Notes in Chapter_37:_Anal_and_Rectal

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Published	07/07/2024	Rectal venous drainage above the dentate is {{c1::internal}} hemorrhoid plexus and below dentate is {{c1::external}} hemorrhoid plexus
Published	07/07/2024	External hemorrhoids cause pain when they {{c1::thrombose}}
Published	07/07/2024	External hemorrhoids are distal to the dentate line and covered by {{c1::sensate}} squamous epithelium
Published	07/07/2024	The 3 hemorrhoid plexuses are 1) {{c1::Left lateral}}2) {{c1::Right anterior}}3) {{c1::Right posterior}}
Published	07/07/2024	Internal hemorrhoid that slides below dentate line with straining is Grade {{c1::I}}
Published	07/07/2024	Internal hemorrhoid that prolapses, but reduces spontaneously is Grade {{c1::II}}
Published	07/07/2024	Internal hemorrhoid that prolapses and must be manually reduced is Grade {{c1::III}}
Published	07/07/2024	Internal hemorrhoid that prolapses and is unable to be reduced is Grade {{c1::IV}}
Published	07/07/2024	Thrombosed external hemorrhoids should be treated with lancing open if {{c1::> 72}} hours or elliptical excision if {{c1::< 72}} hours to r…
Published	07/07/2024	Surgical indications for hemorrhoids are {{c1::recurrence}}, multiple {{c2::thrombosing}}, and large external component
Published	07/07/2024	Grade {{c2::I}} and {{c2::II}} internal hemorrhoids can be treated with {{c1::banding}} (when conservative treatment fails)
Published	07/07/2024	Grade {{c2::III}} and {{c2::IV}} internal hemorrhoids are treated with {{c1::surgery}}
Published	07/07/2024	Rectal prolapse is usually secondary to {{c2::pudendal}} neuropathy and anal spinchter {{c1::laxity}}
Published	07/07/2024	Rectal prolapse is more common in {{c1::females::gender}}
Published	07/07/2024	Which layers of the rectum are involved in prolapse?{{c1::All}}
Published	07/07/2024	Rectal prolapse is treated medically with {{c1::high-fiber diet}}
Published	07/07/2024	{{c1::Perineal rectosigmoid}} resection ({{c2::Altemeier::eponym}}) is the surgical treatment for an older/frail patient with {{c3::rectal p…
Published	07/07/2024	What is the surgical treatment of condylomata acuminata (HPV)?{{c1::Laser surgery}}
Published	07/07/2024	{{c2::90}}% of anal fissures occur at the {{c1::postero-medial}} position
Published	07/07/2024	Chronic anal fissures can leave a residual piece of skin called a(n) {{c1::sentinel pile}}
Published	07/07/2024	{{c1::90}}% of anal fissures heal with medical treatment
Published	07/07/2024	The most serious complication of lateral internal sphincterotomy is {{c1::fecal incontinence}}
Published	07/07/2024	Is inflammatory bowel disease (IBD) a contraindication to internal sphincterotomy?{{c1::Yes}}
Published	07/07/2024	Lateral or recurrent anal fissures may be concerning for {{c1::inflammatory bowel disease (IBD)}}
Published	07/07/2024	Anorectal abscesses are divided into {{c1::perianal}} and {{c1::perirectal}} abscesses
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Published	07/07/2024	{{c1::Ischiorectal}} abscesses penetrate through the external sphincter into the ischiorectal space
Published	07/07/2024	{{c1::Intersphincteric}} abscesses are located in the groove between the internal and external sphincters
Published	07/07/2024	{{c1::Supralevator}} abscesses are superior to the levator ani adjacent to the rectum
Published	07/07/2024	{{c1::Perianal}} abscess form beyond the external sphincter but do not penetrate the ischiorectal space
Published	07/07/2024	A(n) {{c1::horseshoe}} abscess is a complex perirectal abscess that forms posterior to the anal canal
