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minor surg/proctology > proctology > Flashcards

proctology Flashcards

1
Q

the rectum and anal canal start at level ___ and is ___cm in length

A

S3; 12-15cm

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2
Q

the midpoint of the anal canal has an undulating demarcation known as

A

dentate line

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3
Q

the dentate line is __cm from the anal verge

A

2

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4
Q

the dentate line takes a ___ appearance

A

pleated

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5
Q

T/F: the anal canal consists of epithelium of different types at different levels

A

true

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6
Q

there are 6-14 folds within the dentate line known as

A

columns of morgagni

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7
Q

between the columns of morgagni at the lower end there is a small pocket known as

A

crypts

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8
Q

___ are of surgical significance as foreign material may lodge in them, obstructing the ducts of the anal gland and result in abscesses

A

crypts

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9
Q

what are 5 muscles of the rectum

A

internal sphincter, conjoined longitudinal muscle, external sphincter, and levator ani, puborectalis

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10
Q

___ muscle is at the anorectal ring, this muscle coats the rectum and is joined by fibers from the levator ani and puborectalis muscles. It descends between the internal and external anal sphincters. Function is to affix the anal canal and evert the anus during defecation

A

conjoined longitudinal muscle

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11
Q

Lowest portion of the external sphincter is below and lateral to the internal sphincter. There is a palpable groove at this level and is referred to as the

A

intersphincteric groove.

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12
Q

____ is a broad thin muscle that forms the greater part of the floor of the pelvic cavity and is innervated by S4

A

levator ani

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13
Q

___ is the standard position when discussing anorectal disease and treatment

A

left lateral sims

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14
Q

____is a small tear in the thin, moist tissue (mucosa) that lines the anus.

A

anal fissure

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15
Q

___ are Areas of hypertrophied cutaneous tissue located adjacent to the anus, MC posterolateral quadrants of the anus

A

skin tags

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16
Q

___ is an unpleasant cutaneous sensation (various degrees of itching). Men MC 4:1. Perianal skin becomes thin, friable, tender, blistered, ulcerated, and weeping. In later stages, the skin is raw, red, and oozing or pale and thickened (lichenified)

A

pruritus ani

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17
Q

T/F pruritus ani can be caused by antibiotics/ overuse of topical steroids

A

true

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18
Q

T/F pruritus ani can be caused by diet

A

true: coffee, chocolate, tomatoes, spicy food, citrus

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19
Q

There are areas in the anal canal that are highly vascular masses of thick submucosa with smooth muscle and elastic connective tissue (cushions). ____are a sliding downward of this part of the anal canal lining.

A

Hemorrhoids

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20
Q

T/F hemorroids are still a problem even if no symptoms

A

false

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21
Q

what are 4 types of hemorroids

A

internal, external, mixed or strangulated

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22
Q

75% of frank bleeding from bowel is due to what condition

A

internal hemorrhoids

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23
Q

what does 1st degree internal hemorrhoids look like

A

no protrusion but bulge into lumen of rectal canal

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24
Q

2nd degree internal hemorrhoids do what

A

protrude at stool & reduce spontaneously

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25
Q

3rd degree internal hemorrhoids protrude at stool like 2nd degree, but…

A

must be manually reduced

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26
Q

4th degree hemorrhoids also protrude at stool, but..

A

can not be reduced

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27
Q

treatment of hemorrhoids include

A

diet, education, stool softener, suppositories, hot sitz baths.. can also use rubber band ligation

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28
Q

___ is a painful linear ulcer situated in the anal canal and extends below the dentate line to the margin of the anus. Very common
Symptoms: pain for 30min-hours after defecation, frank bleeding, constipation, dysuria
Affects men and women with most located mid-line posterior

A

fissure in ano

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29
Q

a lateral fissure can be indicative of ___

A

severe systemic disease

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30
Q

___ can mimic any condition- often confused with cancer and crohns

A

Schistosomiasis

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31
Q

___ is a sexually transmitted disease of the anorectum that is due to papilloma virus. Cauliflower like masses that are often soft, friable, and bleed easily. 1-6mo incubation period and transmittable. Bleeding and pruritus ani may be only symptoms. Definitive dx made by dark field exam that will demonstrate spirochetes. Treatments include: podophyllin, surgical excision, electro desiccation, cryotherapy, and US.

A

Condylomata acuminata

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32
Q

T/F: any chronic unhealed ulcer should be considered as potentially squamous cell carcinoma

A

true

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33
Q

____ is an abnormal communication between the anal canal and perianal skin

A

fistula in ano

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34
Q

90% of fistula in ano originate in ___ with greatest conc of this area located in posterior aspect of anal canal

A

crypts of morgagni

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35
Q

___ is an acute manifestation while the fistula is a chronic situation. Will have acute pain and swelling. Pain increased with sitting, movement, defecation, coughing, sneezing. Usually history includes diarrhea. Symptoms also include malaise and pyrexia

A

abscess

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36
Q

MC benign condition of the large bowl is..

