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MD2 GIT > Perianal Disease > Flashcards

Perianal Disease Flashcards

(49 cards)

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1
Q

List 5 symptoms of perianal disease

A 
Pain
Bleeding
Prolapsed anal lumps and swelling
Itchiness
Discharge
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2
Q

What components make up the examination for perianal disease?

A 
Inspection
Palpation of perineum
DRE
Sigmoidoscopy
Proctoscopy
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3
Q

Indications for flexible sigmoidoscopy

A

??

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4
Q

Indications for rigid sigmoidoscopy

A

??

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5
Q

What kind of cancers can occur in the anus?

A

SCC
BCC
Melanoma

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6
Q

What kind of cancers can occur in the rectum?

A

Adenocarcinoma

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7
Q

What kind of cancers can occur at the anorectal junction?

A

SCC
BCC
Melanoma
Adenocarcinoma

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8
Q

List 7 common non-malignant perianal conditions

A 
Anal fissure
Haemorrhoids
Anal skin tags
Anal fibrous polyps
Anal fistula
Anal warts
Rectal prolapse
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9
Q

What perianal conditions are usually painless?

A 
Perianal skin tags
Haemorrhoids (1st, 2nd and 3rd degree)
Rectal prolapse
Anal fistula
Cancer (anal margin, low rectal)
Anal fibrous polyps
Anal warts
Pruritis ani
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10
Q

When can anal/rectal cancers cause pain?

A

When they invade nerves, bones and/or sphincters

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11
Q

When do haemorrhoids usually cause pain?

A

When strangulated or prolapsed

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12
Q

What is proctalgia fugax?

A

Sudden, severe episodes of pain
Sporadic and resolves
Not related to defecation

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13
Q

What other perianal conditions cause pain?

A

Anal fissure
Perianal haematoma
Anal abscess

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14
Q

30 year old woman, 3 months post-partum, presents with anal pain on defecation for several weeks
Associated symptoms include bright red bleeding per rectum
DDx?

A

Anal fissure
Strangulated or prolapsed haemorrhoid
Perianal haematoma
Exclude abscess, fistula, cancer

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15
Q

What are the 3 principles of treatment of anal fissure?

A

Simple measures
Chemical sphincterotomy
Surgical sphincterotomy

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16
Q

What causes proctalgia fugax?

A

Spasm of the levator ani (typically the pubococcygeus muscle)

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17
Q

What simple measures are used to treat anal fissure?

A

Topical anaesthetic ointment
Stool softeners, coloxyl and senna
Sitz bath

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18
Q

What agents can be used to achieve a chemical sphincterotomy?

A 
Rectogesic ointment (0.2% GTN; can give headache)
Nifedipine 0.5%/lignocaine 5% gel
Botulinum toxin injection (40-60U into intersphincteric space)
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19
Q

What are the aims of a chemical sphincterotomy?

A

To relax pressure on sphincter and reduce spasm

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20
Q

What is the rationale underlying botox for treatment of anal fissure? What are some of the risks?

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A

Relaxes anal sphincter to allow fissure to heal (does reverse but provides a 60-day window for healing)
Risk of poor bowel control

21
Q

How may a surgical sphincterotomy be achieved?

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A

Lateral sphincterotomy

Fissurectomy or mucosal flap repair

22
Q

What is the risk with surgical sphincterectomy?

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A

Most effective but has risk of minor flatus incontinence (esp in females)
Reserved for intractable cases and in males

23
Q

What is the typical presentation of perianal haematoma?

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A

Acutely painful perianal swelling

24
Q

Mx of perianal haematoma

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A

Conservative

Incisional drainage under LA

25
What are perianal skin tags a sequelae of?
Perianal haematoma
26
What is the typical presentation of perianal skin tag?
Painless | Perianal itch
27
Mx of perianal skin tags
Conservative | Excision
28
25 year old man presents with painful perianal swelling, unable to sit down, with associated fever Likely Dx?
Perianal abscess
29
Describe the different classifications of perianal abscess
Superficial perianal | Deep, ischiorectal or supralevator abscess
30
Describe the different classifications of anal fistula
Low, perianal | High and complex: intersphincteric, transphincteric, extra-sphincteric, supra-levator
31
What are the Sx of perianal abscess and anal fistula?
Chronic discharge of pus Bleeding Irritation
32
Mx of complex anal fistula
Insertion of Seton to eradicate fistula and preserve sphincter function Provides drainage and guides subsequent surgery, fistulotomy or repair
33
Sx of haemorrhoids
Bleeding Prolapse Mucus discharge
34
Describe the classification of haemorrhoids
First degree: internal, bleeds Second degree: prolapse and reducible spontaneously Third degree: non reducible Fourth degree: thrombosed, painful
35
How are first degree haemorrhoids treated?
High fibre diet to regulate bowel habit Avoiding constipation and straining Injection sclerotherapy for bleeding 5% Phenol in almond oil
36
How are second degree haemorrhoids treated?
Diet Rubber band ligation Injection sclerotherapy for symptomatic cases
37
How are third degree haemorrhoids treated?
Diet | Surgery by haemorrhoidectomy
38
How are fourth degree haemorrhoids treated?
Analgesia followed by surgery
39
What are the standard and newer ops available for haemorrhoidectomy?
Standard: Milligan-Morgan excision ligation New: stapled haemorrhoidectomy, Doppler-guided haemorrhoidal artery ligation
40
What are the different types of rectal prolapse?
Full thickness | Internal mucosal
41
Sx of rectal prolapse
``` Anal lump Bleeding Discharge Incontinence Unable to sit ```
42
Sx of anal warts (condyloma acuminata)
Bleeding Discharge Anal lumps
43
Sx of anal cancer
Bleeding Pain Lump Discharge
44
Mx of anal cancer
If in doubt, perform biopsy | Treatment depending on staging: local excision if small and clear of sphincter, usually chemo-irradiation therapy
45
Sx of low rectal carcinoma
Bright red bleeding Mucus discharge Tenesmus
46
What factors are important to assess on DRE if you are concerned about a low rectal carcinoma?
Soft or hard rectal mass | Assess position and distance from anal verge
47
Sx of pruritis ani
Common, mild to severe intractable itch | Bleeding
48
Causes of pruritis ani
Moisture from soiling or discharge Infestations Dermatological
49
Mx of pruritis ani
``` Dependent on underlying cause but may include: Topical steroid Anti-fungal Oral anti-histamine Avoiding excessive wiping Diet Excision of skin tags ```

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