Published	07/07/2024	The types of perirectal abscesses that can form horseshoe abscesses are {{c1::intersphincteric}} and {{c2::ischiorectal}}
Published	07/07/2024	The anorectal abscesses that can be drained through the skin are:1) {{c1::Perianal}}2) {{c2::Intersphincteric}}3) {{c3::Ischiorectal}}
Published	07/07/2024	{{c1::Supralevator}} anorectal abscesses must be drained transrectally
Published	07/07/2024	A sinus or abscess formation over the sacrococcygeal junction is a {{c1::pilonidal cyst}}
Published	07/07/2024	A common complication after anorectal abscess formation is {{c1::anal fistula}}
Published	07/07/2024	Goodsall's rule: {{c1::Anterior}} fistulas connect with anus/rectum in a {{c2::straight line}}
Published	07/07/2024	Goodsall's rule:{{c2::Posterior}} fistulas connect with anus/rectum in a {{c1::curved line towards the midline}}
Published	07/07/2024	The safest surgical treatment for most anal fistulas is {{c1::draining seton stitch}}
Published	07/07/2024	An option for anal fistula treatment for lower 1/3rd fistulas is {{c1::fistulotomy}}
Published	07/07/2024	{{c3::Simple}} rectovaginal fistulas are {{c2::lower::higher or lower}} in the vagina and are most commonly caused by {{c1::trauma}}
Published	07/07/2024	{{c3::Complex}} rectovaginal fistulas are {{c2::higher::higher or lower}} in the vagina and are most commonly caused by {{c1::diverticulitis…
Published	07/07/2024	The treatment for obstetrical rectovaginal fistulas is {{c1::spontaneous healing}}
Published	07/07/2024	There is no good treatment for {{c1::neurogenic}} anal incontinence
Published	07/07/2024	Anal incontinence due to abdominoperineal descent is treated {{c1::conservatively}}
Published	07/07/2024	The surgical treatment for anal incontinence due to obstetrical trauma is {{c1::anterior anal sphincteroplasty}}
Published	07/07/2024	The #1 cause of rectal ulcers in AIDS patients is {{c1::HSV}}
Published	07/07/2024	CMV can cause shallow anal ulcers in AIDS patients and can present similarly to {{c1::appendicitis}}
Published	07/07/2024	Anorectal lesions in AIDS patients require {{c1::biopsy}} to determine management
Published	07/07/2024	Anal cancer is associated with HPV and {{c1::radiation therapy}}
Published	07/07/2024	Anal cancer in the anal {{c1::canal}} is {{c2::above::above or below}} the dentate line
Published	07/07/2024	Anal cancer in the anal {{c1::margin}} is {{c2::below::above or below}} the dentate line
Published	07/07/2024	Squamous cell anal canal cancer is treated with radiation, {{c2::5-fluorouracil}}, and {{c3::mitomycin}} ({{c1::Nigro}} protocol)
Published	07/07/2024	Adenocarcinoma anal canal cancer is treated with {{c1::abdominoperineal resection (APR)}}
Published	07/07/2024	The {{c1::3rd}} most common site for melanoma is the anus and the most common symptom is {{c2::rectal bleeding}}
Published	07/07/2024	Melanoma anal canal cancer is treated with {{c1::abdominoperineal resection (APR)}}
Published	07/07/2024	Anal {{c1::margin::canal or margin}} cancers have a better prognosis
Published	07/07/2024	Squamous cell anal margin cancer is treated with {{c1::wide local excision}} for less than 5 cm and {{c1::chemotherapy/XRT}} for greater than 5 cm
Published	07/07/2024	Basal cell anal margin cancer is treated with {{c1::wide local excision}}
Published	07/07/2024	Anal melanoma is more likely to be anal {{c1::canal}} cancer
Published	07/07/2024	Anal basal cell cancer is more likely to be anal {{c1::margin}} cancer
Published	07/07/2024	Cancers in the superior and middle rectum metastasize to the {{c1::inferior mesenteric (IMA)}} nodes
Published	07/07/2024	Cancers in the lower rectum primarily metastasize to the {{c1::inferior mesenteric (IMA)}} nodes, but also to the {{c2::internal iliac}} nodes
