemorroids

Answer 30

1st degree: Remain in the rectum 2: Prolapse through the anus on defecation but spontaneously reduce 3: As for 2nd-degree but require digital reduction 4: Remain persistently prolapsed

Question 31

Medical rx of haemorroids

Answer 31

Fluids + fibre Topical analgesic + stool softner +/- topical steroids

Question 32

Non-operative rx of haemorroids

Answer 32

Rubber band ligation Sclerosants Infra-red coagulation Cryotherapy

Question 33

Surgical rx of haemorroids

Answer 33

Excisional haemorroidectomy (best, but 2wks off work) Stapled haemorroidopexy

Question 34

When to use medical rx of haemorroids

Answer 34

1st degree

Question 35

When to use non-operative rx of haemorroids

Answer 35

2/3rd degree resistant 1st degree