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Comprehensive Prep > Chapter 37: Anus and Rectum FOCUSED > Flashcards

Chapter 37: Anus and Rectum FOCUSED Flashcards

1
Q

arterial supply to the anus

A

inferior rectal artery

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2
Q

venous drainage of the anus

A

above the dentate is internal hemorrhoid plexus and below the dentate is external hemorrhoid plexus

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3
Q

hemorrhoidal columns

A
  • left lateral - right anterior - right posterior
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4
Q

tx: thromboses external hemorrhoid

A

lance if within 48-72 hours

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5
Q

type of internal hemorrhoids that can be banded

A

can band primary and secondary internal hemorrhoids - do not band external hemorrhoids (painful)

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6
Q

surgery required for what type of internal hemorrhoids

A

surgery for tertiary and quaternary internal hemorrhoids - 3 quadrant resection - need to resect down to the internal anal sphincter (do not go through it)

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7
Q

where does rectal prolapse start?

A

starts 6-7 cm form anal verge

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8
Q

what causes rectal prolapse?

A

secondary to pudendal neuropathy and laxity of the anal sphincters

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9
Q

risk factors for rectal prolapse

A

increased with female gender, straining, chronic diarrhea, previous pregnancy, and redundant sigmoid colons

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10
Q

what layers of the rectum are involved in rectal prolapse?

A

prolapse involves all layers of the rectum

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11
Q

medical treatment: rectal prolapse

A

high-fiber diet

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12
Q

surgical tx: rectal prolapse

A
  • perineal rectosigmoid resection (altemeier) transanally if patient is older and frail - low anterior resection and pexy of residual colon if good condition patient
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13
Q

caused by a split in the anodrem - 90% in posterior midline - causes pain and bleeding after defection; chronic ones will see a sentinel pile

A

anal fissure

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14
Q

medical tx: anal fissure

A

sitz baths, lidocaine jelly, and stool softeners (90% heal)

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15
Q

surgical tx: anal fissure

A

lateral subcutaneous internal sphincterotomy

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16
Q

most serious complication of surgery for anal fissure

A

fecal incontinence

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17
Q

what do you worry about with lateral or recurrent anal fissures?

A

worry about inflammatory bowel disease

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18
Q

can cause severe pain - risk factors: antibiotics, cellulitis, DM, immunosuppressed or prosthetic hardware

A

anorectal abscess

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19
Q

anorectal abscess: can be drained through the skill (all are below the elevator muscles)

A

perianal, intersphincteric, and ischiorectal abscesses

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20
Q

anorectal abscess: can form horseshoe abscess

A

intersphincteric and ischiorectal abscesses

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21
Q

anorectal abscess: need to be drained transrectally

A

supralevator abscesses

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22
Q
  • sinus or abscess formation over the sacrococcygeal junction; increased incidence in men - tx?
A

pilonidal cysts tx: drainage and packing; follow-up surgical resection of cyst

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23
Q

do not need to excise the tract - often occurs after anorectal abscess formation

A

fistula-in-ano

24
Q

what is goodsall’s rule for fistula-in-ano?

A
  • anterior fistulas connect with anus/rectum in a straight line - posterior fistulas go toward a midline internal opening in the anus/rectum
25
tx: fistula-in-ano (lower 1/3 of the external anal sphincter)
fistulotomy (open tract up, curettage out, let it heal by secondary intention)
26
tx: fistula-in-ano (upper 2/3 of the external anal sphincter)
rectal advancement flap
27
most worrisome complication of treatment for fistula in ano
risk of incontinence - you want to avoid damage to the external anal sphincter so fistulotomy is not used for fistulas above the 1/3 of the external anal sphincter
28
tx -\> rectovaginal fistulas: - simple (low to mid-vagina)
tx: trans-anal rectal mucosa advancement flap - many obstetrical fistulas heal spontaneously
29
tx -\> rectovaginal fistulas: - complex (high in vagina)
abdominal or combined abdominal and perineal approach usual; resection and reanastomosis of rectum, close hole in vagina, interpose omentum, temporary ileostomy
30
tx: neurogenic anal incontinence (gaping hole)
no good treatment
31
chronic damage to levator ani muscle and pudendal nerves (obesity, multiparous women) and anus falls below levators
abdominoperineal descent
32
tx: abdominoperineal descent
high-fiber diet, limit to 1 bowel movement a day; hard to treat
33
tx: obstetrical trauma leading to anal incontinence
anterior anal sphincteroplasty
34
what is anal cancer associated with?
xrt and hpv
35
above dentate line
anal canal
36
below dentate line
anal margin
37
what are the different types of squamous cell carcinoma in the anal canal?
epidermoid CA mucoepidermoid CA cloacogenic CA basaloid CA
38
anal cancer: - symptoms: pruritus, bleeding, and palpable mass
squamous cell CA
39
tx: squamous cell CA - anal cancer
nigro protocol (chemo-XRT with 5FU and mitomycin), not surgery - cures 80% - APR for treatment failures or recurrent cancer
40
tx: adenocarcinoma - anal cancer
APR usual; WLE if
41
3rd most common site for melanoma
anal cancer (skin and eyes #1 and #2)
42
how does melanoma spread?
1/3 has spread to mesenteric lymph nodes - hematogenous spread to the liver and the lung is early and accounts for most deaths
43
what is symptomatic melanoma of the anal cancer associated with?
significant metastatic disease
44
anal melanoma: most common symptom
rectal bleeding
45
anal melanoma: appearance
lightly pigmented or not pigmented at all
46
tx: anal melanoma
APR usual; margin dictated by depth of lesion standard for melanoma
47
anal cancer below dentate line - have better prognosis than anal canal lesions
anal margin lesions (below dentate line)
48
- ulcerating, slow growing; men with better prognosis - metastases: go to inguinal nodes
squamous cell cancer - anal margin lesions
49
sx: anal margin lesions (squamous cell CA)
WLE for lesions
50
anal margin lesions: squamous cell CA - primary tx for lesions \> 5cm, if involving sphincter or if positive nodes
chemo-XRT (5-FU and cisplatin) - try to preserve the sphincter here and avoid APR
51
anal cancer: central ulcer, raised edges, rare metastases
basal cell CA
52
tx: anal cancer - basal cell CA
WLE usually sufficient, only need 3-mm margins; rare need for APR unless sphincter involved
53
nodal metastases: superior and middle rectum
IMA nodes
54
nodal metastases: lower rectum
primarily IMA nodes, also to internal iliac nodes
55
nodal metastases: upper 2/3 of anal canal
internal iliac nodes
56
nodal metastases: lower 1/3 of anal canal
inguinal nodes
57
Classification for hemorrhoids

Comprehensive Prep (45 decks)

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