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Clin Med II - GI Exam > Disorders of the Rectum > Flashcards

Disorders of the Rectum Flashcards

1
Q

Where is the most common location for Anal fissures?

A

Posterior midline!!!

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2
Q

What might be indicated by anal fissures found off of the midline?

A 
UC
Crohn's 
HIV/AIDS
TB
Syphillis
Anal Ca.
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3
Q

MC cause of Anal fissure?

A 
Trauma  (MC)
Defecation
Straining
constipation
high sphincter tone
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4
Q

What might a pt who presents to you say about their Anal Fissure pain?

A

“It feels like I’m shitting glass!”

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5
Q

What may occur d/t spasms created by anal fissure pain?

A

reduced blood flow which can lead to mucosal ischemia

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6
Q

sx of anal fissure

A

moderate to severe tearing/throbbing pain

Hematochezia may or may not be present on TP (not severe bleeding though)

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7
Q

What does an acute anal fissure look like?

A

crack in the epithelium (a crack in your back (posterior) crack)

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8
Q

What may a chronic anal fissure look like?

A

fibrosis and development of skin take “sentinel pile”

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9
Q

acute Tx for anal fissure?

A

promote effortless BM
Fiber
Stool softener
Topical anesthetics

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10
Q

Chronix tx for anal fissure?

A

topical NTG

Botox

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11
Q

What percent of anal fissures heal with conservative tx

A

80%

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12
Q

What surgery can be performed to prevent reucurrence of anal fissure?

A

sphincterotomy (may result in incontenence)

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13
Q

Define anal fistula

A

a hollow tract which has primary opening inside anal canal leading to secondary opening in perianal skin

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14
Q

What might cause an anal fistula?

A 
Anorectal or perianal abscess
crohsn
fissures
trauma
ca
radiation
actinomyoces
rectal tuberculosis
chlamydial infections
lympgranuloma venerum
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15
Q

Sx of Anal fistula?

A 
Hx of IBD
Perianal dc (chronic)
itching
Pain -mc in abscess stage 
swelling
bleeding
diarrhea
skin excoriation
external opening (chronic)
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16
Q

What is seen on visual exam of a pt with an anal fistula?

A

external opening

elevation of granulation tissue (fibrous tract)

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17
Q

On DRE what might be observed for a pt with an anal fistula?

A

spontaneous expressible discharge
feel fibrous tract (cord) below skin
sphincter tone

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18
Q

What is the “poor man’s test” anoscopy?

A

Anoscope and hydrogen peroxide. Look through scope into rectum and use syringe to flush hydrogen peroxide int the external opening of supposed fistula. If bubbling is seen through anoscope then it must track up that far.

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19
Q

DDX for anal fistula?

A

Hydradenitis suppurativa
pilonidal cyst
Bartholin gland abscess
Infected sebacceous cyst

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20
Q

Labs for anal fistula

A

none

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21
Q

Imaging for anal fistula?

A 
fistulography
endoanal/endorectal US
MRI with rectal coil
CT scan
scope if suspect IBD
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22
Q

tx for anal fistula?

A 
sitz baths, analgesics, stool bulking agents
Surgical: 
fistolotomy/fistulectomy
seton placement
NaAg tx in office
Fistula plug 
fibrin glue
colostomy
endorectal advancement flap (LIFT)
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23
Q

complications of anal fistula?

A 
bleeding
fecal impaction
thromboses hemorrhoids
recurrence
incontinence
anal steonsis
delayed would healing esp with crohns
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24
Q

Post surgical healing is dependent upon?

A

surgical technique and pt’s compliance

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25
Q

What is the difference between internal hemorrhoids and external hemorrhoids?

A

internal-subepithelial vasculatures above the dentate line (rarely painful)
External-arise from inferior hemorrhoidal veins, below dentate line cause swelling, pain, hygiene issues

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26
Q

Where do hemorrhoids occur?

A

R anterior
R posterior
L lateral

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27
Q

What are M/c rf for hemorrhoids?

A 
Diet (low fiber)
Pregancy
Obesity
abnormally high tension of sphincter muscle
Prolonged sitting on toilet
aging
diarrhea (irritation)
28
Q

Symptoms of hemorrhoids

A

Bleeding-bright red blood streaks on TP/ stool dripping s/p BM
anemia unlikely
prolapse
mucoid dc

29
Q

Stage one of internal hemorrhoids?

