3.08 Anorectal Conditions

Question 1

What distinguishes internal from external hemorrhoids?

Answer 1

pectinate/dentate line

Question 2

general symptoms and signs of hemorrhoids include?

Answer 2

bright red blood per rectum

Question 3

protuberant purple nodoled covered by mucosa?

Answer 3

internal hemorrhoids

Question 4

discomfort and pain are unusual and occur only when there’s extensive inflammation and thrombosis or irreducible tissue.

Answer 4

internal hemorrhoids

Question 5

readily visible on perianal inspection, covered with skin, and usually asymptomatic but can be thrombosed that are exquisitely painful?

Answer 5

external hemorrhoids

Question 6

Differential for hemorrhoids?

Answer 6

other things that cause structural, pain, itching, or bleeding

Question 7

a condition that can lead to rectal discomfort due to perianal spasms that can last up to 20 minutes?

Answer 7

levator ani syndrome or proctalgia fugax

Question 8

procedure to visualize internal hemorrhoids?

Answer 8

anoscopy

Question 9

What is the 1-IV grading for internal hemorrhoids?

Answer 9

I: no prolapse
II: spontaneously reduces
III: requires manual reduction
IV: permanently prolapsed

Question 10

general hemorrhoid countermeasures?

Answer 10

high fiber diets, increased fluid intakes, symptomatic relief via suppositories, warm sitz baths

Question 11

What kind of suppositories for symptomatic relief of hemorrhoids?

Answer 11

Anusol NO hydrocortisone

Question 12

What should you consider for treatment for thrombosed external hemorrhoids?

Answer 12

warm sitz bath
analgesics
incision to remove the clot (if over 48 hours and shrinking may not be necessary)

Question 13

For grade I-III hemorrhoids and recurrent bleeding, you could consider what surgical options?

Answer 13

rubber band ligation *
injection sclerotherapy
electro or infrared coagulation

Question 14

Surgical option for Grade IV hemorrhoids that are persistently bleeding or cause discomfort?

Answer 14

stapled haemorrhoidectomy

Question 15

Where do anal fissures most commonly occur?

Answer 15

posterior midline

Question 16

A common cause of anal fissures?

Answer 16

trauma due to defecation

Question 17

Severe tearing pain during defecation and throbbing discomfort that may lead to constipation, mild, associated hematochezia?

Answer 17

anal fissure

Question 18

Anal fissures that are off the midline may suggest? “CATHS”

Answer 18

crohns disease
anal carcinoma
TB
HIV/AIDs
syphilis

Question 19

What are some interesting TX considerations for anal fissures?

Answer 19

topical lidocaine
topical vasodilators

Question 20

Chronic fissures can be treated with?

Answer 20

topical nitroglycerin or diltiazem
botox
internal sphincterotomy

Question 21

Where are anal abscesses usually located?

Answer 21

anal glands at the base of anal crypts

Question 22

Common causes of anal abscesses?

Answer 22

anal fissures and crohns disease

Question 23

What is usually preceded by an anal abscess?

Answer 23

anal fistula

Question 24

Continuous perianal pain, erythema, fluctuance, swelling?

Answer 24

perianal abscess

Question 25

What may indicate a fistula versus a perianal abscess?

Answer 25

purulent discharge

Question 26

epidermal manifestation attributed to HPV?

Answer 26

condyloma acuminatum

Question 27

What has been related directly to increased neoplastic risk in men and women?

Answer 27

HPV infection

Question 28

Painless bumps, pruritis, or discharge, lesions may appear spontaneously, remain fixed, or progress and be associated with a history of anal intercourse?

Answer 28

Anal condyloma

Question 29

Is anal condyloma related to HPV infectious?

Answer 29

Yup even if lesions are not visible

Question 30

Irregularity in shape, form, or color of anal condylomas may be suggestive of?

Answer 30

melanoma

Question 31

Eruptions of anal condylomas may appear?

Answer 31

pearly, filiform, fungating, cauliflower, plaque-like

Question 32

Condyloma acuminatum and anal fissure sare usually diagnosed?

Answer 32

visual exam/diagnosed clinically

Question 33

What are some things you can do to further asses condyloma acuminatum?

Answer 33

pap smear acetowhitening: subclinical lesions look like white papules

Question 34

What next if you diagnose condyloma acuminatum?

Answer 34

assess for other STDs

Question 35

Treatment for anal warts?

Answer 35

for immunocompetent it may resolve without treatment Relapses are frequent and no TX is satisfactory topicals are frequently ineffective

Question 36

Surgical treatment for anal warts?

Answer 36

cryotherapy electrodessication (smoke maybe infective) carbon dioxide laser treatment (potentially infectious) Surgical excision*

Question 37

What has the highest success rate and lower recurrence rate to treat anal warts?

Answer 37

surgical excision

Question 38

Prevention of anal warts?

Answer 38

Vaccines: Gardasil (6,11) Gardasil 9 (6,11), Cervarix

Question 39

Anal cancer pathophysiology?

Answer 39

squamous cell cancers

Question 40

Metastasis of anal cancer tends to go where?

Answer 40

lymphatics to inguinal lymph nodes

Question 41

Risk factors for anal cancers?

Answer 41

HPV (90%) high risk 16 condyloma acuminata chronic fistulas, etc.

Question 42

What is teh most common initial symptom of anal cancer?

Answer 42

bleeding with defecation

Question 43

What must be ruled out when anal bleeding occurs if hemorrhoids are obvious or diverticular disease dxg?

Answer 43

coexisting cancer

Question 44

Typically what is done to diagnose anal cancer?

Answer 44

colonoscopy but askin one can be done as well

Question 45

What is the primary treatment for SCC anal cancer?

Answer 45

CRT chemoradiotherapy

Question 46

What is indicated if CRT did not resolve in anal tumor regression and there is no metastasis outside the radiation field?

Answer 46

abdominoperineal resection (rectum, anus, sigmoid colon removed)

Question 47

When the rectum falls and comes through the anal opening?

Answer 47

rectal prolapse (anal intussusception)

Question 48

CVause of anal prolapse?

Answer 48

exact unclear but increased abdominal pressure or decreased pelvic floor pressure?

Question 49

What bulges in a partial anal prolapse?

Answer 49

inner lining of rectum

Question 50

Reddish-colored mass that sticks out the anus, especially after a bowel movement, may bleed, uncomfortable?

Answer 50

rectal prolapse

Question 51

Rectal prolapse treatment?

Answer 51

at-home manual reduction surgery

Question 52

When is surgery urgently indicated for a rectal prolapse?

Answer 52

strangulated rectal prolapse that can lead to perforation

Question 53

What is the only cure for rectal prolapse?

Answer 53

repair weakened anal sphicnter and pelvic muscles