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CP3 SURGERY > UGI/CR - Anus and Rectum > Flashcards

UGI/CR - Anus and Rectum Flashcards

1
Q

DDx - child rectal bleed

A 
Constipation /poor diet
Anal fissure 
Juvenile polyp 
Haemorrhoids 
IBD 
NAI
Trauma
Surgical causes - intussusception, volvulus etc
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2
Q

5 most common causes of infective bloody diarrhoea

A 
Noravirus
Rotavirus
Camplobacter 
Shigella 
salmonella
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3
Q

PS Rectal cancer

A

Bright red PR bleed
Tenesmus
PR - mass? +/- mucus

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4
Q

PS Anal cancer

A 
Bleeding 
Pain 
Changes in bowel habit 
pruritis ani 
Masses 
Stricture
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5
Q

Where is the anal canal from?

A

Superior aspect of pelbic diaphragm –> anus

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6
Q

What is the internal anal sphincter?

A

Involuntary sphincter surrounding upper 2/3 anal canal

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7
Q

What is tonic contraction of the internal anal sphincter stimulated by?

A

Sympathetic fibres from superior rectal/hypogastric plexus

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8
Q

Role of parasympathetic fibres on the internal anal sphincter

A

Inhibit tonic contraction

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9
Q

Where is the external anal sphincter

A

Lower 2/3 anal canal

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10
Q

Is the external anal sphincter under voluntary or involuntary control

A

Voluntary control

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11
Q

Which nn mediates the external anal sphincter?

A

Inferior rectal nn

S4

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12
Q

What is a haemorrhoids

A

Disrupted/dilated anal cushions

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13
Q

Where are internal haemorrhoids

A

Above the dentate line

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14
Q

Where are external haemorrhoids

A

Below dentate line

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15
Q

Position of haemorrhoids

A

3,7,11 oclock (when view from lithotomy position)

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16
Q

Why do haemorrhoids arise?

A

Because of breakdown of SM layer, muscularis mucosae

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17
Q

Aetiology haemorrhoids (3)

A

Idiopathic
Incr anal tone (e.g. chronic constipation)
Factors –> congestion superior rectal

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18
Q

Factors causing congestion of superior rectal vv (4)

A

Cardiac failure
Pregnancy
Rectal carcinoma
Any raised IAP

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19
Q

Where does the superior rectal vein drain?

A

Inferior mesenteric vv

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20
Q

Where does the inferior = middle rectal veins drain?

A

Cavally

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21
Q

Link between haemorrhoids and anal rectal varices

A

Anastomoses of anal cushions = portal-caval anastomoses
Anal-rectal varices can co-exist w/ haemorroids in pt w/ portal HTN
Haemorrhoids most commonly arise in abscence of portal HTN

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22
Q

1st degree haemorrhoids

A

Confined to anal canal

Bleed but don’t prolapse

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23
Q

2nd degree haemorrhoids

A

Prolapse on defecation

Then reduce spontaneously

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24
Q

3rd degree haemorrhoids

A

Prolapse outside anal margin on defecation

May be manually reduced

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25
Q

4th degree haemorrhoids

A

Remain prolapsed outside anal margin at all times

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26
Q

Sx haemorrhoids (5)

A 
Bright red rectal bleed
Prolapse
Mucous discharge 
Pruritis ani 
Painful if piles becomes thrombosed/prolapse
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27
Q

Complications haemorrhoids

A

Anaemia

Thrombosis

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28
Q

How long does it take thrombosed haemorrhoids to fibrose?

A

2-3w

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29
Q

Mx of thrombosed haemorrhoids

A

Conservative
Cold compresses
Opioids
Rest

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30
Q

ix Haemorrhoids (4)

A

Abdo exam
PR
Proctoscopy/rigid sigmoidoscopy
Colonoscopy/flexi-sigmoidoscopy

31
Q

Conservative mx haemorrhoids (4)

A 
Consume plenty fl
Try not to strain 
TO analgesia/astringments 
Bulk forming laxative 
Anti-inflammatory creams
32
Q

Non-conservative Mx haemorrhoids

A

Sclerotherapy

Banding + suction

33
Q

What is Sclerotherapy

A

5% phenol + almond oil into each pile

34
Q

What degree piles can be treated with sclerotherapy

A

1st/2nd degree only

35
Q

How often must sclerothearpy be performed?

