Flashcards in Week 8 Deck (92)
What 5 things are important to consider in assessing the severity of liver cirrhosis?
Loss of haustral markings in the distal part of the bowel suggests which disease?
Which test is the single most important factor for considering suitability for a liver transplant?
Behavioural changes, clumsiness and excess salivation could indicated which condition?
What is Wilson's Disease treated with?
How would achalasia present differently to oesophageal malignancy in terms of dysphagia?
Achalasia would present with dysphagia to both liquids and solids from the outset whereas oesophageal malignancy would involve progressive symptoms with dysphagia first to solids and then to liquids.
How are alcohol units calculated?
(Volume (ml) x ABV) Divided by 1000
What is the most likely cause of an elevated ALT and AST in the 10,000s?
Can pain be felt above or below the dentate line in the anal canal?
Anything below the dentate line will be very painful but anything above will not cause pain as there are no sensory fibres to this area
What are haemorrhoids?
Disrupted and enlarged vascular cushions in the lower rectum and the anal canal
What percentage of the population will have symptomatic haemorrhoids at some point in their life?
What is the classical position of the haemorrhoids when the patient is in the lithotomy position and what does this correspond to?
The position corresponds to the branches of the superior haemorrhoids artery at 3, 7 and 11 o'clock
What can cause haemorrhoids?
***Constipation and prolonged straining
Congestion from a pelvic tumour
How might haemorrhoids present?
Painless bleeding - bright red (on the paper/ in the pan)
Describe the classification of haemorrhoids
1st degree - remain in the rectum
2nd degree - protrude through the rectum on defecation but then reduce
3rd degree - ^ &require reduction
4th degree - remain persistently prolapsed
What investigations might be done for haemorrhoids?
Abdominal exam (to rule out other causes)
Proctoscopy (to visualise internal haemorrhoids)
How would haemorrhoids be managed/ treated?
Rubber band ligation
HALO/ THD procedure
*For acutely thrombosis/ painful haemorrhoids
- ice compressions and topical GTN or diltiazem to reduce sphincter spasm
What is a rectal prolapse? What is the difference between a type 1 and type 2 prolapse?
A rectal prolapse is a protruding mass from the anus, especially during defecation
Type 1 - partial - just mucosal layers
Type 2 - complete - transmural / all layers
How would a rectal prolapse present?
Bleeding and mucus per rectum
Poor anal tone on examination
How would a rectal prolapse be managed? consider management of both a complete and incomplete prolapse
- Dietary advice and treatment of constipation
- Bulking agent
- Delform's procedure
- Perineal rectopexy
- Abdominal rectopexy
- Anterior resection
What are some of the causes of rectal prolapse?
Chronic neurological and psychological disorders
What is an anal fissure? Where do these most commonly occur?
A tear in the anal margin due to the massage of a constipated stool
- Usually midline posteriorly but can be anterior
What is the typical presentation of an anal fissure? Which age group are they most common in?
*Sharp and severe pain on defecation after constipation
- pain may last for up to half an hour and becomes dull in character
*Bright red rectal bleeding
*Most common in young people - very rare in the elderly
How are anal fissure managed?
- Stool softeners and dietary advice
- Topical diltiazem or GTN ointment (pharmacological sphyncterotomy)
- Botox injection
What is meant by 'Fistula in Ano' ?
An abnormal communication between two epithelial surfaces - the anal canal and the peri-anal skin
What is the most common cause of fistula-in-ano? State the other less common causes
Inadequate treatment of an anorectal abscess
How might Fistula-In-Ano present?
Bright red PR bleeding
Incontinence of flatus/ stool
How would fistula-in-ano be investigated?
EUA of anorectum
Rigid sigmoidoscopy and proctoscopy
How is fistula-in- and managed?
Laying it open (fistulotomy)
Insertion of Seton suture