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Flashcards in Anal and rectal Deck (26)
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1
Q

arterial supply to the anus

A

inferior rectal artery

2
Q

venous drainage form the anus

A

above dentate line- internal hemorrhoid plexus

below dentate line- external hemorrhoid plexus

3
Q

external hemorrhoids

A

painful
squamous sensate epithelium
TX: lance when thrombosed to relieve pain

4
Q

internal hemorrhoids

A

primary - slides below dentate line
secondary- prolapse that reduces spontaneously
tertiary- prolapse that has to be reduced manually
Quaternary - not able to reduce

TX: band,
quternanry - 3 quadrant resection, down to the internal sphincter

5
Q

rectal prolapse

A

starts 6-7 cm from anal verge
secondary to pudendal neuropathy and laxity of anal sphincters
involves all layers of the rectum
TX: perineal rectosigmoidectomy

6
Q

anatomic defects in pts with chronic rectal prolpase

A

abnormally deep rectovaginal or rectovesical pouch
lax and atonic musculature of the pelvic floor
lack of normal fixation of the rectum and an elongated mesorectum
redundant sigmoid colon
lax and atonic anal sphincter

7
Q

condylomata acuminata

A

HPV

TX laser surgery

8
Q

anal fissure

A

90% posterior midline
pain and bleeding after defecation, chronic ones will see a sentinel pile
TX sitz baths, lidocaine jellly, stool oftners
internal sphincterotomy (EXCEPT IN setting of crohns or UC)
lateral or recurrent fissurres - think inflammatory disease

9
Q

anorectal abscess

A

below levator muscles ( perianal, intersphinteric, ischiorectal) drain through skin
supralevator - drain transrectally, abx

10
Q

pilonidal cyst

A

abscess of sinus fromation over the sacrococcygeal junction

drain and pack - resect cyst

11
Q

fistula in ano

A

unroof and eliminate the primary opening with rectal advancement flap

12
Q

Goodsalls rule

A

anterior fistulas connect with rectum in a straight lines

posterior fistulas go toward midline internal opening in the rectum

13
Q

Simple rectovaginal fistula

A

secondary to infection or obstetrical trauma, low to midvagina < 2.5 cm
TX: transanally unroof and place rectal muscosa advancement flap

14
Q

complex rectovaginal fistula

A

secondary to imflammatory bowel disease, XRT, neoplasm or high in vagina > 2.5 cm
TX: abdominal approach or combine approach usual; resection and re-anastamosis with placement of colostomy

15
Q

anal incontinence

A

neurogenic- no good tx
abdominoperineal descent - damage to levator ani muscle and anus falls below levators, also stretches the pudendal nerves
TX high - fiber diet, limit to 1 bowel movement a day, sphincteroplasty if related to trauma

16
Q

squamous cell ca of anal canal

A

above dentate line

chemotherapy first line TX (nigro protocol)

17
Q

nigro protocol

A

anal squamous cell cancer

mitomycin C and 5 FU

18
Q

anal canal melanoma

A

3rd most common site for melanome
1/3 lymphatic spread to mesenteric lymph nodes
most common symptom - rectal bleeding
TX: APR

19
Q

anal margin squamous cell

A

ulcerating, slow growing
mets to inguinal nodes
TX WLE lesions < 3 cm

20
Q

qnal margin basal cell ca

A

central ulcer, raised edges, rare mets

TX WLE

21
Q

Bowens disease

A

intraepidermal squamous cell CA
malignant, will develop primary cancer of skin
TX local therapy WLE

22
Q

Pagets disease

A

intraepidermal apocrine gland ca
slow growing
positive RAS stain
TX WLE, check for other malingnancies

23
Q

lymphatic drainage superior and middle rectum

A

IMA nodes

24
Q

lymphatic drainage lower rectum

A

IMA nodes, internal iliac nodes

25
Q

lymphatic drainage upper 2/3 anal canal

A

internal iliac and pelvic nodes

26
Q

lymphatic drainage lower 1/3 anal canal

A

inguinal nodes