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Flashcards in Common Anorectal Disorders Deck (31):
1

Anal verge is:

anal opening/where cheeks come together

2

Anatomical anal canal bounds?

dentate/pectinate line to anal verge

3

Surgical anal canal bounds

anal verge to pelvic floor

4

best place to take biopsy of rectum?

valve of houston

5

Above the dentate line:
-lymphatics:
-Blood/venous supply:
-innervation

-inferior mesenteric and para aortic lymph nodes
-blood supply: Superior and middle hemorrhoidal a and v
-both PNS and SNS

6

Below the dentate line:
-lymphatics:
-Blood/venous supply:
-innervation

-inguinal and internal iliac LNS
-blood supply: inferior hemorroidal (to internal pudendal a an v
-Somatic nervous system - pain perception

7

Infection from which space can cause infection in peritoneal cavity and form pelvic abscess?

supralevator space

8

How many valves of houston are there?

3

9

The middle valve of houston is at what level?

peritoneal reflection

10

Location of hemorrhoids as per surgeons?

-right anterior
-right poster
-left lateral

11

3 components of hemorrhoids?

-blood vessels
-connective tissue
-smooth muscle

12

Which muscles hold hemorrhoids in place?

Treitz's muscles

13

Classification of hemorrhoids:

-grade 1= internal buldge into anus without prolapse
-grade 2= internal prolapse during defecation, spontaneously reduce
-grade 3= internal prolapse requiring manual reduction
-grade 4= prolapsed and irreducible (stragulated)

14

Hemorrhoids blood color?

bright red - arterial

15

Red flags for colorectal malignancy:

-abdominal pain
-WL
-loss of appetite
-change in stool caliber
-increased constipation
-blood mixed with stool

16

Non-operative management of hemorrhoids and up to what grade?

-more fiber more water
-dont sit on toilet more than 5 minutes, no straining, no aggressive wiping
-warm tub soaks
-topical agents - local anesthetics, vasoconstrictors, barrier protectors, steroids

up to Grade 3 - Grade 3 some surgical options

17

What grades is rubber band ligation surgery used for?

grade 2 and 3 internal - if it still hurts then the banding was done wrong

18

Hemorrhoidectomy is for what kind of hemorrhoids?

large internal and external or striangulated

19

What to do with thrombosed external hemorroids?

-NEEDS EXCISION

-Do not =incision and drainage

20

Hemorrhoids and pregnant- what options?

-non-operative management unless striangulated

21

Rectal varices:
-seen with what condition and management?

due to portal shunt - portal HTN
manage like portal HTN

22

Anal Fissues:
-where?
-hurt?
-finding/

-ano-linear or oval shaped tear in anal canal distal to pectinate line
-hurt like crazy
-Blood coating side of stool

23

Most common area for acute and chronic anal fissure?

Anterior and posterior

24

Most common area for:
Crohns, UC, Syphillis,TB, leukemia, cancer, HIV- related issues?

Lateral areas

25

Fissure management?

-most heal on own with fiber and water and not straining etc...
-local ointment or sphincter relaxers
-nitrates
-Ca channel blockers - diltiazem, nifedipine

26

Botox tx for fissures?

works but they usually reoccur

27

Most common to least common areas for perianal abscess?

-perianal
-ischioanal
-intersphincteric
-supralevator

28

An anterior opening fistula in ano goes where if more than 3cm from anus with what kind of tract?

posterior via posterior curved tracts = goodsalls rule

29

Anterior opening fistula in ano has what kind of tract?

straight tract = goodsalls rule

30

Perinidal disease:

subcutaneous infection occrin in the upper half of the gluteal cleft - not a cyst! Hair gets in the crease and causes inflammation

31

Hydradenitis is?

infection of the apocrine sweat glands of the skin