Colorectal Disease Flashcards
(34 cards)
What is Fecal Incontinence?
Continuous/recurrent uncontrolled passage of fecal matter (>10mL) for at least 1 month in a patient >3 years of age
What is the best initial test in fecal incontinence?
Flexible Sigmoidoscopy or anoscopy
What is the most accurate test in fecal incontinence?
Anorectal Manometry
What is the most accurate test in fecal incontinence with a hx of anatomic injury?
Endorectal Manometry
How do you treat Fecal Incontinence?
Medical therapy: bulking agents like fiber
Biofeedback: control exercises and muscle-strengthening
Dextranomer/hyaluronic acid injection
Colorectal surgery if no response
What is a Pilonidal Cyst?
Abscess of the sacrococcygeal region arising from infection of the skin and subcutaneous tissue
What are risk factors for a Pilonidal Cyst?
Poor hygeine, obesity and deep natal cleft
What are common symptoms of a Pilonidal cyst?
Sudden onset mild to severe pain in the intergluteal region when sitting or doing activities that stretch the skin overlying the natal cleft
Intermittent swelling, mucoid, purulent or bloody drainage
How do you treat a pilonidal cyst?
Incision and drainage
If recurrent: sinus tract excision
What is an anal fissure?
Tear in the endoderm distal to the dentate line: triggers cycles of recurring anal pain and bleeding which can lead to a chronic anal fissure
Where is the most common location for an anal fissure?
Posterior midline
How do you treat anal fissures?
Sitz baths, increased fiber or stool softeners, topical vasodilators (nitroglycerin)
If no response after 8 weeks: Lateral internal sphincterotomy
Botox
What is considered acute anal fissure pain?
<8 weeks
What is considered chronic anal fissure pain?
> 8 weeks
What is rectal Procidentia (Rectal prolapse)?
Protrusion of all layers of the rectum through the anus, manifesting as concentric rings or rectal mucosa
What are risk factors for rectal prolapse?
Age, Chronic constipation, Multiparity and dementia
What are common symptoms of rectal prolapse?
Pain in the anal area, bleeding, palpable mass
How do you treat rectal prolapse?
Surgical repair
How does an anal abscess present?
Severe, constant pain around the rectum or perineum with or without a fever
How do anal abscesses usually originate?
Obstructed anal crypt gland and generates put that collects in the subcutaneous tissue, intersphincteric plane or other tissue planes
What is seen on physical exam of an anal abscess?
Erythematous, indurated skin area of fluctuant mass over the perianal space
How do you treat an anal abscess?
Surgical drainage and Abx
What are hemorrhoidal veins?
normal anatomic structures located in the submucosal layer of the rectum which enlarge
What are common causes of hemorrhoids?
Constipation, age, prolonged sitting, straining during defecation
