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GI > W8: Benign Anorectal Disorders > Flashcards

W8: Benign Anorectal Disorders Flashcards

Haemorrhoids, Rectal Prolapse, Anal fissue, Fistula in ano

1
Q

What are haemorrhoids?

A

Enlarged vascular swellings in the lower rectum and anal canal

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2
Q

How do haemorrhoids present? (3 main symptoms)

A

-painless bleeding -fresh bright red blood -perianal itchiness

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3
Q

What are 2 usual causes for pruritus ani? (anal itching)

A

-overactive sweat glands -haemorrhoids

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4
Q

What do the 3 degrees of haemorrhoids represent?

A

primary -> internal secondary -> prolapsing third -> prolapsed

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5
Q

When patient is in lithotomy position, the branches of what artery do haemorrhoids classically correspond to and at what points?

A

-branches of superior haemorrhoidal artery -3, 7 and 11 o’clock

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6
Q

What are 3 investigations used when diagnosing haemorrhoids?

A

-PR exam -flexible/rigid sigmoidoscopy -protoscopy

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7
Q

What is management of mild haemorrhoids?

A

-mild: suppositories containing a local anaesthetic and steroids -advice about constipation

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8
Q

What are 4 possible procedures for treating haemorrhoids?

A

-open/stapled haemorrhoidectomy -sclerosation therapy -HALO procedure -rubber band ligation

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9
Q

What is the HALO procedure and what does it involve?

A

-Haemorrhoidal artery ligation operation -involves using doppler ultrasound to identify arteries supplying haemorrhoid and ligating arteries

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10
Q

What is a particular benefit of the HALO procedure for the patient?

A

It is pain-free because stitch is placed in lower rectum where there are few sensory nerves

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11
Q

How does sclerosation therapy work for haemorrhoids?

A

-A sclerosing agent is injected into arteries supplying haemorrhoids -arteries swell and scar and cut of blood supply

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12
Q

What is an anal fissue?

A

Tear in the mucosa of the anus which is distal to the dentate line

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13
Q

What are 3 symptoms of anal fissures?

A

-pain upon defecations -fresh blood -visible crack/tear in skin

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14
Q

What age groups are haemorrhoids common in?

A

-young -old

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15
Q

What are 5 causes of anal fissure?

A

-constipation, large hard stools -recurrent straining -chronic diarrhoea -anal intercourse -pregnancy

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16
Q

What bowel disease are anal fissures linked to?

A

-IBD: Crohn’s & Colitis

17
Q

What is the treatment for anal fissures?

A

-dietary advice, stool softeners -topical anaesthetic e.g. lidocaine -pharmalogical sphyncterotomy (topical diltiazem, topical GTN) -lateral sphyncterotomy -botox injection

18
Q

What does a lateral sphyncterotomy involve?

A

small incision made into sphincter muscles to allow healing

19
Q

What is a fistula in ano?

A

An abnormal opening that starts in the anal canal and ends in one or more external openings on the peri-anal skin

20
Q

What are 3 rare causes of fistulae in ano?

A

-Crohn’s -TB -carcinoma

21
Q

What is most common cause of fistulae in ano?

A

-late/inadequate treatment of anorectal abscess

22
Q

What are the 4 types of fistulae in ano?

A

-extrasphincteric -suprasphincteric -intersphincteric -transphincteric

23
Q

What are 4 investigations used when diagnosing fistulae in ano?

A
  • endoanal ultrasound
  • rigid/flexible sigmoidoscopy
  • protoscopy
  • MRI
24
Q

What are 3 surgical management options for fistulae in ano?

A
  • fistulotomy (fistulae opened, drained and stitched back shut)
  • glue
  • insertion of seton (material put in fistulae to encourage drainage)
25
Q

List 4 complications of fistula in ano.

A
  • pain
  • bleeding
  • infection
  • incontinence of stool or flatus
26
Q

How does rectal prolapse present? (4)

A
  • Protruding mass from anus
  • especially protruding during defecation
  • blood and mucous
  • tenesumus
27
Q

What are the two types of rectal prolapse?

A
  • Incomplete: only musocal prolapse
  • complete: full thickness
28
Q

What is treatment for complete rectal prolapse? (3)

A
  • Rectopexy (rectum is surgically pulled back up and stitched in place)
  • resection
  • Delorme’s procedure (cutting away mucosa and stitching rectum to muscle)
29
Q

What is management for incomplete rectal prolapse?

A

-dietary advice on constipation

GI (29 decks)

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