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Year 2 > Perianal disorders > Flashcards

Perianal disorders Flashcards

1
Q

Define haemorrhoids

A

Disrupted and dilated anal cushions (masses of spongy vascular tissue due to swollen veins around the anus

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2
Q

What are anal cushions

A

Spongy vascular tissue which lines the anus (discontinuous masses)

These contribute to anal closure

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3
Q

Main causes of Haemorrhoids

A
  1. Constipation with prolonged strain
  2. Diarrhoea
  3. Effects of gravity due to posture
  4. Congestion from pelvic tumour, pregnancy, portal hypertension
  5. Anal Intercourse
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4
Q

What structures attach to the anal cushions

A
  1. Smooth muscle and elastic tissue
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5
Q

Why is blood in stools of haemorrhoids bright red

A

They come from capillaries

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6
Q

Why are anal cushions very vulnerable to trauma

A

Bleed readily from the capillaries of the underlying lamina propria

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7
Q

What is the dentate line

A

Squamomucosal junction

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8
Q

Are sensory fibres found above the dentate line

A

No

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9
Q

How does that effect pain in haemorrhoids

A

Piles are NOT painful

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10
Q

When are piles painful

A

If they thrombus when they protrude and are gripped by anal sphincter blocking venous return

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11
Q

Describe the positive feedback-like mechanism of haemorrhoids

A
  1. Vicious cycle:

The vascular cushions protrude through tight annus -> become more congested and hypertrophy -> protrude again more readily

These protrusions may strangulate

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12
Q

Where do internal haemorrhoids originate from

A

Above the dentate line

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13
Q

What are the four degrees of internal haemorrhoids

A

1st - Remain in rectum
2nd - prolapse through anus on defection but spontaneously reduce
3rd - prolapse but can be reduced manually
4th - remain persistently prolapsed

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14
Q

Where do external haemorrhoids originate from

A

Below the dentate line

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15
Q

Why are external haemorrhoids painful

A

There is sensory nerve endings below dentate line

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16
Q

Clinical presentation of haemorrhoids

A
  1. Bright red, rectal bleeding that coats stools
  2. Mucus discharge or pruritus ani (itchy bottom)
  3. Severe anaemia
  4. Weight loss + change in bowel habit should prompt thoughts of pathology
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17
Q

Differential diagnosis of haemorrhoids

A
  1. Perinanal haematoma
  2. Anal fissure
  3. Abscess
  4. Tumour
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18
Q

4 diagnostics for haemorrhoids

A
  1. AXR
  2. Per rectum exam
  3. Proctoscopy (rectal scope)
  4. Sigmoidoscopy
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19
Q

Role of AXR in haemorrhoids

A

Rule out other diseases

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20
Q

Why do we do per rectal exams in haemorrhoids

A

Prolapsing piles can be seen

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21
Q

Can internal haemorrhoids be seen in PR exams

A

No - not palpable

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22
Q

What is used to see internal haemorrhoids

A

Proctoscopy

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23
Q

1st degree treatment of haemorrhoids

A
  1. Increase fluid and fibre

2. Analgesic and stool softener

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24
Q

2nd degree treatment of haemorrhoids

A
  1. Rubber band ligation

2. Infra-red coagulation

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25
Q

What is rubber band ligation

A

CHEAP

band around haemorrhoid to stop blood flow

Causes haemorrhoid to die

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26
Q

Sid-effects to rubber band ligation

A

Bleeding
Infection
Pain

27
Q

What is infra-red coalition

A

Locally coagulates vessels and tethers mucosa to subcutaneous tissue

28
Q

What is final line of treatment for haemorrhoids

A

Surgery

Excision haemmorhoidectomy (excision of piles)
Stupid haemorrhoidpexy
29
Q

How are prolapsed piles and thromboses piles treated

A

Analgesia
Ice packs
stool softeners

30
Q

When does pain from prolapsed or thromboses piles stop

A

2-3 weeks

31
Q

What is an anal fistula

A
  1. An abnormal connection between the epithelialise surface of the anal canal and skin (a track that communicates between skin and anal canal)
32
Q

Main causes of anal fistula

A
  1. Perinanal sepsis
  2. Abscesses
  3. Crohn’s
  4. TB
  5. Diverticular disease
  6. Rectal carcinoma
33
Q

