Anal Path I

Question 1

dentate line

Answer 1

pectinate

important in anal issues

above - glandular
below - squamous

also transitional zone

Question 2

external hemorrhoids

Answer 2

below dentate line

-painful

Question 3

internal hemorrhoids

Answer 3

above dentate line

can prolapse and bleed

Question 4

anal fissure

Answer 4

posterior wall

impacted fecal material
-painful

Question 5

perianal fistula

Answer 5

abnormal connection between epithelialized surface of anal canal and abscess of skin

primary - obstruction

secondary - iatrogenic, diverticulitis, IBD, infection, cancer

Question 6

seton drain

Answer 6

surgical tx of perianal fistula

facilitates healing of fistula and draining

Question 7

pain with bowel movement and stained underwear

Answer 7

perianal fistula

Question 8

opening of anal fistula

Answer 8

can tell location of abscess

Question 9

superior rectal abscess

Answer 9

can be palpated on DRE

• pain worse with bowel movement
• fever/sepsis

Question 10

anal fistulas

Answer 10

are classified - parks

Question 11

crohn disease

Answer 11

can see anal fistula and abscesses

Question 12

anal condyloma

Answer 12

papilliform appearance

contrast to SCC - has smooth and pearly appearance with hemorrhage and necrosis

low risk HPV association

Question 13

koilocytosis

Answer 13

seen with anal condylomas

Question 14

HPV

Answer 14

induces dysplasia of squamous epithelium

virus gets to basal cells - become premalignant - large darker nuclei to surface

Question 15

high grade HPV

Answer 15

large dark nuclei to surface

Question 16

low grad HPV

Answer 16

koilocytes - anal condyloma

Question 17

atypical anal lesion

Answer 17

biopsy needed**

Question 18

CIN

Answer 18

cervical intraepithelial neoplasm

Question 19

AIN

Answer 19

anal intraepithelial neoplasia

low grade

Question 20

SCC of anus

Answer 20

keratin pearly

Question 21

basaloid carcinoma

Answer 21

in transition zone
-rare tumor

-like SCC - same tx

no keratin
-just blue basaloid cells

Question 22

HPV 16 and 18

Answer 22

SCC of anus

Question 23

above dentate lymph

Answer 23

perirectal and paravertebral nodes

Question 24

below dentate lymph

Answer 24

superficial inguinal and femoral nodes

Question 25

prognosis anal ca

Answer 25

tumor diameter and nodal involvement