Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Perianal surgery > Flashcards

Perianal surgery Flashcards

1
Q

key anatomy of rectum?

A

extends from the inferior end of the sigmoid colon along the anterior surface of the sacrum to levator ani muscle

12cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

key anatomy of anal canal?

A

4 cm

levator ani muscle to anal verge

upper 2/3 of canal: lined by columnar epithelium, insensate

lower 1/3 of canal: squamous epithelium, sensate

dentate late = squamomucosal junction

white line = where anal canal becomes true skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

differences between upper 2/3 of anal canal and lower 1/3?

A

upper 2/3:

lined by columnar epithelium

insensate

superior rectal artery and vein

internal iliac nodes

lower 1/3:

squamous epithelium

sensate

middle and inf rectal artery and veins

superficial inguinal nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the dentate line?

A

squamomucosal junction of the anal canal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

internal vs external anal sphincters?

A

internal:

thickening of rectal Smooth muscle -> involuntary control

External:

three rings of skeletal muscle (deep, superficial, subcut) -> voluntary control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the anorectal ring?

A

deep segment of external sphincter which is continuous w puboretalis muscle (part of levator ani)

demarcates junction between anal canal and rectum

palpable on PR 5 cm from anus

must be preserved to maintain continence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a perianal haematoma?

A

subcut bleeding from a burst venule caused by straining/ passage of hard stool

aka external pile (misnomer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

presentation of perianal haematoma?

A

tender blue lump at anal margin

pain worsened by defecation or movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

mx of perianal haematoma?

A

analgesia + spontaneous resolution

or

evacuation under LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is proctalgia fugax?

A

anal pain w no specific cause

usually young, anxious men

crampy anorectal pain, worse at night

unrelated to defecation

assoc w trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is proctalgia fugax assoc w?

A

trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

mx of proctalgia fugax?

A

reassurance

GTN cream

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

perineal warts assoc w?

A

MSM

may be due to HPV

or Syphilis (condylomata lata)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

mx of perineal warts due to syphilis?

A

penicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

mx of perineal warts due to HPV?

A

podophyllin pain

cryo

surgical excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

definition of haemorrhoids?

A

Dilated (enlarged) veins in the walls of the anus

(dilated and disrupted anal cushions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

where are haemorrhoids usually positioned?

A

3, 7 and 11 o clock

(due to this being where the 3 major arteries that feed the vascular plexuses enter the anal canal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

pathophysiology of haemorrhoids?

A

gravity, straining -> engorgement and enlargement of anal cushions

cushions protrude, may be damaged by hard stool-> bright red bleeding

haemorrhoids arise above dentate line -> not painful

may be gripped by anal sphincter -> thrombosis

(strangulated piles are acutely painful, may ulcerate or infarct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

causes of haemorrhoids?

A

constipation w prolonged straining

venous congestion: pregnancy, abdo tumour, portal HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

classification of haemorrhoids?

A

1st degree: never prolapse

2nd: prolapse on defecation but spontaneously reduce
3rd: prolapse on defecation but require digital reduction
4th: remain permanently prolapsed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

features of haemorrhoids?

A

fresh painless PR bleed

pruritus ani

lump in perianal area

severe pain = thrombosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mx of haemorrhoids?

A

conservative:

increase fibre and fluid intake

reduce straining

medical:

topical analgesics, hydrocortisone

laxatives: lactulose, fybogel

interventional:

Banding, cryotherapy, infra red coagulation, injection w sclerosant

Surgical: haemorrhoidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

mx of thrombosed haemorrhoids?

A

analgesia

ice packs

stool softeners

bed rest w elevated foot of bed

pain usually resolves in 2-3 wks

haemorrhoidectomy usually not necessary

24
Q

definition of anal fissure?

A

tear of squamous epithelial lining in lower anal canal

25
Q

causes of anal fissure?

A

constipation

crohns

anal ca

herpes

26
Q

features of anal fissure?

A

intense anal pain esp on defecation

fresh rectal bleeding (on paper)

27
Q

examination of anal fissure?

A

PR often impossible

midline ulcer is seen

may have mucosal tag - sentinel pile

groin LNs suggest complicating factor e.g. HIV

28
Q

mx of anal fissures?

