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Gastroenterology > Anorectal Disorders > Flashcards

Anorectal Disorders Flashcards

1
Q

vascular structures that aid in continence by preventing damage to the sphincter muscle during defecation

A

hemorrhoidal cushions

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2
Q

what leads to prolapse of vascular tissue into the anal canal?

A

engorgement and straining

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3
Q

when a blood clot forms in a portion of the hemorrhoid that is not dangerous, but is painful

A

thrombosed hemorrhoid

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4
Q

hemorrhoid that originates proximal to the dentate line

A

internal hemorrhoid

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5
Q

what type of hemorrhoids are the majority?

A

internal hemorrhoids

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6
Q

why is it important to grade internal hemorrhoids?

A

to determine treatment

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7
Q

grade the internal hemorrhoid: patient presents with painless bleeding. Physical exam shows vascular engorgement bulging into the anal canal without prolapse.

A

grade 1

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8
Q

grade the internal hemorrhoid: patient presents with painless bleeding with perianal itching. Physical exam shows hemorrhoidal prolapse with straining that reduces spontaneously

A

grade 2

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9
Q

grade the internal hemorrhoid: patient presents with painless bleeding, perianal itching, and swelling/straining/soilage with mucus and feces. Physical exam shows hemorrhoid prolapses beyond the dentate line with straining and is only reducible by manual pressure

A

grade 3

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10
Q

grade the internal hemorrhoid: patient presents with pain, bleeding, swelling, soilage, with mucus and feces. Physical exam shows grossly evident prolapse of hemorrhoidal tissue that is non-reducible and chronic inflammatory changes (mucosal atrophy, friability, maceration, and ulceration)

A

grade 4

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11
Q

hemorrhoid that originates distal to the dentate line

A

external hemorrhoid

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12
Q

what is the difference in symptoms between internal and external hemorrhoids?

A

internal hemorrhoids are normally painless

external hemorrhoids are painful when thrombosed

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13
Q

hemorrhoids can exist asymptomatically, but become symptomatic when they are _____ and _____

A

distended
engorged

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14
Q

rectal bleeding can be caused by: (2)

A

external, thrombosed hemorrhoids
grade 4 internal hemorrhoids

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15
Q

why can hemorrhoids be reported as “lumps” or “masses”?

A

with time, internal hemorrhoids protrude further and become irreducible

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16
Q

a patient presents with a bluish perianal nodule, which is erythematous, firm, and tender to touch when thrombosed and inflamed. Dx?

A

external hemorrhoid

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17
Q

what can help visualize an internal hemorrhoid? (2)

A

anoscopy
gentle straining

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18
Q

when does an internal hemorrhoid become palpable on digital rectal exam? (2)

A

prolapsed
thrombosed

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19
Q

what is the conservative treatment for grade 1 and 2 internal hemorrhoids? (2)

A

increased fiber + fluids
limit straining + lingering

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20
Q

what is the conservative treatment for external hemorrhoids? (3)

A

warm sitz bath, analgesics, ointment

prep H
Tucks
Anusol

resolves over 2-3 days

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21
Q

what is the preferred medical treatment for grade 1-3 internal hemorrhoids that have recurrent bleeding despite conservative treatment?

A

rubber band ligation

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22
Q

what is the medical treatment for edematous, painful stage 4 internal hemorrhoids? (2)

A

acutely: prep H, tucks, anusol
ligated later

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23
Q

what is the treatment for chronic severe bleeding in grade 3-4 internal hemorrhoid or acute thrombosed grade 4 internal hemorrhoid with necrosis?

A

surgical hemorrhoidectomy

24
Q

what is the treatment for an acutely thrombosed external hemorrhoid?

A

thrombectomy + elliptical incision + clot removal within first 24-48 hours

25
Q

linear or triangular tears/ulcers that are around 5mm in length

A

anal fissures

26
Q

what is the most common cause of anal fissures?

A

trauma to the anal canal during defecation

27
Q

where do anal fissures most commonly occur?

A

in midline

28
Q

what should we worry about when anal fissures do not occur midline?

A

crohn disease

29
Q

a patient presents with severe, sharp, tearing pain that is worse during BM +/- blood in stool or on toilet paper. There are cracks visible in epithelium of sphincter. Dx?

A

anal fissures

30
Q

what can chronic anal fissures lead to?

A

skin tags at outer edge

31
Q

what 2 diagnostics can cause severe pain and may be deferred if a patient has anal fissures?

A

anoscopy
DRE

32
Q

what is the conservative treatment for anal fissures? (3)

A

increase fiber
sitz baths = reduce pain with BM
topical anesthetics = relief prior to BM

33
Q

what is the prognosis of anal fissures with conservative treatment?

A

healing within 2 months in 45% of patients

34
Q

what are treatment options for anal fissures that do not respond to conservative treatment? (3)

A

topical nitroglycerine OR diltiazem
botox injection
internal lateral sphincterotomy

35
Q

present around the rectum and helps protect muscles and nerves

A

anal crypt glands

36
Q

inflammation and infection with accumulation of purulent material near the anus

A

anorectal abscess

37
Q

what typically causes anorectal abscesses?

A

infection of anal crypt gland after obstruction

38
Q

abscesses have the chance of becoming ____ _____

A

chronic fistulas

39
Q

a patient presents with local swelling around the anus and has severe constant pain that is worse with sitting or having a BM. Dx?

A

anorectal abscess

40
Q

what diagnostic is required if a patient may have an anorectal abscess?

A

digital rectal exam

41
Q

what kind of abscess requires an experienced surgeon?

A

any abscess that involves tissue under the sphincter

42
Q

what imaging should be ordered for suspected anorectal abscess?

A

CT scan w/ contrast

43
Q

what will be seen in labs if a patient has an anorectal abscess?

A

elevated WBCs

44
Q

what are the 3 possible outcomes of an anorectal abscess?

A

spontaneously drain + heal

spontaneously drain + form permanent fistula to skin

remain undrained + lead to sepsis with high M+M

45
Q

what is the treatment for an anorectal abscess?

A

surgical drainage + culture

antibiotics: augmentin OR ciprofloxacin + metronidazole

46
Q

what is the post-op care for anorectal abscess? (4)

A

regular diet
fiber + stool softener
sitz bath
f/u in 2-4 weeks

47
Q

what are 4 risk factors for necrotizing anorectal infections?

A

delay in dx of abscess
virulence of pathogen
metastatic infection
previous abscesses

48
Q

a persistent epithelialized track that connects an abscess with the perirectal skin on the outside skin of buttocks

A

anorectal fistula

49
Q

what is the most common cause of anorectal fistulas?

A

anal abscess

50
Q

a patient presents with erythematous, inflamed perianal skin, tenderness, drainage/bleeding. pn physical exam, an indurated cord is felt in soft tissue. Dx?

A

anorectal fistula

51
Q

what 2 diagnostics can be used by an experience provider to explore the fistula track?

A

anoscopy or sigmoidoscopy

52
Q

how is the diagnosis of anorectal fistula made?

A

H&P

52
Q

what 2 diagnostics should be performed if a patient has IBD or recurrent anorectal fistulas?

A

colonoscopy + barium enema

53
Q

what diagnostic can help with the treatment of anorectal fistulas and diagnose recurrent disease?

A

CT or MRI w/ contrast

54
Q

what is the mainstay of treatment for anorectal fistulas?

A

surgery

Gastroenterology (26 decks)

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