Anorectal Disorders

Question 1

What are the risk factors for haemorrhoidal disorder?

Answer 1

1-age is known to be a risk factor.

2-The typical low-fiber, high-fat Western diet is associated with constipation and straining

Question 2

تعریف External haemorrhoids ؟

Answer 2

External hemorrhoids originate below the dentate line and are covered with squamous epithelium and are associated with an internal component.

Question 3

چه زمانی External haemorrhoids دردناک میشن؟

Answer 3

External hemorrhoids are painful when thrombosed.

Question 4

جنس پوشش Internal haemorrhoids؟

Answer 4

mucosa and transitional zone epithelium and represent the majority of hemorrhoids.

Question 5

ویژگی های استیج ۱ هموروئید و درمانش؟

Answer 5

Enlargement with bleeding

Tx:
Fiber supplementation🥗🥝🥦🥒

Short course of cortisone suppository

Sclerotherapy

Infared coagulation

Question 6

ویژگی های استیج ۲ هموروئید و درمانش؟

Answer 6

Protrusion with spontaneous reduction

Tx:
Fiber supplementation
Short course of cortisone suppository
Sclerotherapy 
Infared coagulation

Question 7

ویژگی های استیج ۳ هموروئید و درمانش؟

Answer 7

Protrusion requiring manual reduction

Tx:
Fiber supplementation

Short course of cortisone suppository

Rubber band ligation

Operative hemorrhoidectomy

Question 8

ویژگی های استیج ۴ هموروئید و درمانش؟

Answer 8

Irreducible protrusion

Tx:
Fiber supplementation
cortisone suppository
Operative hemorrhoidectomy

Question 9

چی باعث میشه که هموروئید پای بیمار رو به مطب پزشک وا کنه؟

Answer 9

bleeding and protrusion

Question 10

ویژگی های درد در هموروئید؟

Answer 10

Pain is less common than with fissures and, if present, is described as a dull ache from engorgement of the hemorrhoidal tissue.

Severe pain may indicate a thrombosed hemorrhoid.

Question 11

ویژگی های bleeding در هموروئید؟

Answer 11

Hemorrhoidal bleeding is described as painless bright red blood seen either in the toilet or upon wiping.

Occasional patients can present with significant bleeding, which may be a cause of anemia; however, the presence of a colonic neoplasm must be ruled out in anemic patients.

Question 12

ابزار تشخیصی هموروئید؟

Answer 12

The diagnosis of hemorrhoidal disease is made on physical examination.

Question 13

اصول معاینه در هموروئید؟

Answer 13

🍓Inspection of the perianal region for evidence of thrombosis or excoriation is performed,

🍓followed by a careful digital examination.

🍓Anoscopy is performed paying particular attention to the known position of hemorrhoidal disease.

🍓The patient is asked to strain. If this is difficult for the patient, the maneuver can be performed while sitting on a toilet. The physician is notified when the tissue prolapses.

Question 14

نحوه افتراق هم‌وروئید از Rectal prolapse?

Answer 14

It is important to differentiate the circumferential appearance of a full-thickness rectal prolapse from the radial nature of prolapsing hemorrhoids.

Question 15

اندیکاسیون کولونوسکوپی در بیمار جوان با هموروئید بدون Family history of colorectal cancer?

Answer 15

In young patients without a family history of colorectal cancer, the hemorrhoidal disease may be treated first
✅ and a colonoscopic examination performed if the bleeding continues.

Question 16

درمان thrombosed hemorrhoid؟

Answer 16

With rare exceptions, the acutely thrombosed hemorrhoid can be excised within the first 72 h by performing an elliptical excision

Sitz baths, fiber, and stool softeners are prescribed.

Question 17

چه مشکلاتی بعد band

Answer 17

Patients may complain of a dull ache for 24 h following band application.

Question 18

در اسکلروتراپی چی تزریق میکنن و چه نکاتی باید رعایت شه؟

Answer 18

During sclerotherapy, 1–2 mL of a sclerosant (usually sodium tetradecyl sulfate) is injected using a 25-gauge needle into the submucosa of the hemorrhoidal complex.

