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A - MSRA Gastrointestinal [7] > [6] Anal Fistula > Flashcards

[6] Anal Fistula Flashcards

1
Q

What is an anal fistula?

A

An abnormal connection (a channel) between the anal canal and the perianal skin

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2
Q

What are anal fistulas associated with?

A

Anorectal abscess formation

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3
Q

Who are anal fissures more common in?

A

Males

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4
Q

What does the formation of an anal fistula typically occur as a consequence of?

A

Anal abscesses

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5
Q

What % of individuals with an anal abscess will develop an anal fistula?

A

Between 25-50%

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6
Q

Is it common for anorectal cancers to present with an anal fistula?

A

No, it is rare

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7
Q

What are the risk factors for anal fistulas?

A

Inflammatory bowel disease
Systemic diseases
History of trauma to anal region
Previous radiation therapy to anal region

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8
Q

What systemic diseases increases the risk of anal fistulas?

A

Tuberculosis
Diabetes
HIV

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9
Q

What do anal fistulae commonly occur in cases of?

A

Chronic anal infection

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10
Q

How do anal fistuale often present?

A

With an intermittent or continuous discharge onto the perineum
They may also cause severe pain, swelling, change in bowel habit, and systemic features of infection

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11
Q

What may the discharge be in anal fistulae?

A

Mucus, blood, pus, or faeces

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12
Q

What will be found on examination with anal fistulae?

A

An external opening on the perineum, which can be fully open or covered in granulation tissue
A fibrous tract may be felt underneath the skin on DRE

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13
Q

What can the Goodsall rule be used for?

A

To clinically predict the trajectory of a fistula tract, depending on the location of the external opening

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14
Q

What does the Goodsall rule say about external openings posterior to the transverse anal line?

A

The fistula tract will follow a curved course to the posterior midline

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15
Q

What does the Goodsall rule say about external openings anterior to the transverse anal line?

A

The fistula tract will follow a straight radial course to the dentate line

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16
Q

What imaging can be used in the investigation of an anal fistula?

A

Rigid sigmoidoscopy
Fistulography
Endo-anal ultrasound
MRI imaging

17
Q

What can a rigid sigmoidoscopy be used for in anal fistulas?

A

To visualise the opening of the tract in the anal canal

18
Q

What are fistulography, endo-anal ultrasound, or MRI imaging used for in anal fistulas?

A

May be used to visualise the remaining part of the tract

19
Q

What is used for the classification of anal fistulae?

A

Park’s classification system

20
Q

What are the types in Park’s classification system?

A

Inter-sphincteric fistula
Trans-sphincteric fistula
Supra-sphincteric fistula
Extra-sphincteric fistula

21
Q

What is the most common type of anal fistula?

A

Inter-sphincteric fistula

22
Q

What is the least common type of anal fistula?

A

Supra-sphincteric fistula

23
Q

What does the definitive management of an anal fistula depend on?

A

Depends largely on the case

24
Q

When may a conservative approach be used in the management of anal fistulae?

A

If the patient has no symptoms

25
Q

What are the surgical options for an anal fistula?

A

Fistulotomy

Placement of a seton and/or opening the perianal skin adjacent to the external opening

26
Q

What does a fistulotomy involve?

A

Laying the tract open and allowing it to heal by secondary intention

27
Q

How is the tract opened in a fistulotomy?

A

A probe is passed into the tract, and the skin, subcutaneous tissue, and internal sphincter are divided in turn, thus opening the tract

28
Q

Is there an impairment in continence following a fistulotomy?

A

If the fistula has a low tract course, continence is rarely impaired post-operatively. If the fistula has a high tract course, then there is a higher chance of impairment in continence

29
Q

What is meant by a low tract course in anal fistulae?

A

The tract travels through less subcutaneous tissue and muscle

30
Q

What is the purpose of the placement of a seton and/or opening the perianal skin adjacent to the external opening?

A

It promotes healing before external closure, and prevents recurrence of an abscess

31
Q

When should surgery for an anal fissure not be performed?

A

In the setting of an acute anorectal abcess

A - MSRA Gastrointestinal [7] (44 decks)

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