A

if fissure recurrent, chronic or difficult to tx, pt needs examination under anaesthesia

conservative:

soaks in warm bath, toileting advice, dietary advice

medical:

laxatives, topical analgesia (Lignocaine, GTN, diltiazem), botulinum injection

surgical: lateral partial sphincterotomy

division of int anal sphincter @ 3 o clock

pre-op anorectal US and mannometry

29
Q

definition of fistula?

A

abnormal connection between 2 epithelial surfaces

30
Q

definition of fistula in ano?

A

abnormal connection between anorectal canal and the skin

31
Q

risk factors for anal fistula?

A

perianal abscess

crohns

diverticular disease

rectal ca

immunosuppression

32
Q

classification of fistula in ano?

A

high: cross sphincter muscles above dentate line
low: dont cross sphincter muscles above dentate line

33
Q

presentation of anal fistula?

A

persistent anal discharge

perianal pain or discomfort

34
Q

ix of anal fistula?

A

MRI

endoanal US

35
Q

mx of anal fistula?

A

extent of fistula must be first delineated by probing fistula @ EUA

Low fistula:

fistulotomy and excision

  • laid open to heal by secondary intention

high fistula:

fistulotomy could damage anorectal ring

suture (a Seton) passed through fistula and gradually tightened over months -> stimulates fibrosis of tract + scar tissue holds sphincter tgt

36
Q

mx of perianal abscess?

A

abx

most require EUA w Incision and drainage

  • wound packed, healing by secondary intention

look for anal fistula which complicates 30% of abscesses

37
Q

examination findings of perianal abscess?

A

septic signs: fever, tachycardia

fluctuant mass on PR

perianal mass or cellulitic area

38
Q

presentation of perianal abscess?

A

throbbing perianal pain

worse on sitting

occasionally a purulent anal discharge

39
Q

definition of pilonidal sinus?

A

pilonidal: ‘nest of hair’
sinus: blind ending tract, lined by epithelial or granulation tissue, which opens into an epithelial surface

40
Q

pathophysiology of pilonidal sinus?

A

hair works its way beneath skin -> foreign body reaction

-> formation of abscess

usually occur in natal cleft

41
Q

risk factors of pilonidal sinus?

A

Males

often overweight w poor personal hygiene

occupations w lots of sitting e.g. truck drivers

42
Q

presentation of pilonidal sinus?

A

recurrent pain

persistent discharge of purulent or clear fluid

abscesses

43
Q

mx of pilonidal sinus?

A

conservative:

hygiene advice, shave/ remove hair from affected area

surgical:

incision and drainage of abscesses

elective sinus excision

44
Q

most common type of anal ca?

A

80% SCCs

45
Q

spread of anal ca to which lymph nodes?

A

above dentate line -> int iliac nodes

below detate line -> inguinal nodes

46
Q

risk factors of anal ca?

A

HPV 16, 18, 31, 33

(increased incidence in MSM/ perianal warts)

47
Q

features of anal ca?

A

perianal pain and bleeding

pruritus ani

faecal incontinence (70% have sphincter involvement @ presentation)

may -> rectovaginal fistula

48
Q

Ix of anal ca?

A

low Hb (ACD)

endoanal US
rectal EUA + biopsy

CT/MRI: assess pelvic spread

49
Q

mx of anal ca?

A

Chemoradiotherapy

Surgery:

  • tumours that fail to respond to radiotx
  • GI obstruction
  • small anal margin tumours (good prognosis) w/o sphincter involvement
50
Q

defintion of rectal prolapse?

A

protrusion of rectal tissue through the anal canal

51
Q

classification of rectal prolapse?

A

type 1: mucosal prolapse

  • partial prolapse
  • commoner in childern esp w CF
  • essentially large piles -> same mx

type 2: full thickness prolapse

  • more common
  • usually elderly females w poor O&G hx
52
Q

Examination findings of anal prolapse?

A

visible prolapse

+/- excoriation and ulceration

decreased sphincter tone on PR

assoc uterovaginal prolapse

53
Q

ix of anal prolapse?

A

sigmoidoscopy to exclude proximal lesions

anal manometry

endoanal US

MRI

54
Q

mx of partial anal prolapse

A

phenol injection

rubber band ligation

surgery: delormes procedure

55
Q

mx of complete anal prolapse?

A

conservative:

pelvic floor exercises, stool softeners

surgery:

Abdo approach - Rectopexy

(mobilised rectum fixed to sacrum w mesh)

perineal approach - Delorme’s procedure

(resect mucosa and suture the two mucosal boundaries)

Surgery (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions