Surgical Aspects of Anorectal Disease

Question 1

Hemorrhoids are due to the progressive weakening of the usual fibrovascular attachments of _______ ______.

Answer 1

anal cushions

Question 2

What is the sliding anal canal theory?

Answer 2

symptoms of hemorrhoids may occur after engorgement from repeated straining which leads to weakening of the usual ‘fibervascular’ attachments of the hemorrhoid to the underlying real wall, over time this contributes to the downward sliding and the rectum

Question 3

What are anatomical signs that an anal fissure is chronic?

Answer 3

development of a sentinel pile (skin tag) or hypertrophy of papilla

Question 4

Treatment of chronic anal fissure includes?

Answer 4

***decreasing internal sphincter spasm
bulking of the stool with fiber
control of pain

Question 5

What is the most likely cause of perianal abscess?

Answer 5

1 cause infected anal gland- glands are connected via ducts to small pockets (crypts at the base of the anal valves, formed by longitudinal folds)

Question 6

What its the most common type of anal fistula as well as other types possible?

Answer 6

most common is a intersphincteric fistula

other kinds:
extrasphincteric, transsphincteric and supraphincteric fistula

best way to help the patient heal is to open up the fistula and drain and heal to the air, which may or not be possible considering the involvement of the sphincter in the fistula tract. (fistulotomy is the best treatment)

Question 7

What is rectal procidential?

Answer 7

full thickness paroles of the rectum, will note the circumferential folds vs. the radial folds of a mucosal-only prolapse (these are graded 1-4)