Ano-rectal Flashcards

(28 cards)

1
Q

Linear or rocket-shaped ulcers, generally <5 mm in length

Acute = <8 weeks, severe tearing pain during defecation followed by throbbing, hematochezia

Chronic = >8 weeks, severe, tearing pain during defecation followed by throbbing, hematochezia

A

anal fissures

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2
Q

anal fissures are common in

A

Infants and middle-aged adults

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3
Q

Large caliber stool/constipation, vaginal delivery, anal intercourse

MC in posterior midline

Can also be from cancer (anything that deviates from midline is suspicious), Crohn’s, HIV/AIDs, anorectal TB, lymphogranuloma venereum

A

anal fissures

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4
Q

PE: upon anal exam:

crack in epithelium, fibrosis, skin tag “sentinel pile”

A

anal fissure

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5
Q

how do you treat an anal fissure?

A

Increased fiber, sitz bath

Acute = topical anesthetic (lidocaine)

Chronic = topical NTG, diltiazem ointment, nifedipine, botox injection, sphincterotomy

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6
Q

Acute: Rectal pain, deep-seated, swelling
Tenderness or redness, fluctuant mass, fever
Chronic: Persistent or recurrent perianal pain, swelling or tenderness, lump and/or discharge from opening

A

abscess

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7
Q

Perianal itching, purulent discharge, inability to sit down

A

perianal fistula

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8
Q

RFs for — —-/—:
Men
30s-50s
Crohn’s
Previous infection
DM
HIV
Pregnancy
Anal intercourse

A

perianal abscess/fistula

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9
Q

acute or chronic, primary (abscess) or secondary (disease)

Glands become infected

Staph aureus

MC location = posterior rectal wall

A

perianal abscess/fistula

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10
Q

PE: tender, fluctuant mass on palpation

DRE + may need imaging needed to check for deeper abscess

Labs

Parks classification of fistulas

A

perianal abscess/fistula

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11
Q

How do you treat perianal abscesses and fistulas?

A

Abscess: Surgical drainage (local or OR)

Cellulitis, underlying immunosuppression, or systemic signs of infection :
→ metronidazole and ciprofloxacin
OR augmentin

Fistula: treat infection, surgery/fistulotomy

WASH: warm water cleansing, analgesics, sitz baths, high fiber

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12
Q

bright red and painless discharge in stool should make you think what?

A

internal hemorrhoid

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13
Q

perianal pain with no blood should make you think what?

A

a lot of things but external hemorrhoids are the answer!

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14
Q

Bright red blood on toilet paper or stool, mucus/stool leakage, “fullness” sense in perianal area, itching/burning, visible if external

Internal = painless bright red blood, pruritus, fullness, mucus discharge

External = perianal pain aggravated with defecation (thrombosed!)

A

hemorrhoids

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15
Q

RF for ——-:
Developed countries
Low fiber, high fat western diet → constipation, straining
Diarrhea
Prolonged period of sitting
Obesity
Low fiber

A

hemorrhoids

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16
Q

Internal = cluster of tissue containing arterioles, veins, and smooth muscle above the pectinate line (generally painless, and bleed)

External = cluster of tissue containing vessels and muscle below pectinate line (generally painFUL and don’t bleed)

17
Q

PE: DRE to grade internal hemorrhoids, always examine for other abnormalities, performed in prone or left lateral position

Bright red blood or thrombosed or not detected = anoscopy

With hematochezia = proctosigmoidoscopy or colonoscopy

Discolored, very tender = thrombosed

18
Q

How do you treat stage I/II hemorrhoids conservatively?

A

Decrease straining: high fiber diet, increase fluid intake with meals, avoid straining, limit time on toilet <5 min

19
Q

How do you treat stage I/II/III hemorhoids medically?

A

rubber band ligation, injection sclerotherapy, application of electrocoagulation

20
Q

how do you treat stage IV hemorrhoids?

A

prolapsed = topical creams, foams, suppositories with emollients, topical anesthetics, vasoconstrictors, astringents, steroids

21
Q

How do you treat thrombosed hemorrhoids?

A

Surgery for chronic severe bleeding, acute thrombosed stage IV (few people)

Excision for thrombosed hemorrhoids within 24-48 hours of onset or refer to surgeon!
>48 = resolves spontaneously

22
Q

Early lesions silent

Anal itching and bleeding, pain/pressure, localized tumor/tissue looks abnormal

A

anal carcinoma

23
Q

Common patients at risk for anal carcinomas include

A

Receptive anal intercourse
Anorectal warts
MSM
HIV+
Solid organ transplant
Women who have HPV-ass lesions

24
Q

MCC = SCC, associated with HPV (16 and 18)

Gardasil vaccine lowers risk

A

anal carcinoma

25
How do you treat an anal carcinoma?
2-3cm = wide excision Larger or involving deeper tissue → combo therapy (excision, radiation, chemo)
26
Acutely spontaneously reduces, but after time results in Mucous discharge, bleeding, incontinence, sphincter damage
rectal prolapse
27
Full thickness uncommon and caused by surgery, trauma, excessive straining with weak pelvic support
rectal prolapse
28
How do you treat a rectal prolapse?
surgery