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Surgery M4 part 2 > Anal canal diseases > Flashcards

Anal canal diseases Flashcards

1
Q

What are the causes of anal fissures?

A
  • chronic constipation with passage of hard mass
  • dragging of the mucosa by a prolapsed pile
  • traumatic tearing by an enema nozzle, or large anal speculum
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2
Q

What are the common locations for an anal fissure to occur?

A
  • mid-posterior point (90%)

- mid-anterior (10%)

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3
Q

What is the difference between acute & chronic anal fissure?

A

ACUTE CHRONIC

  • no fibrosis - fibrosis
  • superficial - deep
  • mobile - fixed
  • internal sphincter spastic - fibroses sphincter
  • no piles - piles
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4
Q

What are the local symptoms of anal fissures?

A
  • severe pain at defecation
  • bleeding within or after defecation
  • anal discharge -> pruritis -> itching
  • pruritis
  • constipation
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5
Q

What are the reflex symptoms of anal fissures?

A
  • bladder: dysuria -> retention
  • GYN: dysmenorrhea & dyspareunia
  • back pain sometimes referred to posterior aspect of thighs
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6
Q

What are the signs of anal fissures?

A
  • acute anal fissure is seen
  • chronic anal fissure is felt
  • > elongated indurated ulcer
  • > sentinel pile
  • > fibroid internal sphincter
  • > hypertrophied papilla
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7
Q

What are the complications of anal fissures?

A
  • chronicity
  • abscess
  • perianal or submucous fistula
  • pruritis ani & eczema of perineal skin
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8
Q

How should acute anal fissures be treated?

A
  • high fiber diet & laxatives
  • local anesthetic ointment (lignocaine)
  • glyceryl trinitrate ointment -> gives headaches
  • warm bath for 10 - 15 minutes (Sitz bath)
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9
Q

How is a chronic anal fissure treated?

A

lateral internal sphincterotomy operation

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10
Q

What is the difference between internal & external hemorrhoids?

A

INTERNAL EXTERNAL

  • lower rectum upper anal canal - lower anal canal
  • columnar epithelium - skin
  • varicosity of internal hemorrhoidal plexus - external hemorrhoidal plexus
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11
Q

What are the causes of secondary piles?

A
  • congestive heart failure or constrictive pericarditis
  • liver cirrhosis & portal hypertension
  • pregnancy
  • fibroid
  • retroperitoneal sarcoma
  • carcinoma of the rectum
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12
Q

What are the precipitating factors of primary piles?

A
  • stricture urethra
  • chronic constipation
  • prolonged standing
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13
Q

What are the number & position of piles?

A

determined by the superior rectal artery

  • right anterior -> 11 o’clock
  • right posterior -> 7 o’clock
  • left lateral -> 3 o’clock
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14
Q

What is the clinical picture of hemorrhoids?

A
  • bleeding per rectum -> fresh bright
  • prolapse
  • discharge
  • pruritis ani
  • pain if complicated
  • secondary anemia
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15
Q

What is used for rectal examination of piles?

A
  • proctoscopy

- sigmoidoscopy

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16
Q

What are the complications of hemorrhoids?

A

GENERAL

  • secondary anemia
  • portal pyemia

LOCAL

  • bleeding
  • prolapse
  • thrombosis of prolapsed pile due to sphincteric spasm (surgery within 24hrs)
  • infection -> perianal suppuration & sloughing
  • ulceration
  • fibrosis
  • anal fissure due to traction
17
Q

How are hemorrhoids/piles graded?

A

GRADE I -> no protrusion
GRADE II -> protrusion with spontaneous reduction
GRADE III -> protrusion manually reduced
GRADE IV -> protrusion that does not reduce

18
Q

How are hemorrhoids treated?

A
  • first & degree: conservative, inject sclerotherapy, rubber band ligation, photocoagulation
  • third & fourth: surgery
    if secondary piles -> treat the cause
19
Q

If pile prolapse is circumferential, which surgical procedure is done?

