Colorectal Surgery and Perianal Conditions Quiz

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Questions and Answers

What is the most common cause of perianal fistulas?

  • Ulcerative Colitis
  • Chronicization of acute suppurations (correct)
  • Tuberculosis
  • Actinomycosis

What is the primary treatment for perianal abscesses?

  • Observation and monitoring
  • Antibiotics only
  • Surgical intervention (correct)
  • Anti-infective vaccination

Which of the following are characteristics of superficial abscesses?

  • Fluctuating swellings in the anus-rectal submucosa (correct)
  • Extensive bulging and redness
  • Deeply located in the ischiorectal space
  • Absence of pain on palpation

Which of the following can complicate untreated perianal abscesses?

<p>Fistula formation (C)</p> Signup and view all the answers

What is the name of the space where ischiorectal phlegmon develops?

<p>Ischiorectal space (D)</p> Signup and view all the answers

What is a characteristic feature of ischiorectal phlegmon?

<p>Extensive bulging and redness of the integument (B)</p> Signup and view all the answers

What type of fistula has two orifices?

<p>Complete fistula (A)</p> Signup and view all the answers

Which of the following conditions can sometimes cause perianal fistulas?

<p>Ulcerative Colitis (C)</p> Signup and view all the answers

Which of the following is a key advantage of hydrosonography for colorectal cancer?

<p>Is non-invasive and cost-effective, allowing for potential screening. (B)</p> Signup and view all the answers

What is the primary use of abdominal ultrasound in the context of colorectal cancer?

<p>To identify potential lymph node involvement or metastases. (C)</p> Signup and view all the answers

Which of the following tumor markers is commonly used for post-operative monitoring in rectal cancer patients?

<p>CEA (C)</p> Signup and view all the answers

Which of the following conditions is NOT mentioned as a differential diagnosis of rectal cancer?

<p>Gastritis (B)</p> Signup and view all the answers

What is the primary aim of curative (radical) surgical interventions for rectal cancer?

<p>To remove the entire tumor and affected lymph nodes. (C)</p> Signup and view all the answers

Which surgical procedure is mainly used for tumors located at the recto-sigmoid junction?

<p>High anterior resection (B)</p> Signup and view all the answers

Which of the following statements is TRUE regarding scheduled surgical treatment for rectal cancer?

<p>It can involve radical-vis surgery for curative purposes. (D)</p> Signup and view all the answers

What is the main limitation of intra-rectal ultrasound in the context of rectal cancer?

<p>It cannot accurately determine the extent of local invasion. (C)</p> Signup and view all the answers

What is the initial conservative treatment approach for rectal prolapse in children?

<p>Observation and management (C)</p> Signup and view all the answers

Which procedure is suitable for elderly patients with associated hard tissues in the treatment of rectal prolapse?

<p>Thiersch procedure (B)</p> Signup and view all the answers

What is the peak incidence age range for rectal cancer?

<p>60-69 years (C)</p> Signup and view all the answers

Which of the following is NOT considered a protective dietary factor against carcinogenesis in rectal cancer?

<p>Red meat proteins (C)</p> Signup and view all the answers

What type of cancer is recognized as a separate entity from colon cancer?

<p>Rectal cancer (A)</p> Signup and view all the answers

Which geographical region has the highest incidence of rectal cancer?

<p>Romania (C)</p> Signup and view all the answers

Which genetic condition is associated with a higher risk of developing hereditary nonpolyposis colorectal cancer?

<p>Lynch syndrome (D)</p> Signup and view all the answers

What factor contributes to increased carcinogenesis in patients who have undergone cholecystectomy?

<p>Increased bile acid levels (A)</p> Signup and view all the answers

What is primarily associated with grade IV hemorrhoidal prolapse?

<p>Hemorrhoidal thrombophlebitis with mucosal ulceration (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with grade IV hemorrhoidal prolapse?

<p>Hemorrhoidal thrombosis without anus swelling (A)</p> Signup and view all the answers

What is a common complication of untreated hemorrhoidal prolapse?

<p>Anal fissures (C)</p> Signup and view all the answers

Which of the following is part of the prophylactic treatment for hemorrhoids?

<p>Avoiding a sedentary lifestyle (D)</p> Signup and view all the answers

What type of fistulas connect the rectum to the integument after passing through the ischiorectal fossa?

<p>Ischiorectal fistulas (C)</p> Signup and view all the answers

What is a common clinical sign of a perianal fistula?

<p>Perianal purulent discharge (C)</p> Signup and view all the answers

What type of surgery is NOT mentioned as a surgical option for complicated hemorrhoids?

<p>Hernia repair (B)</p> Signup and view all the answers

What is the primary method for exploring fistulas?

<p>Fistulography (D)</p> Signup and view all the answers

What is the purpose of rectal curettage in the examination of hemorrhoids?

<p>To reveal soft masses inside the anal canal (B)</p> Signup and view all the answers

Which of these is a curative treatment option for hemorrhoids?

