Anal Diseases

Question 1

define perianal disease

Answer 1

thesis recurrent abscess formation, leading to pain and leakage

Question 2

diagnosis of perianal disease

Answer 2

PR examination

Question 3

management of perianal disease

Answer 3

surgical drainage

antibiotics

Question 4

define haemorrhoids

Answer 4

enlarged vascular cushions in the lower rectum and anal canal

Question 5

presentation of haemorrhoids

Answer 5

painless bleeding

itch

Question 6

diagnosis of haemorrhoids

Answer 6

PR examination
proctoscopy
sigmoidoscopy

Question 7

management of haemorrhoids

Answer 7

only if symptomatic
grade I- III= sclerosation or rubber banding
grade IV= haemorrhoidectomy
HALO/THD procedure (locates artery supplying haemorrhoid and ties it off)

Question 8

define a rectal prolapse

Answer 8

rectum loses its normal attachments inside the body (can be partial or complete)

Question 9

presentation of a rectal prolapse

Answer 9

protruding mass from the anus (particularly after defecation)
PR bleeding and mucus

Question 10

diagnosis of rectal prolapse

Answer 10

PR shows poor anal tone

Question 11

management of rectal prolapse

Answer 11

rectoplexy (reattachment of rectum)
Derlome’s procedure (mucosa and muscle removed)
anterior resection (removal of that part of rectum)
too frail for surgery = bulking agents and manual reduction education

Question 12

define an anal fissure

Answer 12

this is a tear in the anal margin, due to a constipated stool

Question 13

what does multiple fissures indicate?

Answer 13

Crohn’s

Question 14

presentation of an anal fissure

Answer 14

acute pain following an episode of constipation (can b up to 1/2 hour after)
PR bleeding

Question 15

management of an anal fissure

Answer 15

dietary advice
stool softener e.g. docusate
GTN cream and diltiazem to relax sphincters
sphincterotomy or botox injection

Question 16

define an anal fistula

Answer 16

abnormal communication between two epithelial surfaces

Question 17

presentation of an anal fistula

Answer 17

recurrent abscess, pain, itch, PR bleeding

Question 18

diagnosis of an anal fistula

Answer 18

examination
proctoscopy
sigmoidoscopy

Question 19

management of an anal fistula

Answer 19

insertion of seton (suture if high fistula)
LIFT procedure (closure and removal of infected tissue)

Question 20

classification of haemorrhoids

Answer 20

1st degree= no prolapse
2nd degree= prolapse when straining and return on relaxation
3rd degree= can be pushed back
4th degree= permanent prolapse

Question 21

topical therapies for haemorrhoids

Answer 21

anusol and germoloid creams

Question 22

score for major lower GI bleeds for discharge planning

Answer 22

Oakland score

Question 23

what causes an anorectal abscess?

Answer 23

infection originating in cryptoglandular epithelium lining the anal canal that spreads to soft tissues with abscess formation

Question 24

location of anorectal absccesses

Answer 24

ischiorectal
intersphincteric
supralevator
perianal

Question 25

what to expect if extreme pain in haemorrhoids

Answer 25

blood supply strangulation

Question 26

what is a perianal haematoma cause?

Answer 26

rupture of perianal subcutaneous blood vessel

Question 27

presentation of perianal haematoma

Answer 27

blue/ black bulge at anal margin

Question 28

classification for anal fistula

Answer 28

Park’s classification

Question 29

what is Goodsall’s rule?

Answer 29

transverse line through the anus in lithotomy position. Fistula with opening anterior to this will follow a straight line to the anus. Fistulae with an opening posterior will follow a curved line

Question 30

what is the pilonidal sinus?

Answer 30

hair containing sinus that can cause inflammation

Question 31

management of pilonidal sinus

Answer 31

hygiene
shaving
surgery - incision and drainage, WLE and flap

Question 32

RF for anal carcinoma

Answer 32

HPV

receptive anal intercourse

Question 33

most common anal carcinoma

Answer 33

squamous cell

Question 34

management of anal carcinoma

Answer 34

radiotherapy +/- chemotherapy