Anorectal Disorders Flashcards by Sarah Anderson

What is the Blood vessel, and lymph innervation of the anal and rectal canal

Arterial
=Superior/inferior rectal artery

Venous
=Superior/inferior
rectal vein

Lymphatic
= para-rectal nodes + superficial inguinal nodes

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What muscle later becomes the internal anal sphincter

Circular

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What controls the voluntary external anal spinchter

Inferiori rectal nerve which is a branch of the Perineal branch of the 4th sacral nerve

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What control the involuntary internal anal spinchter

Sympathetic fibres from the inferior hypogastric plexus

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What is the common presentation of an-rectal disorders

Pain
haemorrhage
Dysfunction

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What is the 4 classifications of an-rectal disorders

Inflammation
Infection
Malignancy
Trauma

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What are 3 examples of congenital ano-rectal abnormalities

Imperforate anus

Uro-Genital Fistulae

Hirschprung’s Myenteric Plexus Deficiency

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What is 7 examples of acquired an-rectal abnormalities

Haemorrhoids

Fissure

Abscess

Fistula-in-ano

Ulceration

Cancer

Control of Continence

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What is the Haemorrhoids and where is it located

Painful, swollen veins that may bleed

Located internal and external to the anal canal

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What is the presentation and symptoms of haemorrhoids

Extreme itching around anus

Irritation and pain around anus

Itchy or painful lump or swelling around anus

Faecal leakage

Painful bowel movements

Melaena

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What is the treatment of Haemorrhoids

Pain relief

Fibre supplements

Rubber band ligation

Stapled anoplexy

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What is stapled apoplexy

surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position

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What does stapled anoplexy treat

Rectal prolapse and haemorrhoids

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What is the complications of haemorrhoids

Bleeding

Anemia

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What is the symptoms of anal fissure

Sharp pain when passing stool

Followed by burning pain lasting several hours

Melaena

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What is the aetiology of anal fissures

Constipation
- Straining causes tear in lining

Persistent diarrhoea

IBD

Pregnancy and childbirth

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How is the symptoms of anal fissures Managed

Should resolve independently

Pain relief

Hydration
Fibre
May be given laxatives by GP

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What is the complications of anal fissures

Failure to heal:
chronic > 6 weeks

Recurrence - prone to having another one.

A tear that extends to surrounding muscles

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What is the medical treatment of anal fissure

Topical nitric oxide
Glycerine trinate pasta
Diltiazem Calcium blocker

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What is the mechanism of medical treatment of anal fissure

Relax internal anal spinchter

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What is the surgical treatment of anal fissureand how does it work

Internal lateral spinchtereotomy

procedure helps by lowering the resting pressure of the internal anal sphincter, which improves blood supply to the fissure and allows faster healing

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What is the presentation of perianal abscess

Painful, boil like swelling near anus

Red in colour, warm to touch

Pus near anus

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What is the aetiology of perianal abscess

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Fissure becomes infected

STI

Blocked anal glands

Infection of small anal glands

What is the symptoms of perianal abscess

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Constant, throbbing pain
- worse when seated

Skin irritation around anus

Discharge of pus

Constipation or pain associated with bowel movements

What is the treatment of perianal abscess

Surgical incision and drainages Post drainage relief Antibiotics

What is the complication of perianal abscess

Fistulas | - due to leaving channel behind from drainage

What is the presentation of anal fistula

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

What is the aetiology of anal fistulas

Most develop after an abscess IBD Diverticulitis

What is the symptoms of anal fistulas

Skin irritation around anus Constant throbbing pain Worse pain when: - Seated - Moving - Bowel movement - Coughing Smelly discharge from anus Melaena Pus in stool Swelling and redness around anus Bowel Incontinence

What is the treatment of Fistulas

Fistulotomy Seton sutures Or Fill fistula: - Advancement flap procedure - Bioprosthetic plug - Firbin glue

What happens in the procedure of a fistulomy

cutting along the whole length of the fistula to open it up so it heals as a flat scar

When is fistulomy not recommended

Not suitable for fistulas that pass through much of the sphincter muscles as can cause incontinence Carry out other procedures

What happens in the procedure of seaton suture

A seton is a piece of surgical thread that is left in the fistula for several weeks to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles

What is the benefit of loose or tight fit seton

Can be done loosely to avoid infection or pain Can be done tightly to cut through tissue and allow the fistula to heal flat

What is the aetiology of anal ulceration

Crohn’s Malignancy Syphilis Nicorandil (Angina drug)

Where is the locations and prevalence of the colorectal cancer sites

``` Right Colon 27% Transverse 10% Left Colon 36% Rectum 16% Anus 3% Others 8% ```

What is the symptoms of anorectal cancer

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

What procedures are used for the diagnosis of colorectal cancer

Examination Colonoscopy CT colonography MRI guided colonoscopy

What is the dukes stages (A-D) classification of anorectal cancer

A= submucosa B1= Muscle B2= Wall C1= lymph nodes not apical C2= apical D= Distant metastasises

What is the treatment of anorectal cancer

Anal squamous cell carcinoma - Radiotherapy Rectal adenocarcinoma - Neoadjuvant chemoradiation - Laprascopic resection

What is the two types of incontinence

Urge Bowel incontinence - express sudden urge to go to the toilet and don't make it on time Passive incontinence - experience no sensation before soiling themselves

What are the problems of the rectum that result in incontinence

Constipation Diarrhoea Scarring of rectum Haemorrhoids

How does Constipation (the leading cause) result in bowel incontinence

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

What is the overall aetiology of incontinence

Problems with rectum Problems with spinchter muscle weakened or damaged muscle Childbirth Injury Bowe//rectal surgery

What is the nerve innervation of the anorectal canal

Upper half: Sympathetic and parasympathetic innervation from hypogastric plexus Lower Half: somatic motor and sensory innervation from inferior rectal nerve

What is the aetiology of nerve damage

Diabetes MS Stroke Spina Bifida

What does the therapy of Sacral nerve root stimulator implant treat

Treats bladder and bowel problems - nerve damage - faecal incontinence - overreactive bladder - urge incontinence - chronic anal fissures

How does the therapy of sacral nerve root stimulator work

Implantation of a programmable stimulator subcutaneously access via the S3 foremen which delivers low amplitude electrical stimulation to the sacral nerve allowing the somatic motor nerves to control spinchters

What are investigations for anorectal disorders

AnoRectal Manometry | EndoAnal Ultrasound

What happens first in a sacral nerve root stimulator

Initial test with implant trial for a day | then if effective receive permanent implant

What does the sacrum nerves control function over

Pelvic floor | stimulate sacral nerve promotes contraction in pelvic floor

What is the causes on congenital abnormality imperforate anus

- Rectum may end in a pouch and not connect to colon - Rectum has opening to other structures - stenosis of anus - No anus

What is the presentation of hirshprungs mesenteric plexus deficiency

congenital disorder of the colon in which ganglion cells, are absent in myenteric plexus causing chronic constipation as are responsible for moving food in the intestine.

What is the signs of Hirschprungs myenteric plexus deficiency

Failure to defecate in first 48 hours of life | Vomiting bile

What is the treatment and management ofHirschprungs myenteric plexus deficiency

Surgery to remove uninnervated section of bowel and attach the rectum to a section innervated Pre op: - Give direct IVnutrition - Bowel washouts - possible antibiotics

Anorectal Disorders Flashcards

(55 cards)