Flashcards in Common Anorectal Disorders Deck (31):
Anal verge is:
anal opening/where cheeks come together
Anatomical anal canal bounds?
dentate/pectinate line to anal verge
Surgical anal canal bounds
anal verge to pelvic floor
best place to take biopsy of rectum?
valve of houston
Above the dentate line:
-inferior mesenteric and para aortic lymph nodes
-blood supply: Superior and middle hemorrhoidal a and v
-both PNS and SNS
Below the dentate line:
-inguinal and internal iliac LNS
-blood supply: inferior hemorroidal (to internal pudendal a an v
-Somatic nervous system - pain perception
Infection from which space can cause infection in peritoneal cavity and form pelvic abscess?
How many valves of houston are there?
The middle valve of houston is at what level?
Location of hemorrhoids as per surgeons?
3 components of hemorrhoids?
Which muscles hold hemorrhoids in place?
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)
Hemorrhoids blood color?
bright red - arterial
Red flags for colorectal malignancy:
-loss of appetite
-change in stool caliber
-blood mixed with stool
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
What grades is rubber band ligation surgery used for?
grade 2 and 3 internal - if it still hurts then the banding was done wrong
Hemorrhoidectomy is for what kind of hemorrhoids?
large internal and external or striangulated
What to do with thrombosed external hemorroids?
-Do not =incision and drainage
Hemorrhoids and pregnant- what options?
-non-operative management unless striangulated
-seen with what condition and management?
due to portal shunt - portal HTN
manage like portal HTN
-ano-linear or oval shaped tear in anal canal distal to pectinate line
-hurt like crazy
-Blood coating side of stool
Most common area for acute and chronic anal fissure?
Anterior and posterior
Most common area for:
Crohns, UC, Syphillis,TB, leukemia, cancer, HIV- related issues?
-most heal on own with fiber and water and not straining etc...
-local ointment or sphincter relaxers
-Ca channel blockers - diltiazem, nifedipine
Botox tx for fissures?
works but they usually reoccur
Most common to least common areas for perianal abscess?
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
Anterior opening fistula in ano has what kind of tract?
straight tract = goodsalls rule
subcutaneous infection occrin in the upper half of the gluteal cleft - not a cyst! Hair gets in the crease and causes inflammation