Anorectal Lecture Flashcards

(42 cards)

1
Q

Do you feel pain above or below the dentate line?

A

BELOW!

(no pain felt above the dentate line)

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2
Q

Divides the rectal mucosa above from the squamous epithelium below

Divides the:
Nervous system*
Vascular supply
Lymphatic drainage

A

Dentate line

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3
Q

insensate- anorectal mucoa

sensate- anoderm

..which one is above and which one is below the dentate line?

A

Insensate (anorectal)= ABOVE

Sensate (anoderm)= BELOW..*pain*

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4
Q

Which anal sphincter….

smooth muscle, involuntary

A

Internal

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5
Q

Which anal sphincter…

skeletal muscle (voluntary)

A

External

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6
Q

Squamous epithelium

Anoderm

Sensate

PAIN*

A

Below the dentate line

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7
Q

Tear in the anoderm
90% are posterior

Causes: hard stool or prolonged diarrhea

Sx: “tearing” pain with BM
hematochezia (blood on TP)
pain usually subsides between BMs

A

Anal fissure

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8
Q

MC cause of painful rectal bleeding

A

Anal fissure

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9
Q

Should you do a rectal exam if pt has anal fissure?

A

NO

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10
Q

Bulk agents

Stool softners

Sitz baths

Hydrocortisone containing ointments

A

Medical tx for anal fissures

(90% heal with medical tx)

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11
Q

If medical tx fails,

what is the gold standard surgery for anal fissures?

A

Lateral internal anal sphincterotomy

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12
Q

Location of most anorectal abscesses

A

Posterior rectal wall

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13
Q

Anal crypts with gland obstruction is the origin for…

A

Anorectal abscesses

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14
Q

S. Aureus
Bacteroides
Proteus
Strep

..all cause?

A

Infection of anal ducts and glands..leading to anorectal abscesses

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15
Q

MC anorectal abscess

A

Perianal abscess

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16
Q

These start from the anal crypts and can spread…..

  1. superficially to external sphincter, resulting in perianal abscess* (MC!)
  2. deep thru external sphincter into fat of ischiorectal fossa
  3. deep into supralevator space
  4. intersphincteric
A

Anal abscess

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17
Q

Severe pain!
worse with.. sitting, coughing, defecating

PE: palpable fuctuant mass
VERY painful DRE

18
Q

Tx= surgical drainage
postop Sitz bath

50% cured with just drainage
50% develop fistula

19
Q

Chronic cryptoglandular abscess

abnormal communication between 2 epithelium lined surfaces

*has an external oepning in perirectal skin and an internal opening in anal canal

*originates in infected crypt and tracks externally to site of previous drainage

20
Q

Used as a guide to determine location of internal opening

A

Goodsall’s Rule

21
Q

Fistulas with an external opening anteriorly

…will track internally via a ______ line

22
Q

Fistulas with an external opening posteriorly

…will track internally via a _______ line

23
Q

Persistent drainage
Usually painless but can have itching

tx= fistulotomy, tract left open to heal by secondary intention
(MUST preserve sphincter muscle)

24
Q

External venous tissue
50% of ppl over 50 have

MC anorectal problem in adults >50

25
26
Anal canal is lined by these "cushions" that consist of vascular and connective tissue 3 columns: R anterolateral, L lateral, R posterolateral \*these cushions engorge during defecation to protect anal canal from abrasions
Hemorrhoid plexus
27
Caused by: Hard stool Excessive straining Pregnancy Increased intraabdominal pressure (leading to increased venous engorgement)
Hemorrhoids
28
These hemorrhoids are **painless!** bc they are above the dentate line Bleed May prolpase, are palpable on DRE **\*painless bright red blood with defecation** **MC cause of rectal bleeding**
Internal hemorrhoids
29
These hemorrhoids are **painful!** bc they are below the dentate line Covered with anoderm Usually dont bleed May thrombose, VERY painful! Pain and discomfort, esp at time of defecation
External hemorrhoids
30
Which type of polyp is the most rare of the adenomas but has the highest risk of cancer, with 40%
Villous adenomas
31
MC type of polyp but only has a 5% risk of cancer
Tubular adenoma
32
1st and 2nd degree hemorrhoids
1st degree= bleed 2nd degree= bleed and prolapse **spontaneously reduce\***
33
Which degree internal hemorrhoid... Bleed and prolapse, require manual reduction
3rd degree
34
Which degree internal hemorrhoid: automatic referall bleed/incarcerate
4th degree
35
Fiber, water, stool softner, avoid straining Cortisone to shrink (Anusol HC) Nupercainal ointment numbing agent
Tx for 1st and 2nd degree internal hemorrhoids
36
Tx= surgical! ## Footnote **Excisional hemorrhoidectomy**
tx for 3rd and 4th degree hemorrhoids
37
What is the grading of external hemorrhoids?
There are none!
38
Acutely thrombosed hemorrhoids are excised outside mucocutanous junction usually within how many hours?
24-48
39
Midline post- sacral intergluteal fold superior to anus clinically identified by opening of sinus tract that may contain a tuft of hair **MC men 20-30 (almost always under 40!!)**
Pilonidal cyst
40
Usually asymptomatic but can develop abscess formation and drainage Sx: like perianal abscess but different spot PE: **fluctuant mass with erythematous "halo"** **purulent D/C Pain at gluteal cleft**
Pilonidal cyst
41
Tx for Pilonidal cyst?
Surgery with secondary closure
42
Sudden watery diarrhea after pt has had chronic constipation
Fecal impaction