A

confined to anal canal

bleeding no prolapse

30
Q

Stage 2 of internal hemorrhoids

A

Protrude from anal opening

bleeding, mild prolapse, w/ spontaneous reduction

31
Q

Stage 3 of internal hemorrhoids

A

Prolapsed

requires manual reduction s/p BM

32
Q

Stage 4 of internal hemorrhoids

A

chronically prolapsed won’t go back in
strangulated
sense of fullness, discomfort, mucoid d/c, irritation, staining, pain

33
Q

Conservative tx is reserved for which stages of hemorrhoids?

A

1 and 2

34
Q

What is the conservative tx for hemorrhoids?

A

high fiber diet
increased fluid intake
fiber supplement
manual reduction supplemented with suppository (sugar-weird)

35
Q

What stages can be tx medically for hemorrhoids?

A

1, 2 (that have failed conservative tx), and 3

36
Q

What is tx for stage 1, 2, and 3 medically for hemorrhoids?

A

Injection sclero
rubber band ligation
electrocoagulation

37
Q

Surgical tx is reserved for which stages of hemorrhoid?

A

3 and 4

38
Q

What is the surgical tx for hemorrhoids?

A

excision

reserved for chronic severe bleeding, acutely thromboses

39
Q

What is the other name for thrombosed external hemorrhoid?

A

perianal hematoma

40
Q

sx of thrombosed external hemorrhoid

A

otherwise healthy pt with hemorrhoid s/p coughing or heavy lifting
-acute onset severe pain
tense bluish perianal nodule covered with skin
pain most severe first few hours and gradually subsides 2-3 days

41
Q

Tx for thromboses hemorrhoid?

A

Warm sitz bath, analgesics ointments

if eval within 24-48hr’s removal of clot hastens symptoms resolution

42
Q

Where do rectal abscesses begin?

A

in the anal glands and teach through various planes in the anorectal region. May track through internal and external sphincter muscles to enter ischiorectal space.

43
Q

sx of rectal abscess?

A

continuous throbbing perianal pain

44
Q

Why is it important to always consider rectal abscess with acute rectal pain?

A

delay in diagonsis can lead to necrotizing infection. esp in immune compromised pt’s

45
Q

What is best tx for rectal abscess?

A

surgical drainage under local anesthesia

if larger and more complex best in OR

46
Q

In a supralevator abscess it is important to ______ when treating?

A

identify and tx the process causing the abscess as well as relieve abscess with surgical drainage

47
Q

Are Abx required for a perianal abscess?

A

No unless the pt has DM

48
Q

Offending agent of pilonidal abscess is almost always____?

A

hair

49
Q

t/f pilondal abscess is NOT an anorectal abscess?

A

true

50
Q

tx for Pilonidal abscess

A

surgical excision (last resort) keep area hair free

51
Q

What are some of the treatable causes of perianal pruritis?

A

infection
dermatitis
hemorrhoids

52
Q

How can you determine the possibility of a treatable cause of perianal pruritis

A

KOH smear, Bx
DRE
Anoscope

53
Q

What agents should be avoided in a pt who c/o perianal pruritis

A 
caffiene
spicy food
citrus
peppermint
tomato
ETOH
smoked/cured foods
54
Q

What might cause fecal incontinence?

A 
childbirth
rectal prolapse
episiotomy
prior anal surgery
prior pelvic radiation
physical trauma
55
Q

What is the definition of fecal incontinence

A

loss of stool

56
Q

If fecal incontinence is accompanied by unawareness of the situation what should you consider?

A

loss of central awareness s/a dementia, CVA, MS

Periopheral nerve injury d/t spinal cord injury, aging, diabetes

57
Q

tx for fecal incontinence?

A 
fiber
avoid caffeine
cotton ball to soak up leakage
resolve underlying hemorrhoids, diarrhea etc.
kegal, anal wink
sacral nerve stim
artificial bowel/sphincter
58
Q

What is the only way to tx a full thickness rectal prolapse?

A

surgically

59
Q

What is the best way to examine a pt with rectal prolapse?

A

with them sitting on toilet

60
Q

MC form of rectal Ca?

A

adenocarcinoma

61
Q

RF for rectal ca?

A

Age
smoking
Fam hx colorectal ca?
High fat diet from primarily animal sources

62
Q

sx of rectal ca?

A

tenesmus
hematochezia
pelvic pain
enlarged inguinal lymph nodes

63
Q

Diagnostics for Rectal Ca?

A

CT to eval loacal and possible disseminated dz

Bx

64
Q

Tx for Rectal Ca?

A

chemo, surgery for refractory or recurrent dz

65
Q

What is more common in the US Rectal ca or Anal ca?

A

Rectal Ca more common

66
Q

What is the MC associated dz of anal ca?

A

HPV

Clin Med II - GI Exam (14 decks)

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