Rectal Popcorn

Question 1

Columnar rectal epithelium

Insensate

Answer 1

ABOVE dentate line

Question 2

Squamous anal epithelium

Sensate

Answer 2

BELOW dentate line

Question 3

3 sxs of rectal dz

Answer 3

• Pain
• Bleeding
• Discharge

Question 4

Age/Gender for pilonidal cyst?

Answer 4

19 - 21 yrs

MEN

Question 5

Tx for Pilonidal Cysts:

• Asymptomatic?
• Acute abscess?
• Chronic?
• Cellulitis?
• Prevention?

Answer 5

• Asymptomatic: none
• Acute abscess: I&D
  
  • Superior healing w/ unroofing & curettage of cavity
• Chronic: surgical excision
• Cellulitis: Abx (Cephalosporin + Metronidazole)
• Prevention: Natal cleft clean & hair free

Question 6

Prolonged sitting/straining

Answer 6

Hemorrhoids

Question 7

Internal or External Hemorrhoids?

• ABOVE dentate?
• BELOW dentate?

Answer 7

• Above: internal
• Below: external

Question 8

Which degree hemorrhoid?

• DOES NOT protrude outside of lumen

Answer 8

1st degree internal

Question 9

Which degree hemorrhoid?

• PROTRUDES w/ defecation
• Redues spntsly

Answer 9

2nd degree internal

Question 10

Which degree hemorrhoid?

• PROTRUDES w/ defecation
• Reduces manually

Answer 10

3rd degree internal

Question 11

Which degree hemorrhoid?

• PROTRUDES permanently!
• Incarcerated

Answer 11

4th degree internal

Question 12

Which hemorrhoid?

• Severe perianal pain & lump

Answer 12

Thrombosed

(internal or external)

Question 13

Tx?

• 1st and 2nd degree internal hemorrhoids Asymptomatic (3)

Answer 13

• bulking agents,
• incr. water intake,
• avoid constipation

Question 14

Tx?

• 1st and 2nd degree internal hemorrhoids SYMPTOMATIC

Answer 14

• Rubber band ligation,
• infrared coagulation (laser light causes coag and necrosis)

Question 15

Tx?

• 3rd degree internal hemorrhoids

Answer 15

• Non-operative interventions are NOT effective (usually)
• Rubber band ligation
• Mixed internal/external: surgical hemorrhoidectomy

Question 16

Tx?

• 4th degree internal hemorrhoids

Answer 16

• Non-operative interventions are NOT effective at all
• Surgical hemorrhoidectomy

Question 17

Tx?

• External hemorrhoids

Answer 17

Symptomatic therapy

Question 18

Tx?

• Thrombosed hemorrhoids (internal or external)

Answer 18

• Self-limited, resolve in 7 – 10 days
• Sitz baths, mild analgesics
• **Hydrocortisone (suppository, foam such as Anusol HC supp. Or Proctofoam HC)**
• First 24 – 48 hours à evacuate under local anesthesia

Question 19

Tx for Anorectal Abscess

Answer 19

Complete drainage

• (I&D in Operating Room)
• Abx

Question 20

What condition needs to be ruled out with Fistula-in-Ano?

Answer 20

Crohn’s Disease

Question 21

T/F

• Fistulas NEVER heal spontaneously & require surgical correction

Answer 21

True

Question 22

Tx for Fistula-in-Ano?

Answer 22

• Fistulotomy: unroofing the fistula tract & allowing fistula to heal by secondary intention
  
  • Probe used intraoperatively to identify fistula tract
• Avoid damage to large portion of sphincter muscle to prevent incontinence.

Question 23

Which location of anal fissures are MC?

Answer 23

Posterior

Question 24

Tx for anal fissures?

Answer 24

• Avoid constipation or diarrhea
• Bulk laxatives (fiber improves constipation & diarrhea)**
• Mild analgesics
• Sitz baths
• Nitroglycerin or Diltiazem cream (small amount to minimize side effects)
  
  • SE of nitro: hypotension & HA
• Chronic: surgery (lateral internal sphincterotomy to relieve spasm)

Question 25

Tx for rectal prolapse?

Answer 25

• Prevent constipation
• Refer to colorectal surgeon for further eval/tx

Question 26

• Occurs when fascia weakens & allows rectum to bulge into vagina

Answer 26

Rectocele

Question 27

What is the MC cause of SEVERE anorectal pain

Answer 27

Anal Fissures