Perianal Disease Flashcards Preview

MD2 Surgery and Anaesthesia > Perianal Disease > Flashcards

Flashcards in Perianal Disease Deck (37):
1

What are the common symptoms of perianal disease?

Bleeding
Pain
Prolapsed anal lumps - swellings
Itchiness
Discharge

2

What does a perineal examination involve?

Inspection
Palpation of perineum - use KY/lignocaine gel
DRE
Sigmoidoscopy
Proctoscopy

3

What is sigmoidoscopy?

Scope that reaches 1/2-2/3 of sigmoid colon

4

What is proctoscopy?

Can do with lubricant alone, without anaesthesia
See in colorectum

5

What are malignant conditions of the perineum?

Anal cancers
- SCC
- BCC
- Melanoma
Low rectal adenocarcinoma

6

What are non-malignant conditions of the perineum?

Anal skin tags
Anal fissure
Haemorrhoids
Anal fibrous polyps
Anal fistula
Anal warts
Rectal prolapse

7

What are painful perianal conditions?

Anal fissure
Strangulated and prolapsed haemorrhoids
Perianal haematoma
Anal abscess
Anal cancer invading sphincter
Low rectal cancer invading sphincter
Proctalgia fugax

8

What are painless perianal conditions?

Perianal skin tags
1st, 2nd, and 3rd degree haemorrhoids
Rectal prolapse
Anal fistula
Anal margin cancer
Low rectal cancer
Anal fibrous polyps
Anal warts
Pruritis ani

9

What is an anal fissure?

Tear/ulcer of anal junction

10

What is the difference between an acute and chronic anal fissure?

Acute - no induration
Chronic - induration

11

What is the treatment for anal fissure?

Topical anaesthetics ointment
Stool softeners
- Coloxyl and senna
Sitz bath
Chemical sphincterotomy
Surgical sphincterotomy

12

What is a sitz bath?

Sit in bowl with water and soap/salt for 10-15 min > dry area well

13

What is the treatment for a perianal haematoma?

Conservative - will resolve in a few days
Incisional drainage under local anaesthetic > don't need to stitch

14

Of what are perianal skin tags a sequelae?

Perianal haematoma

15

Why can perianal skin tags be itchy?

May ooze mucus

16

What is the treatment for perianal skin tags?

Conservative
Excision

17

What are the different types of anal abscesses?

Superficial
- Perianal
Deep
- Intersphincteric
- Ischiorectal

18

Which anal abscesses cause fever?

Ischiorectal

19

What is the treatment for an anal abscess?

Drainage
May not need Abx, unless signs of spread or immunocompromise

20

What is the surgical procedure for an anal fistula?

Seton insertion
- Eradicate fistula
- Preserve sphincter function
Guides subsequent surgery/fistulotomy/repair

21

What is the most common cause of haemorrhoids?

Constipation

22

What is the classification of haemorrhoids?

1st degree = internal - seen only with endoscope
2nd degree = prolapse > reduce spontaneously
3rd degree = non-reducible
4th degree = thrombosed and painful

23

What is the treatment for first degree haemorrhoids?

High fibre diet > regulate bowel habit
Avoid straining
Injection sclerotherapy for bleeding
5% phenol in almond oil

24

What is the treatment for second degree haemorrhoids?

Diet
Rubber band ligation/injection sclerotherapy for symptomatic cases

25

What is the treatment for third degree haemorrhoids?

Diet
Haemorrhoidectomy

26

What is the treatment for fourth degree haemorrhoids?

Analgesia
Surgery

27

What is the treatment for partial rectal prolapse?

Do nothing

28

What is the treatment for complete rectal prolapse?

Sedate
Pack with sugar crystals > reduces oedema
Gently reduce

29

What are the symptoms of anal warts?

Bleeding
Discharge
Anal lumps

30

What causes anal warts?

HPV

31

What are the symptoms of anal cancer?

Bleeding
Pain
Lump
Discharge

32

What is the principle of management for anal cancer?

If in doubt, biopsy

33

What is the treatment for anal cancer?

Depends on staging
- Local excision if small and clear of sphincter
- Usually chemoradiotherapy

34

What are the symptoms of low rectal carcinoma?

Bright red bleeding
Mucous discharge
Tenesmus

35

What should be assessed on digital rectal exam in suspected low rectal carcinoma?

Soft/hard rectal mass
Position and distance from anal verge

36

What are the causes of pruritis ani?

Many
Moisture from soiling/discharge
Infestations
Dermatological

37

What is the treatment for pruritis ani?

Topical steroid
Anti-fungals
Oral antihistamine
Avoid excessive wiping
Diet
Excise skin tags