Common Anorectal Disorders Flashcards
(31 cards)
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:
- 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
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
Infection from which space can cause infection in peritoneal cavity and form pelvic abscess?
supralevator space
How many valves of houston are there?
3
The middle valve of houston is at what level?
peritoneal reflection
Location of hemorrhoids as per surgeons?
- right anterior
- right poster
- left lateral
3 components of hemorrhoids?
- blood vessels
- connective tissue
- smooth muscle
Which muscles hold hemorrhoids in place?
Treitz’s muscles
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:
- abdominal pain
- WL
- loss of appetite
- change in stool caliber
- increased constipation
- 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?
- NEEDS EXCISION
- Do not =incision and drainage
Hemorrhoids and pregnant- what options?
-non-operative management unless striangulated
Rectal varices:
-seen with what condition and management?
due to portal shunt - portal HTN
manage like portal HTN
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
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?
Lateral areas