⚠️ Care must be taken not to inject the anal canal circumferentially, or stenosis may occur.

Question 19

انواع جراحی ها برای هموروئید و کدومشون بیشترین Efficacy رو داره؟

Answer 19

1-excisional hemorrhoidectomy,

2-transhemorrhoidal dearterialization (THD),

3-or stapled hemorrhoidectomy (“the procedure for prolapse or hemorrhoids” [PPH])

All surgical methods of management are equally effective in the treatment of symptomatic third and fourth-degree hemorrhoids. However, because the sutured hemorrhoidectomy involves the removal of redundant tissue down to the anal verge, unpleasant anal skin tags are removed as well.

The stapled hemorrhoidectomy is associated with less discomfort; however, this procedure does not remove anal skin tags and an increased number of complications are
associated with use of the stapling device.

THD uses ultrasound guidance to ligate the blood supply to the anal tissue, hence reducing hemorrhoidal engorgement.

Question 20

رو کدوم هموروئیدی ها نباش هیچ پروسیجری انجام بدیم؟

Answer 20

1- immunocompromised

2-active proctitis

Question 21

What are the acute complications associated with the treatment of haemorrhoids? 4

Answer 21

1-pain
2-infection
3-recurrent bleeding
4-urinary retention🚽

Question 22

Lead to complications of treatment of haemorrhoids?

Answer 22

1-fecal incontinence as a result of injury to the sphincter during the dissection.

2-Anal stenosis may develop from overzealous excision, with loss of mucosal skin bridges for reepithelialization.

3-Finally, an ectropion (prolapse of rectal mucosa from the anal canal) may develop. Patients with an ectropion complain of a “wet” anus as a result of inability to prevent soiling once the rectal mucosa is exposed below the dentate line.

Question 23

ابسه انورکتال در مردا شایع تره یا زنا؟

Answer 23

is more common in men than women by a ratio of 3:1.

Question 24

پیک سنی ابسه انورکتال؟

Answer 24

the third to fifth decade of life

۳۰ تا ۶۰ سال

Question 25

Risk factors for anorectal abscess?

Answer 25

``` immunocompromised patients : 1-diabetes 2- hematologic disorders 3-inflammatory bowel disease (IBD) 4-persons who are HIV positive. ``` These disorders should be considered in patients with recurrent Perianal infections

Question 26

انواع ابسه انورکتال از نظر لوکیشن؟ ۴

Answer 26

1-Anorectal abscesses are perianal in 40–50% of patients 2-ischiorectal in 20–25% 3-intersphincteric in 2–5% 4-supralevator in 2.5%

Question 27

پاتوفیزیولوژی ابسه انورکتال؟

Answer 27

Anorectal abscess results from an infection involving the glands surrounding the anal canal. Normally, these glands release mucus into the anal canal, which aids in defecation. When stool accidentally enters the anal glands, the glands become infected and an abscess develops.

Question 28

علایم و هالمارک ابسه های انورکتال؟

Answer 28

Perianal pain and fever are the hallmarks of an abscess. Patients may have difficulty voiding and have blood in the stool.

Question 29

Ddx of Anorectal absecess?

Answer 29

A prostatic abscess may present with similar complaints, including dysuria. Patients with a prostatic abscess will often have a history of recurrent sexually transmitted diseases. On physical examination, a large fluctuant area is usually readily visible.

Question 30

یافته های تشخیصی ابسه در لب تست ها؟

Answer 30

laboratory evaluation shows an elevated white blood cell

Question 31

اندیکاسیون وورک اپ در ابسه انورکتال؟

Answer 31

Diagnostic procedures are rarely necessary unless evaluating a recurrent abscess. A CT scan or MRI has an accuracy of 80% in determining incomplete drainage If there is a concern about the presence of IBD, a rigid or flexible sigmoidoscopic examination may be done at the time of drainage to evaluate for inflammation within the rectosigmoid region. A more complete evaluation for Crohn’s disease would include a full colonoscopy and small-bowel series.

Question 32

گولد استاندارد درمانی ابسه؟

Answer 32

As with all abscesses, the “gold standard” is drainage.

Question 33

در کدوم بیماران باید تخلیه آبسه در اتاق عمل و با بیهوشی انجام شه؟ 3

Answer 33

``` For patients who have a 1-complicated abscess 2-or who are diabetic 3-or immunocompromised, drainage should be performed in an operating room under anesthesia. ``` These patients are at greater risk for developing necrotizing fasciitis.