<p>Mild laxatives (B)</p> Signup and view all the answers

Which treatment is typically performed for uncomplicated fistulas?

<p>Surgical excision of the exact area (D)</p> Signup and view all the answers

What is the nature of rectal prolapse?

<p>Descent of the upper rectum through the anus (C)</p> Signup and view all the answers

What is a consequence of repeated bleeding from hemorrhoidal prolapse?

<p>Anemia (A)</p> Signup and view all the answers

Which factor is NOT incriminated in the etiopathogenesis of rectal prolapse?

<p>Chronic diarrhea (C)</p> Signup and view all the answers

What distinguishes mucosal rectal prolapse from other types?

<p>Only the rectal mucosa leaves its position (B)</p> Signup and view all the answers

What happens to a fistula without treatment?

<p>It has no tendency to heal (B)</p> Signup and view all the answers

What is a key procedure that must be performed during surgeries on rectal cancer involving Denonvilliers fascia?

<p>Dilaceration of the constituent lamellae of Denonvilliers fascia (D)</p> Signup and view all the answers

Which is a goal of palliative surgery in advanced stages of rectal cancer?

<p>To prevent possible complications (B)</p> Signup and view all the answers

Local surgery procedures for rectal cancer are performed under what conditions?

<p>Low tumors without invasion of the rectal wall (A)</p> Signup and view all the answers

What is the aim of adjuvant radiotherapy in rectal cancer treatment?

<p>To sterilize remaining tumor material after surgery (B)</p> Signup and view all the answers

What is a characteristic of radical radiotherapy for rectal cancer?

<p>Effective for small tumors less than 5 cm (B)</p> Signup and view all the answers

Which is a common unwanted effect of chemotherapy in the treatment of rectal cancer?

<p>Stomatitis (A)</p> Signup and view all the answers

Why is chemotherapy considered less effective as an adjuvant treatment compared to radiotherapy in rectal cancer?

<p>Tumors develop resistance to chemotherapy quickly (C)</p> Signup and view all the answers

What type of local technique can be utilized in the treatment of rectal cancer?

<p>Electrocoagulation (B)</p> Signup and view all the answers

Flashcards

Grade IV Hemorrhoidal Prolapse

A condition where the internal rectal lining (mucosa) protrudes outside the anus during defecation.

Hemorrhoidal Thrombophlebitis

An inflammation of the veins in the hemorrhoids, often leading to pain, swelling, and blood clots.

Anal Fissure

A painful tear in the lining of the anus.

Cryptitis

Inflammation of the crypts (small folds) in the lining of the anus.

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Milligan-Morgan Operation

A surgical procedure for hemorrhoids that involves removing a section of the hemorrhoidal tissue.

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Transfixing Ligation

A surgical procedure for hemorrhoids that involves tying off the base of the hemorrhoid.

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Prophylactic Hemorrhoid Treatment

Treatment approach that aims to prevent hemorrhoids or worsen existing ones.

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Curative Hemorrhoid Treatment

Treatment that aims to cure existing hemorrhoids.

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Subcutaneous Fistula

A type of fistula that extends from the anus to the skin surface.

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Submucous Fistula

Fistulas located within the mucous membrane lining the rectum.

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Transsphincteric Fistula

A type of fistula in which the fistulous tract passes through the sphincter muscle that controls the anus.

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Extrasphincteric Fistula

A type of fistula where the fistulous tract does not completely cross the sphincter muscle.

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Ischiorectal Fistula

A type of fistula that extends from the rectum to the skin surface. The tract travels through the ischiorectal fossa (space between the rectum and the pelvic bone).

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Rectal Prolapse

A condition where part of the rectum protrudes outwards through the anus, caused by a weakness in the rectal wall.

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Mucosal Rectal Prolapse

A specific type of rectal prolapse where only the mucosal lining of the rectum protrudes.

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Propriuzis Rectal Prolapse

A type of rectal prolapse where the entire rectal wall protrudes through the anus.

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Anorectal Prolapse

A condition where the lining of the rectum protrudes through the anus, often appearing as multiple cylinders.

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Thiersch Procedure

A medical procedure that involves stitching the anus closed to correct prolapse, often using materials like silver wire or nylon.

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Perineal Tightening

A surgical intervention for rectal prolapse that involves tightening perineal muscles.

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Anorectal Resection

A type of rectal cancer treatment that involves removing part of the rectum.

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Rectal Cancer

Cancer that occurs in the rectum, a part of the large intestine.

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Lynch 2 Syndrome

A genetic disorder that increases the risk of developing rectal cancer and other cancers.

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Familial Adenomatous Polyposis

A frequent cause of rectal cancer, it is characterized by multiple polyps in the rectum.

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Ulcero-Hemorrhagic Rectocolitis

A condition that increases the risk of rectal cancer, often caused by inflammation of the rectum and colon.

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Perianal abscess

An infection that occurs under the skin surrounding the anus.