A

polyps

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37
Q

T/F neoplastic polyps are found with carcinoma

A

true

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38
Q

MC complaint area of IBS

A

lower GI

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39
Q

MC lesion that exists between the anus and isch tub

A

abscess

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40
Q

complication of keesay method

A

bleeding

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41
Q

what is keesay method treatment for

A

internal hemorroid

42
Q

3 common tests for GI

A

spect, colonoscopy, manual inspection

43
Q

another name for the dentate line

A

pectinate line

44
Q

what does the pectinate line divide

A

the upper 2/3 from the lower 1/3 rectum

45
Q

HPV treatment options

A

electrosurgery / excision, freezing, topicals

46
Q

what is the purpose of the prostate

A

makes fluid that combined with sperm cells from the testicles makes semen

47
Q

what are s/s of pinworm

A

pinworm MC in kids (5-10yo) and easily spread. S/S= itching pain rash and presence in stool

48
Q

what is tenesmus

A

recurrent inclination to evacuate bowels, pain/cramping- feeling urge even after defication

49
Q

what causes tenesmus

A

inflammatory bowel disease MC: Chrons and UC

50
Q

what can you palpate on DRE

A

prostate, uterus, ovaries, and sometimes the bladder

51
Q

if the prostate feels boggy, soft, non-tender, might have

A

BPH

52
Q

if prostate is painful with palpation could be

A

prostatis

53
Q

if prostate feels rock hard what is a likely dx

A

cancer

54
Q

what is the median sulcus

A

on prostate and separates the 2 lateral lobes

55
Q

another name for the median sulcus is

A

longitudinal groove

56
Q

what does the prostate encircle

A

the urethra

57
Q

where is the prostate location in relation to the bladder

A

just inferior

58
Q

diabetes can cause what condition/complication with relation to the anus

A

puritis ani -> bleeding and anal fissures -> abcess??

59
Q

patients require transrectal US guided biopsy if have one of these 3 scenarios (relation to PSA lvls and DRE findings)

A
  1. PSA 4-10ng/ml with abnormal DRE
  2. PSA >10ng/ml- regardless DRE
  3. palp nodule on DRE regardless of PSA
60
Q

normal feel of a prostate with DRE

A

rubbery and walnut sized

61
Q

DRE of prostatitis is pain but could also feel how

A

soft and boggy

62
Q

what is prostatitis

A

inflammation of the prostate (25% GU concerns from young-mid age men)

63
Q

is prostatitis symptomatic? *

A

acute- yes; chronic can be asymptomatic…. MC LBP

64
Q

what is a risk factor for prostatitis (another health condition)

A

diabetes

65
Q

T/F: bacterial prostatitis has SUDDEN onset

A

yes

66
Q

what causes bacterial prostatitis and most UTIs

A

escherichia coli

67
Q

____ has S/S like prostatitis, can be due to msl spasm and like nerve entrapment

A

prostadynia

68
Q

what is another name for chronic pelvic pain syndrome (CPPS)

A

prostadynia

69
Q

what is BPH

A

benign prostate hyperplasia

70
Q

T/F BPH can lead to prostate cancer

A

no; its benign… but they can co-exist (does not increase risk)

71
Q

where does BPH happen

A

in transitional zone

72
Q

do patients with BPH have symptoms

A

20% do

73
Q

what are some symptoms of BPH

A

can block lower urinary tract, interrupt stream, cause hesitation, and urgency

74
Q

what can cause an increased PSA besides cancer?

A

BPH, recent DRE (for 2 days!), and prostatitis

75
Q

what does PSA stand for

A

prostate specific antigen

76
Q

a PSA of 0-4 is considered…

A

normal*

77
Q

PSA level 4-10 is considered

A

slightly increased; 10-20 moderately

78
Q

what PSA level is considered severe increase

A

20-35

79
Q

T/F PSA varies with age

A

yes; it increases- so there will be different norms per age gp *

80
Q

what is finasteride

A

a treatment used for BPH

81
Q

another name for finasteride

A

PROSCAR

82
Q

what is the difference between finasteride and alpha blocker that can also be used to treat BPH

A

finasteride will decrease size of prostate as well as help with symptoms. alpha blocker has no effect on size

83
Q

what are 3 surgery options available for BPH

A

TURP (core out), laser, prostatectomy

84
Q

what are some risk factors for developing prostate cancer

A

over 50yo; african american, family hx, smoking, diet/weight, and vasectomy might

85
Q

what is a supplemental option that can treat BPH without affecting PSA levels

A

saw palmetto

86
Q

____ causes prostate to feel like “pebble”

A

cancer

87
Q

T/F: prostate cancer can cause urinary obstruction

A

false

88
Q

why doesn’t prostate cancer affect urinary tract like BPH?

A

cancer usually is peripheral, not central

89
Q

what are some S/S of prostate cancer

A

blood in urine/semen, pain in back, hips, and thighs

90
Q

what percent of prostate cancer is asymptomatic

A

47%

91
Q

why is prostate cancer so serious

A

can met to bone

92
Q

what is bisphosphonates (fosamax) used to treat

A

helps increase bone density and slows loss of bone density

93
Q

what medication can be used to help decrease risk of fracture from met to bone

A

fosamax

94
Q

T/F cyrosurgery is an option for prostate cancer

A

yes

95
Q

MC type of prostate cancer

A

adenocarcinoma

96
Q

____ is a score used to evaluate tissue samples from a tumor and determine how progressed the tumor is/malignant

A

Gleason score

97
Q

T/F: gleason score of 1-5 is bad

A

false- it is low risk; over 10 is increased risk

98
Q

finestride (used to treat BPH) can also be used to treat,,,

A

prostadynia

99
Q

T/F: penile cancer and prostate cancer are related

A

no

100
Q

another name for hemorroids

A

piles

101
Q

what are hemorroids

A

swelling of veins in the lower part of the rectum

minor surg/proctology (2 decks)

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