Rectum, Anal Canal and Anus (Butt stuff)

Question 1

Rectal varices are associated with?

Answer 1

Lower portal hypertension

Question 2

Rectal polyps are?

Answer 2

Adenomas

Question 3

Rectal polyps are investigated the same way as?

Answer 3

Colonic polyps

Question 4

How do you treat rectal cancer?

Answer 4

Anterior resection
End colostomy
Abdominal-peri-anal resection

Question 5

Abdominal peri-anal resection requires?

Answer 5

Neo-adjuvant radiotherapy

Question 6

What are complications of rectal cancer?

Answer 6

Faecal incontinence

Question 7

What is a rectal prolapse?

Answer 7

Rectal wall slides through anus

Question 8

Subtypes of rectal prolapse are

Answer 8

Partial (anterior muscle prolapse)

Complete (full thickness)

Question 9

How does rectal prolapse present?

Answer 9

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

Question 10

What is noticed on examination for rectal prolapse?

Answer 10

Usually poor anal tone

Question 11

How do you treat an incomplete rectal prolapse?

Answer 11

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

Question 12

How do you treat a complete rectal prolapse?

Answer 12

Surgery

if too frail: bulking agent and education on manual reduction

Question 13

What are haemorrhoids?

Answer 13

Enlarged vascular cushions in lower rectum and anal canal

Question 14

How do haemorrhoids present?

Answer 14

Painless bleeding

Perianal itch

Question 15

What are characteristics of PR bleeding in haemorrhoids?

Answer 15

Fresh/bright red blood

Not mixed with stool (usually on paper)

Question 16

How do investigate haemmorhoids?

Answer 16

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

Question 17

How do you treat haemorrhoids?

Answer 17

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

Question 18

What is sclerosation therapy?

Answer 18

Inject with phenol in almond oil - causes vessels to shrink

Question 19

What is the HALO/THO procedure?

Answer 19

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

Question 20

Why is the HALO/THO procedure pain free?

Answer 20

No pain receptors

Question 21

What is an anal fissure?

Answer 21

Tear in the anal margin due to passage of constipated stool

Question 22

Where are anal fissures usually located?

Answer 22

Posterior midline

Question 23

Multiple anal fissures are commonly linked to?

Answer 23

Crohn’s disease

Question 24

How do anal fissures present?

Answer 24

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

Question 25

How do you treat anal fissures?

Answer 25

``` Dietary advice Stool softeners Pharmacological sphyncterectomy Lateral sphyncterectomy Botox injection ```

Question 26

What is pharmacological sphyncterectomy?

Answer 26

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

Question 27

What is a fistula in-ano?

Answer 27

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

Question 28

How does a fistula in ano present?

Answer 28

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

Question 29

How do you investigate a fistula in-ano?

Answer 29

EUA of anorectum Rigid/flexible sigmoidoscopy Proctoscopy

Question 30

How do you treat a fistula in ano?

Answer 30

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

Question 31

Anal cancers are typically?

Answer 31

Squamous cell carcinomas

Question 32

Anal SCCs are associated with?

Answer 32

HPV

Question 33

Anal cancer can progress from?

Answer 33

AIN (Anal intra-epithelial neoplasia)

Question 34

How does anal cancer present?

Answer 34

Perianal pain and bleeding Palpable lesion Faecal incontinence

Question 35

How do you investigate anal cancer?

Answer 35

Rectal EUA and biopsy?

Question 36

What does EUA stand for?

Answer 36

Examination under anaesthesia

Question 37

How do you treat anal cancer?

Answer 37

Radiotherapy and platinum based chemotherapy | Surgery if far enough from anal sphincter

Question 38

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

Answer 38

They will have lifetime faecal incontinence anyway