Published	07/07/2024	Cancers in the anal canal metastasize to the {{c1::internal iliac}} nodes
Published	07/07/2024	Cancers in the anal margin metastasize to the {{c1::inguinal}} nodes
Published	07/07/2024	The incidence of hemorrhoids in patients with portal hypertension is {{c1::the same as everyone else::↑↓}}
Published	07/07/2024	Anal varices in patients with portal hypertension account for major bleeding events {{c1::1}}% of the time
Published	07/07/2024	Two groups of patients where hemorrhoidectomies should almost never be performed or performed with serious caution are anorectal {{c1::Crohn's}}&…
Published	07/07/2024	Posthemorrhoidectomy hemorrhage occurs roughly {{c1::2}}% of cases, treatment includes packing, tamponade with foley balloon, or suture ligation
Published	07/07/2024	{{c3::Horseshoe}} abscesses are drained using the {{c2::Hanley}} procedure where several incisions are madePosterior midlineLateral incision…
Published	07/07/2024	Which antibiotics do you give after abscess drainage?{{c1::None :)}}
Published	07/07/2024	In patients with recurrent anal abscesses you should consider the possible diagnosis of {{c2::Crohn's}} or {{c1::hidradenitis suppurativa}}
Published	07/07/2024	The technical definition of a fistula is an abnormal communication between two {{c1::epithelialized}} surfaces
Published	07/07/2024	Elective sigmoidectomy is indicated in patients with uncomplicated diverticulitis who are {{c2::immunocompromised}} or who have {{…
Published	07/07/2024	{{c1::Inter}}sphincteric fistula
Published	07/07/2024	{{c1::trans}}sphincteric fistula
Published	07/07/2024	{{c1::Supra}}sphincteric fistula
Published	07/07/2024	{{c1::Extra}}sphincteric fistula
Published	07/07/2024	When anal fistula tracts are difficult to visualize, how do you find their openings? - Using a {{c1::surgical probe}} - Injecting {{c2::hydr…
Published	07/07/2024	Main methods to treat anal fistulas: - Fistulotomy - Seton  - {{c3::Anorectal advancement flap::very surgical}} - {{c1::Fibri…
Published	07/07/2024	The downside of using fibrin glue for anal fistulas is {{c1::high rates of recurrence}}
Published	07/07/2024	Downside of using {{c2::bioprosthetic plug}} for anal fistulas is they are expensive and have decreased healing rate with high rate of …
Published	07/07/2024	Which anal fistula treatment requires 5 days of maintenance with IV therapy and NO oral nutrition?{{c1::Anorectal advancement flap}}
Published	07/07/2024	Patients with rectal Crohn's develop fistulas {{c1::100}}% of the time
Published	07/07/2024	Crohn's patients will end up with fecal incontinence as a result of aggressive {{c1::surgeons}} as opposed to aggressive {{c1::disease}}
Published	07/07/2024	Crohn's disease anal fistula management: - Firstline - {{c1::medical (steroids, 6MP, infliximab, etc)}} - For very minor low fistulas - {{c2…
Published	07/07/2024	The most common post-op complication of hemorrhoidectomy is {{c1::urinary retention}}
Published	07/07/2024	Are prophylactic antibiotics in hemorrhoidectomy indicated?{{c1::No}}
Published	07/07/2024	The main advantage of {{c2::stapled hemorrhoidopexy}} is {{c1::less pain}} post-op compared to hemorrhoidectomy
Published	07/07/2024	The main risk factors for post-op hemorrhoidectomy {{c1::urinary retention}} is {{c2::diabetes}}, general anesthesia, excising > {{c3::2}} columns,…
Published	07/07/2024	Although sclerotherapy for hemorrhoids (grade {{c4::1}} and {{c4::2}}) is not used much, it usually involves injecting {{c1::quinine}}, {{c2…
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