A

Monthly

36
Q

SE sclerothearpy (3)

A

Pain
Prostatitis
Infection

37
Q

What degree piles can Banding and suction be used for?

A

1st - 3rd

38
Q

Where must Banding + suction be positioned?

A

Above the dentate line

39
Q

What degree haemorrhoids is surgery used on

A

3rd + 4th degree

40
Q

Types of surgery used for piles Mx

A

Stapled haemorrhoidopexy

Haemorrhoidal aa ligation (HALO)

41
Q

What is a perianal haematoma?

A

Thrombosed external pile

42
Q

Why is a perianal haematoma painful?

A

Because it is covered by squamous epithelium + nerves

43
Q

PS perianal haematoma

A

Sudden pain + lump on anal verge

Lump is tense, smooth, dark-blue, cherry sized

44
Q

Mx perianal haematoma in acute phase

A

Drain under LA

45
Q

Role of anal sinuses/crypts

A

Release mucous when compressed by faeces

46
Q

What are anorectal abscesses usually caused by?

A

Gut organisms

–> fistula

47
Q

What conditions are anorectal abscesses associated with? (5)

A 
Chrons 
Malignancy 
TB 
UC
DM
48
Q

PS Anorectal abscess (2)

A

Painful tender swellings

Constant discharge

49
Q

Mx Anorectal abscess

A

Incision + drainage under GA + seton

50
Q

What is a pilonoidal sinus?

A

Obstruction of natal cleft hair follicles 6cm above the anus
–> abscess formation w/ foul discharge

51
Q

Who gets pilonoidal sinus?

A

Obese males

52
Q

Mx pilonoidal sinus

A

Incision of sinus tract
1’ closure
Pre-op Abx
Hygiene + hair removal advice given

53
Q

Diagnostic tests perianal warts

A

Operative exploration

Or MRI

54
Q

Ix if suspect higher up sepsis in peri-anal wart s

A

EAU

55
Q

Def fistula in ano

A

A track that communicates between the skin + anal canal/rectum

56
Q

Aetiology fistula in ano

A 
TB
Chrons 
Diverticular disease 
Rectal carcinoma 
ICC
57
Q

Ix fistula in ano

A

Exam under anaesthetic
EAU (Endoanal USS)
MRI

58
Q

What does Goodsalls rules relate to?

A

Relates external opening of an anal fistula to the internal opening

59
Q

Goodsalls rules - Posterior fistulas

A

Curved track w/ opening in the posterior midline

60
Q

Goodsalls rules - anterior fistulas

A

Direct opening into the anal cavity

61
Q

Mx of superficial low level distula in ano

A

Laid open to heal by fistulotomy

62
Q

Mx of high fistula

A

Injcted w/ fibrin glue/fistula plug + dries up

63
Q

Use of Seton suture in fistula Mx

A

Gradually tightened over time to maintain continence

64
Q

Med Mx recurrent fistulae/Chrons fistula

A

Metronidazole

65
Q

What is an Anal fissure

A

A tear in the sensitive anal canal distal to the dentate line, producing pain on defecation.

66
Q

Which gender mostly gets anal fissures

A

Males

67
Q

RK Anal fissures (5)

A 
Constipation 
Chrons disease 
Anorectal infection (TB/HIV)
STIs (herpes/syphilis) 
Haematological malig
68
Q

Sx Anal fissure (5)

A 
Sharp burning pain, worse on defecation 
Then dull ache lasting for hrs 
Assoc constipation 
pruritis ani 
bleeding on defecation
69
Q

o/e anal fissure (3)

A 
Midline longitudinal tear in rectal mucosa 
Sentinal pile (ext) 
PR not poss b/c pain + sphincter spasm
70
Q

Ix Anal fissure

A

Proctoscopy + Sigmoidoscopy under GA

To exclude other disease

71
Q

Mx Anal fissure - conservative (3)

A

Small may heal spont
LLA + LUbe - Sx relief
Fl/fibre/bulk-laxative

72
Q

Med Mx Anal fissure

A

0.4% GTN cream (relaxes sphincter)

Botulinum toxin injection (lasts 8w)

73
Q

Mx of Intractable anal fissure

A

Lateral sphincterotomy under GA

CP3 SURGERY (19 decks)

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