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Ischiorectal phlegmon

A deep infection occurring in the space between the anus and the ischium bone.

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Fluctuating swelling

A collection of pus that fluctuates, meaning it feels soft when pressed.

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Rectal coughing

A condition where the body can not cough effectively due to pain.

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Anal Fistula

A deep wound that communicates between the anus and the skin surrounding it, acting as a passage for drainage.

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Blind Fistula

A fistula where there is only an opening outside the anus.

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Incision and Drainage

The surgical procedure used to treat perianal abscesses.

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Sphincterotomy

A surgical procedure that can be used to treat anal fistulas, where a small part of the anal sphincter is cut to prevent obstruction.

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Metorectal Removal

Surgical removal of the rectum and surrounding tissues, often used in early stages of rectal cancer.

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Dilaceration of Denonvilliers Fascia

A technique separating layers of tissue, particularly the Denonvilliers fascia, surrounding the rectum.

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Section of Lateral Ligaments and Middle Rectal Arteries

Surgical cutting of ligaments and blood vessels near the rectum. Part of the metorectal removal procedure.

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Pelvic Nerve Plexuses

A collection of nerves in the pelvis that need to be preserved during rectal surgery. It's crucial for bladder and bowel control.

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Palliative Surgery

Surgery aiming to relieve symptoms and improve quality of life, not to cure the disease, often performed in advanced stages of rectal cancer.

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Local Surgery (Per Anum)

A procedure used to remove rectal tumors through the anus, typically smaller and with less involvement.

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Radiotherapy for Rectal Cancer

Using high-energy rays to target and destroy cancerous cells in the rectum.

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Chemotherapy for Rectal Cancer

A combination of drugs to fight cancerous cells, often used alongside other treatments.

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Hydrosonography

A diagnostic imaging technique that uses ultrasound waves to visualize the rectum and surrounding tissues. It helps assess the spread of rectal cancer and identify lymph node involvement.

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Intra-rectal ultrasound

A type of ultrasound examination performed by inserting a probe into the rectum to visualize the rectal wall and surrounding tissues. It helps determine the extent of local invasion of the tumor.

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Abdominal Ultrasound

A type of ultrasound examination that scans the abdomen to detect possible metastatic spread of rectal cancer to other organs.

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Tumor markers

Blood tests that measure the levels of certain proteins produced by cancer cells. They are used to monitor for recurrence of rectal cancer after surgery.

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Surgical treatment

The main treatment approach for rectal cancer, involving surgical removal of the tumor, surrounding tissues, and nearby lymph nodes.

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Radical-vis surgery

Surgical intervention aimed at completely removing the rectal tumor, including the mesorectum and regional lymph nodes. It's a curative approach.

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High anterior resection

Surgical procedure used for tumors located at the recto-sigmoid junction. It involves removing a section of the rectum and sigmoid colon.

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Paleactive-surgical interventions

Surgical procedures that aim to relieve symptoms of rectal cancer without completely removing the tumor. It's used when the cancer is advanced.

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Study Notes

Ano-rectal Surgical Pathology

  • Rectum Anatomy: 15-25 cm, extends from S3 vertebra to the anocutaneous line, with multiple curves and a dilated rectal vault. The anal canal is ~3 cm long with vertical folds (Morgagni columns).

  • Vascularization: Supplied by superior, middle, and inferior hemorrhoidal arteries, with venous plexuses connecting portal and caval systems.

Hemorrhoids

  • Definition: Varicose veins in hemorrhoidal plexuses (internal, external, mixed). Caused by factors like constipation, HTP, and chronic pressure.
  • Grade IV: Complete prolapse outside defecation, often with thrombophlebitis.
  • Symptoms: Itching, bleeding, pain, anemia.
  • Diagnosis: Visual inspection, anoscopy, rectoscopy.
  • Treatment: Medical for mild cases (laxatives, anti-inflammatories), surgery for severe cases (electroresection, ligation, excision).

Anal Fissure

  • Definition: Ulceration in the anal canal, typically due to sphincter spasm.
  • Treatment: Topical ointments for recent cases, surgery (sphincterotomy) for chronic ones.

Ano-Rectal Discharge

  • Causes: Abscesses, phlegmons, fistulas.
  • Symptoms: Pain, fever, possible complications (sepsis, fistula).
  • Treatment: Surgical drainage and excision of infected tissues.

Rectal Prolapse

  • Definition: Protrusion of rectal tissue through the anus.
  • Causes: Weak tissues, excessive intra-abdominal pressure.
  • Treatment: Conservative in children, surgery (resections, perineal tightening) in adults.

Rectal Cancer

  • Epidemiology: Most common in older adults (60-69 years), with higher incidence in some regions (e.g., France).
  • Etiology: Environmental (red meat, alcohol) and genetic factors (FAP, Lynch syndrome).
  • Diagnosis: Colonoscopy, CT, X-rays, and biopsy.
  • Treatment: Surgical resection (curative or palliative), chemotherapy, radiotherapy.

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