A

stapled hemorrhoidectomy

20
Q

What is the cause of perianal hematoma?

A

rupture of dilated anal vein as a result of severe straining

  • sudden onset of painful lump inn the anus
  • swelling tense & tender
  • bluish in color with smooth shining skin
21
Q

How is a perianal hematoma treated?

A
  • if patient presents within 48hrs -> evacuation
  • if patient presents late -> conservative treatment
  • if untreated -> resolution
  • > ulceration
  • > suppuration
  • > fibrosis gives rise to skin tag
22
Q

What are the causes of ano-rectal suppurations?

A
  • infected hair follicle, sebaceous cyst, perianal hematoma or fissure
  • infection while treating piles
  • spread of infection from nearby organs
  • Crohn’s disease, cancer, leukemia, & lymphoma
23
Q

What are the clinical features of ano-rectal suppuration?

A
  • pain increasing with perianal movement
  • pruritis
  • generally unwell
  • fever
  • swelling
  • cellulitis
  • induration
  • fluctuation
  • subcutaneous mass
  • DRE: fluctuation BUT DONT WAIT till u feel it
24
Q

What are the classifications of anorectal abscesses?

A
  • perianal 60%
  • ischiorectal 20%
  • intersphincteric 15%
  • supralevator 4%
25
Q

What investigations are used to diagnose anorectal abscesses?

A

anal ultrasonography
CT
MRI

26
Q

How are anorectal abscesses treated?

A

early drainage because delay can cause

  • prolonged infection
  • tissue destruction
  • chances of sphincter dysfunction
  • promotes fistula formation
27
Q

What are the causes of anal fistulas?

A
  • Crohn’s
  • ulcerative colitis
  • cancer rectum
28
Q

What are the classifications of anal fistulas?

A
  • inter-sphincteric 70% -> internal sphincter to intersphincteric space then perineum
  • trans-sphincteric 25% -> internal & external sphincter into ischiorectal fossa then perineum
  • supra-sphincteric 4% -> intersphincteric space to above puborectalis muscle into ischiorectal fossa then peritoneum
  • extra-sphincteric 1% -> from perianal skin through levator ani to rectal wall
29
Q

What is Goodsall’s rule?

A
  • any anterior fistula that is 3cm or less from the anus has a straight course
  • any anterior fistula that is more than 3cm away from anus curves to the back
  • any posterior fistula has a curved course
30
Q

What are the imaging studies used to see a fistula?

A

1- fistulography -> may not be accurate due to fibrosis

2- MRI -> study of choice

31
Q

How are fistulas treated?

A
  • fistulotomy -> reroof the canal & curettage the floor -> heals by fibrosis
  • fistulectomy -> complete excision of tract
  • for high fistula: two stage operation SETON PLACEMENT
  • anorectal fistula: conical drainage
32
Q

What are the indications of Seton placement?

A
  • complex fistula
  • recurrent fistula
  • anterior fistula in females
  • poor pre-op sphincter pressure
  • immunosuppressed

healing in 6 weeks

33
Q

What is a pilonidal sinus?

A
  • infective process occurring in natal cleft or sacrococcygeal region (between buttocks, umbilicus, & axilla)
  • in young adults & teenagers
  • common in hair dressers
34
Q

What are the clinical features of pilonidal sinus?

A
  • discharge
  • throbbing pain
  • swelling above coccyx in midline
  • tufts of hair may be seen in opening
35
Q

What are the complications of pilonidal sinus?

A
  • sacral osteomyelitis
  • necrotizing fasciitis
  • meningitis
36
Q

How are pilonidal sinuses treated?

A

in jackknife position (prone) all sinus tracts are removed + methylene blue is injected

  • antibiotics with surgery
  • incision & drainage if abscess
37
Q

What are the causes of recurrence of a pilonidal sinus?

A
  • improper removal
  • existing diverticulum
  • entry of new tufts of hair
  • breakage of scar

Surgery M4 part 2 (36 decks)

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