Anal and Perianal Dz Flashcards Preview

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Flashcards in Anal and Perianal Dz Deck (67):
1

where is the rectal blood supply

iliac artery

2

what lymphs nodes can be felt for rectal cancer

inguinal lymph nodes

3

where does the anal canal stand and end?

start at dentate line
ends at anal verge

4

what cause perirectal abscesses?

Columns of morgagni each with crypts

5

most common symptom of rectal cancer?

bleeding

6

can you do radiation on rectal cancer patients?

yes, helps reduce size before removal

7

what do you do for Lesions in the middle and upper third of the rectum

low anterior resection (LAR)

8

For lower third rectal cancers
Rectum and anus removed
Permanent colostomy

Abdominal perineal resection (APR)

9

Protrusion of the full thickness of the rectal wall through the anus – concentric rings

full thickness rectal prolapse

10

prolapse w/ Only the mucosa protrudes from the anus

mucosal prolapse

11

when do rectal polapses peak?

Peaks in occurrence are noted in the fourth and seventh decades of life, and most patients (80-90%) are women

12

tx for rectal prolapse

abomdinal appraoch- anterior resection w/ rectopexy

13

what do you need to do before surgical tx for rectal prolapse

colonscopy pre-op to exclude CA

14

most common anorectal problem?

hemorrhoids

15

vascular connective tissue originating above the dentate line

internal hemorrhoids

16

vascular complexes underlying the richly innervated anoderm (below the dentate line)

external hemorrhoids

17

External hemorrhoids become symptomatic with

thrombosis

18

Internal hemorrhoids become symptomatic when the internal complex becomes chronically ________ or the tissue prolapses into the anal canal

engorged

19

pain complaints w/ internal hemorrhoids

bleeding and itching

20

internal hemorrhoid w/ bleeding w/o prolapse

stage 1

21

internal hemorrhoid bleeding w/ prolapse but reduce sponatenously

stage 2

22

internal hemorrhoid bleeding with prolapsed that require manual reduction

stage 3

23

internal hemorrhoid prolapsed and cannot be reduced

stage 4

24

what are hemorrhoids associated w/

associated with constipation, chronic diarrhea, straining, pregnancy, pelvic masses, and family history

25

what should you rule out w/ rectal bleeding

r/o CA and IBD

26

Bright red blood per rectum on TP or outside of stool
Mucous discharge
Rectal fullness or discomfort

internal hemorrhoid

27

Sudden severe perianal pain
Perianal mass

external hemorrhoids

28

medical tx for hemorrhoids

treat constipation or diarrhea
stool softeners and bulking agents
exercise

29

tx for internal hemorrhoids

elastic band ligation

30

what is injection sclerotherapy doen for?

1st and 2nd degree internal hemorrhoids

31

what is excisional hemorrhoidectomy done for?

3rd and 4th degree and mixed

32

Thrombosed external hemorrhoids can be excised or the clot evacuated if they present in less than ___ hours after the onset of symptoms

48

33

A linear tear or superficial ulcer of the anal canal at the anal margin
Most commonly posterior in the midline

anal fissure

34

what are anal fissure associated w/?

constipation and/or trauma to the anal canal from hard stool

35

cardinal symptom of anal fissure

severe anal pain on defecation w/ some BRB

36

______ fissures or ulcers are usually multiple, in atypical locations, and relatively pain free

Crohn’s

37

_________________ are usually squamous cell cancers and are usually deeper with heaped up edges, in atypical locations, and usually pain free

Neoplastic ulcers

38

Tx for anal fissures

Relax the anal sphincter either medically or surgically to promote healing of the ulcer

39

mainstay tx for anal fissure

laternal internal spinchterotomy

40

meds for anal fissures

nitroglycerine
CCB

41

risk w/ laternal internal spinchterotomy

fecal incontinence

42

who have increased risk w/ anorectal abscess

diabetes, Crohn’s disease, and the immunocompromised

43

Severe anal pain
Palpable mass usually present on perianal or digital rectal exam
Systemic sepsis

Anorectal abscess

44

tx for anorectal abscess

surgical drainage (I and D) may need to be done in OR

45

An abnormal communication between the anorectum and the perianal skin

anorectal fistula

46

causes of anorectal fistula

crohn's
carcinoma
radiation damage
TB

47

May present with recurrent perirectal abscesses or with a chronic and intermittent bloody/purulent drainage associated with pain and discomfort

anorectal fistula

48

tx for anorectal fistula

fistulotomy or seton

49

An acquired, chronic inflammatory condition in which hair becomes embedded in the subcutaneous tissue causing a foreign body reaction

Pilonidal Dz

50

patients can present with an acute abscess, a chronic draining sinus, or an asymptomatic sinus

pilonidal diseaes

51

who is pilonidal dz common in?

young caucasian men 15-24 w/ dark and stiff hair

52

diagnosis of pilonidal dz

identifying small opening or pits in the midline natal cleft of the sacrococcygeal region

53

tx for pilonidal dz (non-operative)

hair removal, meticulous hygiene, antibiotics

54

Operative tx for pilonidal Dz

excision, incision and drainage
must go all the way down to sacral fascia
usually left open

55

Sexually transmitted and caused by the human papilloma virus (HPV)
Most commonly seen in homosexual males and are associated with anal sex

Perinanal warts (condylomata acuminata)

56

what can perianal warts be a precursor to?

invasive squamous cell carcinoma

57

Tx for perinanal warts

combination of electrocautery fulguration and sharp excision

58

topical preparation for perinanal warts

25% podophyllin

59

what are most anal cancers

Most are squamous cell cancers with rare melanomas and adenocarcinomas of anal gland origin

60

risks for anal cancer

anal sex, immunodeficiency, anal warts, other STDs

61

Anal margin cancers occur outside the ___________

anal verge

62

Anal canal cancers occur inside the _________

anal verge

63

how does anal margin CA present

Typically presents with mass, bleeding, pain, discharge, itching, and tenesmu

64

tx for anal margin cancer

Wide local excision vs abdominoperineal resection +/- chemoradiation

65

all patients w/ hemorrhoids need what?

rectal exam for CA

66

1st line tx for large anal canal tumors

Chemoradiotherapy (Nigro regimen)

67

tx for small tumors of anal canal cancer

local excision