Anorectal conditions

Question 1

What are the common presentations of anorectal conditions?

Answer 1

Pain
Haemorrhage
Dysfunction

Question 2

What are the classifications of anorectal conditions?

Answer 2

Inflammation
Infection
Malignancy
Trauma

Question 3

What are the congenital anorectal conditions?

Answer 3

Inperforate anus
Uro-genital fistulae
Hirschprung’s myenteric plexus deficiency

Question 4

What are the causes of an imperforate anus?

Answer 4

Rectum may end in a pouch which does not connect with colon
Rectu may have openings to other structures
Stenosis of anus or no anus

Question 5

What is the treatment of imperforate anus?

Answer 5

Surgery

Question 6

What is Hirschsprung’s myenteric plexus deficiency?

Answer 6

Stool becomes stuck in anus as nerves supplying the end of the colon are missing/not working

Question 7

What are the signs of Hirschsprung’s?

Answer 7

Failure to defaecate in first 48 hours of life

Vomiting

Question 8

What is the treatment of Hirschsprung’s?

Answer 8

Surgery to remove uninnervated section and attach rectum to a section with innervation

Question 9

What is done pre op in Hirschsprung’s?

Answer 9

IV nutrition
Bowel washouts
Possible antibiotics

Question 10

What are the acquired anorectal abnormalities?

Answer 10

Haemorrhoids
Fissure
Abscess 
Fistula
Ulceration
Cancer
Incontinence

Question 11

What are haemorrhoids?

Answer 11

Painful, swollen veins that may bleed

Question 12

What are the signs and symptoms of haemorrhoids?

Answer 12

Irritation, pain and extreme itching around anus
Itchy or painful lump or swelling around anus
Faecal leakage
Painful bpwel movements
Melaena

Question 13

What is the treatment of haemorrhoids?

Answer 13

Pain relief
Fibre supplements
Rubber band ligation
Stapled anopexy

Question 14

What are the complications of haemorrhoids?

Answer 14

Anaemia

Bleeding

Question 15

What are the signs of an anal tissue?

Answer 15

Sharp pain when passing stool followed by a burning pain for several hours
Melaena

Question 16

What are the causes of an anal tissue?

Answer 16

Constipation- straining can cause a tear in the lining
Persistant diarrhoea
IBD
Pregnancy and childbirth

Question 17

What is the treatment of an anal fissure?

Answer 17

Should resolve itself
Fibre
Hydration
Pain relief
Possible laxatives

Question 18

What is an anal abscess?

Answer 18

Collection of pus near anus, usually as a result of infection of small anal glands

Question 19

What is the most common type of anal abscess?

Answer 19

Perianal abscess

Question 20

What is a perianal abscess?

Answer 20

Painful, boil lie swelling ear the anus

Red in colour, warm to touch

Question 21

What are the causes of anal abscesses?

Answer 21

Infected fissure
STI
Blocked anal glands

Question 22

What are the symptoms of an anal fissure?

Answer 22

Constant throbbing pain, worse when seated
Skin irritation around anus
Discharhe of pus
Constipation or pain associated with bowel movements

Question 23

What is the treatment of anal abscesses?

Answer 23

Surgical incision and drainage

Post drainage pain relief and possible antibiotics

Question 24

What are the complications of an anal abscess?

Answer 24

Fistula formation

Question 25

What is an anal fistula?

Answer 25

Narrow channel with internal opening in anal canal and external opening in skin near the anus

Question 26

What are the causes of anal fistulae?

Answer 26

Abscess which, when draining away, leaves behind a tunnel IBD Diverticulitis

Question 27

What are the symptoms of an anal fistula?

Answer 27

``` Skin irritation around anus Constant throbbing pain which is worse when seated, moving, having a bowel movement or coughing Smelly discharge from anus Melaena Pus in stool Swelling and redness around anus Bowel incontinence ```

Question 28

What is the treatment of anal fistulae?

Answer 28

Fistulotomy Seton suture Fill fistula with glue, block with plug, or cover with a flap of tissue

Question 29

What is a fistolotomy?

Answer 29

Cutting open length of fistula so it heals as a flat scar

Question 30

What are the causes of anal ulceration?

Answer 30

Crohn's Malignancy Syphilis Nicorandil- angina drug

Question 31

What are the symptoms of anal cancer?

Answer 31

``` Rectal bleeding Itching and pain around anus Small lumps around anus Discharge of mucus from anus Bowel incontinence ```

Question 32

How is anal cancer diagnosed?

Answer 32

Examination Colonoscopy CT colonography MRI guided colonoscopy

Question 33

What is the classification system of anal cancer?

Answer 33

Dukes

Question 34

What is Dukes A anal cancer and the 5 year survival?

Answer 34

Submucosal cancer | 90%

Question 35

What is Dukes B anal cancer and the 5 year survival?

Answer 35

B1- muscle invasion 80-85% | B2- wall invasion 70-75%

Question 36

What is Dukes C anal cancer and the 5 year survival?

Answer 36

C1- lymph nodes not apical 50-65% | C2- lymph nodes apical 25-45%

Question 37

What is Dukes D cancer and the 5 year survival?

Answer 37

Distant mets | <5%

Question 38

What are the 2 types of anal cancer?

Answer 38

Squamous cell carcinoma | Rectal anenocarcinoma

Question 39

How is anal squamous cell carcinoma treated?

Answer 39

Radiotherapy

Question 40

How is rectal adenocarcinoma treated?

Answer 40

Neoadjuvant chemoradiation | Laprascopic resection

Question 41

What are the types of incontinence?

Answer 41

Urge bowel incontinence | Passive incontinence

Question 42

What is urge bowel incontinece?

Answer 42

Sudden urge to go to the toilet and are unable to make it in time

Question 43

What is passive incontinence?

Answer 43

Experience no sensation before soiling themselves

Question 44

What are the 3 causes of bowel incontinence?

Answer 44

Problems with rectum Problems with sphincter muscles Nerve damage

Question 45

What are the rectal reasons for incontinence?

Answer 45

Constipation Diarrhoea Scarring of rectum Severe haemorrhoids

Question 46

How can constipation cause incontinence?

Answer 46

Bowel impaction can cause rectal wall muscles to weaken, allowing watery stools to leak around the impacted stools and out of the anus

Question 47

What can cause the sphincter muscles to weaken or be damaged?

Answer 47

Childbirth Injury Rectal/bowel surgery

Question 48

What nerves supply in the internal anal sphincter?

Answer 48

Sympathetic fibres of the inferior hypogastric plexus

Question 49

What nerves supply the external anal sphincter?

Answer 49

Inferior rectal nerve and perineal branch of S4

Question 50

What nerve ssupply the anal canal?

Answer 50

Upper 1/2- hypogastric plexus | Lower 1/2- inferior rectal nerves

Question 51

What can cause damage to the nerves supplying the anal canal?

Answer 51

Diabetes MS Stroke Spina bifida