Question 34

ایا برای همه بیماران با ابسه انورکتال انتی بیوتیک میذاریم؟

Answer 34

``` Antibiotics are only warranted in patients who are 1-immunocompromised 2-have prosthetic heart valves 3-artificial joints 4-diabetes 5-IBD ```

Question 35

What is the most common cause of rectal bleeding in infancy?

Answer 35

Anal fissures occur at all ages but are more common in the third through the fifth decades. A fissure is the most common cause of rectal bleeding in infancy. The prevalence is equal in males and females. It is associated with constipation, diarrhea, infectious etiologies, perianal trauma, and Crohn’s disease. Anatomy and Pathophysiology Trauma to the anal canal occurs following defecation. This injury occurs in the anterior or, more commonly, the posterior anal canal. Irritation caused by the trauma to the anal canal results in an increased resting pressure of the internal sphincter. The blood supply to the sphincter and anal mucosa enters laterally. Therefore, increased anal sphincter tone results in a relative ischemia in the region of the fissure and leads to poor healing of the anal injury. A fissure that is not in the posterior or anterior position should raise suspicion for other causes, including tuberculosis, syphilis, Crohn’s disease, and malignancy. Presentation and Evaluation A fissure can be easily diagnosed on history alone. The classic complaint is pain, which is strongly associ- ated with defecation and is relentless. The bright red bleeding that can be associated with a fissure is less extensive than that associated with hemorrhoids. On examination, most fissures are located in either the posterior or anterior position. A lateral fissure is worrisome because it may have a less benign nature, and systemic disorders should be ruled out. A chronic fissure is indicated by the presence of a hypertrophied anal papilla at the proximal end of the fissure and a sentinel pile or skin tag at the distal end. Often the circular fibers of the hypertro- phied internal sphincter are visible within the base of the fissure. If anal manometry is performed, elevation in anal resting pressure and

Question 36

In which age and Anal fissure are more common?

Answer 36

Ff

Question 37

انال فیشر در مردا شایع تره یا خانوما؟

Answer 37

رذ

Question 38

What are the cause of anal fissure? 5

Answer 38

Ff

Question 39

ترومایی که در هنگام دفیکیشن ایجاد میشه بیشتر به کدم قسمت کانال اناله؟

Answer 39

The posterior anal canal

Question 40

فیشر انال اگر که کجا باشه به دلایل دیگه فکر میکنیم و اون دلایل چیان؟ ۴

Answer 40

ال

Question 41

چیا پاتوگونومیک ان برای انال فیشر؟

Answer 41

2-sawtooth deformity with paradoxical contractions of the sphincter muscles

Question 42

درمان انال فیشر؟

Answer 42

The management of the acute fissure is conservative. Stool softeners for those with constipation, increased dietary fiber, topical anes- thetics, glucocorticoids, and sitz baths are prescribed and will heal 60–90% of fissures. Chronic fissures are those present for >6 weeks. These can be treated with modalities aimed at decreasing the anal canal resting pressure including nifedipine ointment applied three times a day and botulinum toxin type A, up to 20 units, injected into the internal sphincter on each side of the fissure. Surgical manage- ment includes anal dilatation and lateral internal sphincterotomy. Usually, one-third of the internal sphincter muscle is divided; it is easily identified because it is hypertrophied. Recurrence rates from medical therapy are higher, but this is offset by a risk of incontinence following sphincterotomy. Lateral internal sphincterotomy may lead to incontinence more commonly in women.