Clinical presentation of anal fistulas

A
  1. Pain
  2. Discharge
  3. Pruritus ani (itchy bottom)
  4. Systemic abscess if it becomes infected
34
Q

How are anal fistulas diagnosed

A
  1. MRI

2. Endoanal ultrasound

35
Q

Why is an MRI done for anal fistulas

A
  1. Exclude sepsis

2. Detect associated conditions

36
Q

Why is an endoanal ultrasound done for anal fistulas

A

Determines tracks location and underlying cause

37
Q

What causes discharge from anal fistulas

A

Blockage of deep intramuscular gland ducts causes formation of abscesses -> discharges

38
Q

How are anal fistulas treated

A
  1. Surgical (Fistulotomy ande cisión)

2. Drian abscess with antibiotics if infected

39
Q

What is an anal fissure

A
  1. Painful tear in sensitive skin-lined lower anal canal, distal to the dentate line resulting in pain on defecation
40
Q

Posterior or anterior - most common anal fissure

A

Posterior

41
Q

What gender do anal fissure most occur in

A

Females

42
Q

What conditions can cause anal fissures

A

Crohn’s

Ulcerative colitis

43
Q

Main causes of anal fissures

A

HARD FAECES
Spasms may constrict inferior rectal artery = ischaemia which makes healing difficult

Syphilis
Herpes
Trauma
Anal cancer

44
Q

Clinical presentation of anal fissures

A
  1. Extreme pain on defecation

2. Bleeding

45
Q

How are anal fissures diagnosed

A
  1. History alone
  2. Confirmed on perianal inspection
  3. rectal examination is often not possible due to pain and sphincter spasm
46
Q

How is anal fissure treated

A
  1. Increase fibre and fluids to soften stool
  2. LIDOCAINE OINTMENT + GTN OINTMENT OR DILITIAZEM

BOTOX (2ND LINE)

SURGERY

47
Q

Clinical presentation of perianal abscess

A
  1. Painful swellings
  2. Tender
  3. Discharge
48
Q

What sexuality are perinala abscesses commonly found in

A

2/3 times more common in gay sex

49
Q

How are perianal abscesses diagnosed

A
  1. MRI

2. Endoanal ultrasound

50
Q

How are perianal abscesses treated

A
  1. Surgical excision

2. Drainage with antibiotics

51
Q

What are pilonidal sinuses

A
  1. Hair follicles get stuck under the skin in the natal cleft (butt crack) resulting in irritation and inflammation leading to small tracts that get infected
52
Q

What gender are pilondial sinuses common in

A

Males

53
Q

Risk factors for pilondial sinuses

A
  1. OBESE caucasians
  2. Large amount of body hair
  3. Sedentary jobs
  4. Occupation involving sitting or driving
  5. Family History
54
Q

Clinical presentation of pilondial sinuses

A

Acute:

  1. Painful swelling over days
  2. Pus filled and foul smell
  3. Systemic signs of infection

Chronic:
4 in 10 have repeated recurrent pilondial sinuses
Infection never clears completely

55
Q

How are pilondial sinuses diagnosed

A

Clinical exmianition

56
Q

How are pilonidal sinuses treated

A
  1. Surgery (excision of sinus tract as primary closure and pus drainage + pre-op antibiotics)
  2. Hygiene and hair removal advice
57
Q

What is irritable bowel syndrome

A

A mixed group of abdo symptoms in which no organic cause can be found

58
Q

What age does IBS arise in

A

Under 40

59
Q

What gender does IBS effect

A

Females

60
Q

What exacerbates symptoms of IBS

A
  1. Stress
  2. Food
  3. Gastroenteritis
  4. Menstruation
61
Q

What is gastroenteritis

A

Infectious diarrhoea

62
Q

Main causes of IBS

A
  1. Depression, anxiety
  2. Psychological stress and trauma
  3. GI infection
  4. Sexual, physical or verbal abuse
  5. Eating disorders
63
Q

What are the three types of IBS

A
  1. IBS - C (constipation)
  2. IBS - D (Diarrhoea)
  3. IBS - M (constipation and diarrhoea)
64
Q

Risk factors for IBS

A
  1. Female
  2. Long diarrhoea
  3. High hypo-chrondrial anxiety and neurotic score at time of initial illness

Year 2 (155 decks)

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