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MRCS med school > Perianal disease > Flashcards

Perianal disease Flashcards

1
Q

Pruritis ani causes

A

Moist/soiled anus

threadworm

others

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2
Q

Pruritis ani rx

A

hygiene

anaesthetic cream,

moist wipe post-defecation,

avoid spicy food, steroid/antibiotic cream.

capsaicin

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3
Q

Fissure-in-ano def

A

tear in squamous cell lining of lower anal canal

mostly posterior

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4
Q

Fissure-in-ano cause

A

hard faeces

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5
Q

Fissure in ano 1st line rx

A

lidocaine+GTN ointment

or topical diltiazem

diet: high fibre, fluids

stool softner

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6
Q

Fissure in ano 2nd line

A

botox + diltiazem

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7
Q

Surgical rx of fissure in ano

A

lateral partial internal sphincterotomy

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8
Q

Fistula in ano pathophysiology

A

intramuscular gland ducts block

abscess formation

fistula

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9
Q

Causes of fistula in ano

A

perianal sepsis/abscess

crohns

TB

diverticular disease

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10
Q

Ix for fistula in ano

A

MRI

Endoanal US scan

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11
Q

Rx of fistula in ano

A

Fistulotomy + excision

If high (sphincter): seton suture tightened over time to maintain continence

If low: laid open to heal by secondary intention

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12
Q

Perianal haematoma def

A

thrombosed external pile

2-4 mm dark blueberry looking thing

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13
Q

Perianal haematoma rx

A

evacuated under LA or left to resolve spontaneously

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14
Q

Pilonidal sinus

A

obstruction of natal cleft hair follicles (6 cm above anus)

inflammation and secondary tracks opening laterally, d/c puss

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15
Q

Pilonidal sinus rx

A

excision of sinus tract + primary closure

hair removal advice

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16
Q

Rectal prolapse types

A

Type 1: Mucosa

Type 2: all layers

protruding through anus

17
Q

Rx of rectal prolapse

A

Rectopexy (rectum fixed to sacrum) ± mesh insertion ± rectosigmoidectomy

18
Q

Perianal warts types

A

Condylamata acuminata (viral)

Condylamata acuminata of Bushke & Loewenstein (low-grade, non-mets verrucous cancer)

Condylamata lata (2ndary to syphillis)

19
Q

Condylomata acuminata rx

A

Podophyllotoxin

Imiquimod

Cryotherapy

20
Q

Proctalgia fugax

A

Idiopathic, intense, brief, stabbing/crampy rectal pain, often worse at night

21
Q

Proctalgia fugax rx

A

reassurance

inhaled salbutamol

topical GTN or diltiazem

22
Q

RFs for anal cancer

A

Syphillis

Warts (HPV 6,11,16,18,31,33)

Homosexual receptive sex

23
Q

Anal cancer cell type

A

mostly squamous cell

24
Q

Differentiation of anal cancer

A

above dentate line: poorly differentiated, poor prognosis

Below dentate line/anal margin: well diff, good prognosis

25
Q

Anal ca rx

A

Radiotherapy + chemo

(2nd line: anorectal excision+colostomy)

26
Q

Haemorroids aka

A

piles

27
Q

Haemorroids def

A

disrupted and dilated anal cushions

28
Q

Anal cushion def

A

Three anal cushions at 3,7,11 o clock

Discontinuous masses of spongy vascular tissue that line the anus

Contribute to anal closure

29
Q

Pathophysiology of haemorroids

A

Constipation -> vascular cushions protrude through tight anus -> congested -> hypertrophy ->protrude even more

30
Q

Classification of haemorroids

A

1st degree: Remain in the rectum

2: Prolapse through the anus on defecation but spontaneously reduce
3: As for 2nd-degree but require digital reduction
4: Remain persistently prolapsed

31
Q

Medical rx of haemorroids

A

Fluids + fibre

Topical analgesic + stool softner

+/- topical steroids

32
Q

Non-operative rx of haemorroids

A

Rubber band ligation

Sclerosants

Infra-red coagulation

Cryotherapy

33
Q

Surgical rx of haemorroids

A

Excisional haemorroidectomy (best, but 2wks off work)

Stapled haemorroidopexy

34
Q

When to use medical rx of haemorroids

A

1st degree

35
Q

When to use non-operative rx of haemorroids

A

2/3rd degree

resistant 1st degree

MRCS med school (44 decks)

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