Anorectal Conditions - Sasek Flashcards Preview

Adult/Ped Medicine 4 > Anorectal Conditions - Sasek > Flashcards

Flashcards in Anorectal Conditions - Sasek Deck (15):
1

External Hemorrhoids

  • below dentate or pectinate line
  • covered by squamous epithelium
  • sensory innervation
  • acute pain when thrombosed
    • if thrombosed typically bluish in color
    • excise clot if necessary
    • NSAIDs, analgeics, stool softeners, preparation H, Tucks

1

Anorectal Abscess

secondary to infection originating in the anal glands

presentation: anorectal, drainage of blood/pus

*early sepsis can result

physical exam: hot, red, tender area; adjacent to anus

treatment: I&D, broad spectrum antibiotics

2

Internal Hemorrhoids

  • ABOVE dentate (pectinate) line
  • covered by mucosa - no sensory innervation
  • asymptomatic bleeding
  • bright red spotting on toilet paper; dripping into toilet

2

Classification of Internal Hemorrhoids

First Degree: small size, bleeding only

Second Degree: medium size, prolapse under pressure, reduce spontaneously

Third Degree: large size, permanent prolapse, reduce manually

Fourth Degree: large size, proplaspe can't be reduced - refer to colorectal surgeon

3

Management of Hemorrhoids

Conservative:
  • decrease straining
  • avoid prolonged sitting
  • symptomatic treatment for pruitis/irritation
    • steroid creams
    • suppositories
    • analgesic cream
    • sitz bath

Office Based:

  • rubber band ligation (1, 2, 3 degree)
  • infrared coagulation (1, 2, 3 degree)

Surgery:

  • when hemorrhoid is unreducable (4 degree)

3

Rectal Carcinoma

painless mass or palpable mass on rectal exam

5

Identify key history elements for anorectal disorders

HPI: OLD CHARTS + ICE

PMH:

  • similar problems in past
  • hx of IBD, IBS
  • hx of radiation, cancer
  • recent pregnancy
  • chronic constipation
  • bowel habits
  • liver disease
  • medications

FH:

  • hemorrhoids

SH:

  • sexual history
  • anal intercourse (preferences, practices, protection)
  • abuse
  • drug use (cocaine)

6

Proctitis

inflammation of the lining of the rectum

causes:

  • IBD
  • infectious: C. dif salmonella, N. gonorohoeae, chlamydia trachomatis, HSV, HPV
  • icschemia
  • radiation

symtpoms:

  • rectal pain
  • mucopurulent discharge
  • fecal urgency or tenesmus
  • constipation

physical exam:

  • DRE may be difficult
  • HSV may have vesicles

diagnosis:

  • CBC
  • stool culture
  • gonoccal swabs
  • endoscopy

treatment:

  • treatment based on underlying cause

8

Identify key physical exam findings and diagnostic tests for anorectal disorders

PHYSICAL EXAM

Age - peaks 45-65 years

GU Exam

  • inspect rectal area
  • DRE
  • anoscopy

Abdominal Exam - if colonic etiology

DIAGNOSTICS

Laboratory - CBC for anemia, infection

Diagnostic Tests - anoscopy, colonoscopy

11

Pruritis Ani

causes:

  • fecal soilage
  • perspiration
  • hemorrhoids
  • infection, malignancy

treatment:

  • bulk forming agent
  • sitz baths
  • witch hazel pads
  • steroid creams
  • good hygiene

12

Rectal Prolapse

  • protrusion of mucosa or entire thickness of rectum

12

Anal Fissure

laceration or tear in anal canal distal to dentate line (posterior midline)

painful with defecation; usually due to passing hard stool

viewed on inspection

treatment: topical analgesia, soften stool, may need surgery

13

Pathophysiology &

Causes of Symptomatic Hemorrhoids

Pathophysiology: usually secondary to increased intra-abdominal pressure
 
Causes
  • aging
  • chronic diarrhea or constipation
  • pregnancy/child birth
  • prolonged sitting
  • straining
  • heavy lifting
  • anal intercourse
  • pelvic tumors

14

Condyloma Accuminata

  • anogenital warts from HPV

15

Anal Skin Tag

  • pervious thrombosed hemorrhoid