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22 Cards in this Set
- Front
- Back
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What is the difference between internal and external haemorrhoids?
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Internal - superior haemorrhoidal veins, above dentate line, portal circulation
External - inferior haemorrhoidal veins, below dentate line, systemic circulation |
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Which locations are haemorrhoids usually found?
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Left lateral
Right anterior Right posterior 3, 7, 11 0'clock |
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How do haemorrhoids usually present?
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painless rectal bleeding
Can get prolapse, mucus, pruritus, bruning pain, rectal fullness |
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What acute presentations of haemorrhoids can you get?
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Strangulated - necrotic and ulcerated
Thrombosed - acute pain, oedematous, congested purple mass |
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What are the different degrees of haemorrhoids?
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1st degree - bleed but do not prolapse
2nd degree - prolapse with straining but spontaneous reduction 3rd degree - prolapse requiring manual reduction 4th degree - permanent prolapse - cannot be manually reduced |
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Which haemorrhoids internal or external are more likely to be painful?
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external
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Management of haemorrhoids?
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Medical management recommended for 1st and 2nd degree - high fibre bulk diet, steroid cream, sitz baths
Excisional haemorrhoidectomy for 3rd and 4th degree and incarcerated haemorrhoids Can do sclerotherapy for bleeding haemorrhoids Can do band ligation for 2nd and 3rd degree |
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What is the definition of an anal fissure?
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tear of anal canal below dentate line
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In which position are the majority of anal fissures?
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posterior midline - 90%
10% anterior midline If not on the midline consider other causes like IBD, leukaemia, anal carcinoma, STIs, TB |
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What are the clinical features of an anal fissure?
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tearing pain with defectation
Haematochezia Sentinel skin tags (thickened mucosa/skin at the distal end of the anal fissure that looks like a small haemorrhoid) |
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How do you manage anal fissures?
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focus on breaking cycle of pain, spasm, and ischaemia
bulk agents, stool softeners, warm sitz baths 2% lidocaine jelly for symptomatic relief topical nitroglycerin increases local blood flow promoting healing (can produce headache) Can do botulinum toxin - temporary mm paralysis - inhibits release of ACh - stops sphincter spasm Can do surgery (lateral internal sphincterotomy) - but high rates of incontinence |
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What is the most common tumour of the anal canal?
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SCC
can also get malignant melanoma - 3rd most common site for primary after skin, eyes |
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What are the 3 types of colonic adenoma?
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tubular
Villous Tubule-villous |
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What is the most common site of colonic ischaemia?
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splenic flexure
rare in the rectum |
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How might colonic ischaemia present?
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carmp like abdominal pain (may not get pain) followed by attack of rectal bleeding - often dark red
fever and leukocytosis might be present |
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How do you manage colonic ischaemia?
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Hydration
ABs Bowel rest - NG decompression Surgery - resection of all necrotic bowel if irreversible disease, full thickness necrosis, stricture/obstruction, worsening clinical course |
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When do you give antibiotics to treat C.difficile?
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if ill
if ileus, ilatation or pseudomembranous colitis |
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What complications can you get with diverticulosis?
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Diverticulitis
bleeding - painless rectal bleeding, 2/3 of massive lower GI bleeds |
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When do you perform surgery on diverticulitis?
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If large abscess/fistula
peritonitis Don't need to if phlegmon or small pericolic abscess |
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What is the medical management for diverticulitis?
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admit, NPO, fluid resuscitation, NG + suction, IV antibiotics
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What is the difference between tubular and villous polyps?
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Tubular - small < 2cm; common; pedunculated
Villous - > 2cm; less common; sessile |
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Which type of polyp tubular or villous has a higher malignant potential?
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villous (sessile)
Left sided predominance |
