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Gastrointestinal Conditions (JBR) > Rectum, Anal Canal and Anus (Butt stuff) > Flashcards

Rectum, Anal Canal and Anus (Butt stuff) Flashcards

1
Q

Rectal varices are associated with?

A

Lower portal hypertension

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2
Q

Rectal polyps are?

A

Adenomas

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3
Q

Rectal polyps are investigated the same way as?

A

Colonic polyps

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4
Q

How do you treat rectal cancer?

A

Anterior resection
End colostomy
Abdominal-peri-anal resection

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5
Q

Abdominal peri-anal resection requires?

A

Neo-adjuvant radiotherapy

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6
Q

What are complications of rectal cancer?

A

Faecal incontinence

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7
Q

What is a rectal prolapse?

A

Rectal wall slides through anus

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8
Q

Subtypes of rectal prolapse are

A

Partial (anterior muscle prolapse)

Complete (full thickness)

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9
Q

How does rectal prolapse present?

A

Protruding has from anus especially during defection (may reduce spontaneously)
Bleeding and passing mucous per rectum common

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10
Q

What is noticed on examination for rectal prolapse?

A

Usually poor anal tone

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11
Q

How do you treat an incomplete rectal prolapse?

A

Children: dietary advice and Rx of constipation
Adult: treat similar to haemorrhoids

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12
Q

How do you treat a complete rectal prolapse?

A

Surgery

if too frail: bulking agent and education on manual reduction

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13
Q

What are haemorrhoids?

A

Enlarged vascular cushions in lower rectum and anal canal

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14
Q

How do haemorrhoids present?

A

Painless bleeding

Perianal itch

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15
Q

What are characteristics of PR bleeding in haemorrhoids?

A

Fresh/bright red blood

Not mixed with stool (usually on paper)

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16
Q

How do investigate haemmorhoids?

A

PR exam
Rectal sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy if > 50 years old

17
Q

How do you treat haemorrhoids?

A 
Symptomatic
Sclerosation
Rubber band ligation
Open/stapled haemorrhoidectomy
HALO/THO procedure
18
Q

What is sclerosation therapy?

A

Inject with phenol in almond oil - causes vessels to shrink

19
Q

What is the HALO/THO procedure?

A

Haemorrhoidal artery ligation under general/spinal anaesthesia
Use USS to locate arteries and tie them off

20
Q

Why is the HALO/THO procedure pain free?

A

No pain receptors

21
Q

What is an anal fissure?

A

Tear in the anal margin due to passage of constipated stool

22
Q

Where are anal fissures usually located?

A

Posterior midline

23
Q

Multiple anal fissures are commonly linked to?

A

Crohn’s disease

24
Q

How do anal fissures present?

A

Acute onset of severe anal pain usually following a period of constipation
“glass passing through the back-passage”
Pain lasts for up to half an hour
Bright red rectal bleeding

25
Q

How do you treat anal fissures?

A 
Dietary advice
Stool softeners
Pharmacological sphyncterectomy 
Lateral sphyncterectomy
Botox injection
26
Q

What is pharmacological sphyncterectomy?

A

0.3% GTN, 2% diltiazem - PR for 6 weeks

27
Q

What is a fistula in-ano?

A

Abnormal communication between the epithelial surfaces of the anal canal and perianal skin

28
Q

How does a fistula in ano present?

A

Majority arise from delay from treatment or inadequate treatment of anorectal abscess

29
Q

How do you investigate a fistula in-ano?

A

EUA of anorectum
Rigid/flexible sigmoidoscopy
Proctoscopy

30
Q

How do you treat a fistula in ano?

A 
Laying open (cut) 
Insert seton (drain) 
LIFT procedure (ligate inter sphincter fistula tract) 
Glue/Permacol
Defunctioning colostomy
31
Q

Anal cancers are typically?

A

Squamous cell carcinomas

32
Q

Anal SCCs are associated with?

A

HPV

33
Q

Anal cancer can progress from?

A

AIN (Anal intra-epithelial neoplasia)

34
Q

How does anal cancer present?

A

Perianal pain and bleeding
Palpable lesion
Faecal incontinence

35
Q

How do you investigate anal cancer?

A

Rectal EUA and biopsy?

36
Q

What does EUA stand for?

A

Examination under anaesthesia

37
Q

How do you treat anal cancer?

A

Radiotherapy and platinum based chemotherapy

Surgery if far enough from anal sphincter

38
Q

If anal cancer is very close to the anal sphincter, you remove the entire anus because?

A

They will have lifetime faecal incontinence anyway

Gastrointestinal Conditions (JBR) (33 decks)

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