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Gastroentrology > 3: Anal Lesions > Flashcards

3: Anal Lesions Flashcards

(73 cards)

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1
Q

Define a haemorrhoid

A

Abnormal enlargement of anal vascular cushion

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2
Q

What is a first-degree haemorrhoid

A

Remains in rectum

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3
Q

What is a second-degree haemorrhoid

A

Protrudes on defecation - spontaneously reduces

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4
Q

What is a third-degree haemorrhoid

A

Protrudes on defecation - needs to be manually reduced

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5
Q

What is a fourth-degree haemorrhoid

A

Continually protruding - cannot be manually reduced

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6
Q

Aside from ‘degree classification’ how can haemorrhoids be categorised

A

Internal vs. External

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7
Q

Where do internal haemorrhoids arise

A

Superior Haemorrhoidal Plexus

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8
Q

What is the difference between internal and external haemorrhoids

A

Internal - painless

External - cutaneous pain

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9
Q

When is the peak incidence of haemorrhoids

A

45-65y

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10
Q

What are 5 risk factors for haemorrhoids

A
  1. Age
  2. Straining eg. chronic constipation
  3. Raised intra-abdominal pressure (pregnancy, obesity)
  4. FH
  5. Portal HTN - due to HF
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11
Q

How do internal haemorrhoids present

A

Painless
Pruritus
Bright-red bleeding

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12
Q

How do external haemorrhoids present

A

Painful mass

Pruritus

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13
Q

What is the most common position for haemorrhoids by ‘clock face’

A

3, 7 and 11 O’Clock

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14
Q

How are haemorrhoids investigated

A

DRE

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15
Q

What imaging may be used to confirm diagnosis of haemorrhoids

A

Protoscopy

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16
Q

How are the majority of haemorrhoids managed

A

conservatively

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17
Q

What are the 4 conservative measures for managing haemorrhoids

A
  1. Increase fibre
  2. Fluids
  3. Stool-softening laxatives
  4. Topical analgesia
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18
Q

How can first and second degree haemorrhoids be managed

A

Rubber band ligation

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19
Q

What surgical procedure is indicated for third and fourth degree haemorrhoids

A

Haemorrhoidectomy

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20
Q

What is the dentate line

A

A circular line comprised of anal valves. It separates upper from lower anus.

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21
Q

Where is the embryological origin above the dentate line

A

Endoderm

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22
Q

Where is the embryological origin below dentate line

A

Ectoderm

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23
Q

What is the cell type above the dentate line

A

Simple columnar

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24
Q

What is the cell type below the dentate line

A

Stratified squamous

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25
What is blood supply above dentate line
Superior rectal artery
26
What is the superior rectal artery a branch of
Inferior mesenteric. a
27
What supplies blood to below the dentate line
Inferior rectal artery
28
What is the inferior rectal artery a branch of
Internal pudendal artery
29
Explain venous drainage above the dentate line
``` Internal haemorrhoid plexus Superior rectal vein Inferior mesenteric vein Splenic vein Portal vein Hepatic vein ```
30
Explain venous drainage from below the dentate line
External haemorrhoid plexus Internal pudendal vein Common iliac vein
31
What is the lymphatic drainage above the dentate line
Inferior iliac lymph nodes
32
What is the lymphatic drainage below the dentate line
Superficial inguinal lymph nodes
33
What type of muscle comprises the internal-anal sphincter
Involuntary muscle
34
What type of muscle comprises the external anal sphincter
Skeletal muscle
35
What innervates the external anal sphincter
Pudendal Nerve
36
When may injection sclerotherapy be used to treat haemorrhoids
Grade I or II haemorrhoids
37
What is injection sclerotherapy
5% Phenol is injected into haemorrhoids
38
What is the main complication of injection sclerotherapy
High failure rate
39
What are the indications for rubber band ligation of haemorrhoids
Internal haemorrhoids
40
What are 2 complications of rubber band ligation
Pain | Bleeding
41
When is a haemorrhoidectomy indicated
Grade 3 or 4 haemorrhoids
42
What is an anorectal abscess
Collection of pus in anal or rectal region
43
How do anorectal abscesses present clinically
Intermittent perianal pain - worse on sitting down
44
On examination how will a perianal abscess appear
Red tender mass, possibly with purulent discharge
45
How are peri-anal abscesses investigated
DRE under anaesthesia
46
How are peri-anal abscesses managed
Drainage
47
What is a complication of pero-anal abscesses
Peri-anal fistula
48
What is the most common cause of perianal abscesses
E.coli
49
What imaging is gold-standard for investigation of perianal abscesses
Trans perianal US
50
What are two risk factors for perianal abscesses
DM | Crohn's disease
51
What is an anorectal fistula
Abnormal connection between anal canal and perianal skin
52
In which gender are anorectal fistulas more common
Males
53
What causes anorectal fistulas
Often secondary to perianal abscess
54
What are 3 risk factors for anorectal fistulas
``` Diabetes Crohn's disease Previous radiotherapy HIV Previous anal trauma ```
55
How do anorectal fistulas present
Continuous faecal discharge | Can cause: pain, change in bowel habit and systemic features of infection.
56
In what position are 90% of fistulas located
Posterior midline (6 O' Clock position)
57
What imaging is used to investigate fissures in ano
Rigid sigmoidoscopy
58
How will an anal fissure present clinically
Intense pain post-defecation that may last for several hours Bright red blood on defecation
59
What is rectal prolapse
Where a portion or all of the rectum protrudes out of the anus
60
What is partial thickness rectal prolapse
Where rectal mucosa protrudes out the anus
61
What is full-thickness rectal prolapse
Where entire rectal wall protrudes out the anus
62
What is an anal cancer
cancer that lies exclusively in the anal canal
63
What age-group does anal cancer typically occur
85-89
64
What causes 90% of anal cancers
HPV Infection
65
What strands of HPV are cancerous
HPV16 + HPV18
66
Give 5 risk factors for anal cancers
MSM: especially if higher number sexual partners HIV Women with CIN or cervical cancer Smoking Immunosuppressive drugs
67
How do anal cancers present
Pain and bleeding
68
What type of cancer are anal cancers mostly
Squamous cell carcinoma
69
What precedes development of invasive anal cancer
Anal intra-epithelial neoplasm (AIN)
70
What is development of AIN associated with
HPV
71
What investigations are performed for anorectal cancer
``` Protoscopy Examination under anaesthesia HIV test Cervical smear (females) US-guided FNA lymph nodes CT CAP to stage MRI to stage ```
72
What is used to manage anal cancer
Chemoradiotherapy
73
What is used for advanced anal cancers
Abdominoperineal resection (APR)

Gastroentrology (18 decks)

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