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Colorectal Pathologies Flashcards

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1
Q

External hemorrhoids are arising from?

A

Dilated veins arising from inferior hemorrhoid plexus

Distal to the dentate line (sensate area)

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2
Q

Are external hemorrhoids painful or painless?

A

PAINFUL

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3
Q

Internal hemorrhoids are arising from?

A

Dilated submucosal veins of superior rectal plexus

Above the dentate line (insensate area)

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4
Q

Are internal hemorrhoids painful or painless?

A

PainLESS

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5
Q

List some risk factors of hemorrhoids?

A 
Low fiber 
High-fat diet
Pregnancy 
Straining 
Prolonged sitting 
Obesity
Portal HTN-liver issues (cirrhosis)
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6
Q

List some clinical features of hemorrhoids?

A

Bleeding and rectal prolapse (MC)
BRBPR
Anemia (rare)

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7
Q

List some clinical features of external hemorrhoids?

A

usually asymptomatic

when sxs are present: thrombosed and pain for several days

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8
Q

Does external hemorrhoids subside or constant?

A

Gradually subside

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9
Q

List some clinical features of internal hemorrhoids?

A

Painless

Mass is present when they prolapse

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10
Q

What are some management options for hemorrhoids?

A 
Sitz bath
Ice packs 
Stool softeners
High fiber, high fluid diet
Topical steroids (hydrocortisone suppositories or topical cream)
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11
Q

Surgical management options for hemorrhoids?

A

Rubber band ligation for internal hemorrhoids

Hemorrhoidectomy

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12
Q

Indications for hemorrhoidectomy?

A 
not responsive to conservative tx
severe/chronic prolapse (stage IV)
hemorrhoid strangulation
very large anal tags
fissure present
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13
Q

Rectal prolapse is MC in what sex and what age?

A

6x more common in females

> 60 yrs old

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14
Q

Women with rectal prolapse have higher incidence of what?

A

pelvic floor disorders

- urinary incontinence, rectocele, cystocele, enterocele

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15
Q

Children with rectal prolapse will have what?

A

CF

-get sweat chloride test

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16
Q

What is rectal prolapse?

A

circumferential full-thickness protrusion of rectal wall through the anal orifice

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17
Q

Rectal prolapse is associated with?

A

Redundant sigmoid colon
Pelvic laxity
Deep rectovaginal
Chronic constipation

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18
Q

What nerve is affected by rectal prolapse?

A

pudendal nerve

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19
Q

What are some clinical features of mucosal prolapse?

A

radial grooves around the anus

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20
Q

What causes a mucosal prolapse?

A

connective tissue laxity between submucosa and underlying musculature of the anal canal

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21
Q

What is anismus?

A

attempting to defecate against closed pelvic floor

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22
Q

Tx for rectal prolapse?

Study These Flashcards
A

Recognize and refer

Stool bulking agents, hydrate, fiber supplement

23
Q

What are anal fissures?

Study These Flashcards
A

linear lesions (tear) in the rectal wall

24
Q

MC location of anal fissures?

Study These Flashcards
A

posterior midline

25
MCC of anal fissures?
Constipation-passage of large, hard stool
26
Abnormal location of anal fissures?
Lateral | - consider infectious dx or Crohns
27
Clinical features of anal fissures?
Tearing pain on defecation Hematochezia Bright red blood on the toilet paper
28
Chronic anal fissure clinical features
Sentinel tag at the caudal aspect of fissure Pruritus ani intermittent bleeding pain
29
What is an anorectal abscess?
Localized inflammatory process associated with soft tissue and anal gland
30
Clinical features of anorectal abscess?
``` Pain - worsens with movement/strain Erythema Cellulitis Mass by inspection and palpation Fever sxs of sepsis-w/ deep abscess Urinary retention ```
31
Anorectal abscess is polymicrobial how many antibiotics do you need to tx?
Multiple antibiotis are needed
32
The procedure of thrombosed external hemorrhoid
Excision - anesthetize - elliptial incision of skin overlying clot - remove clot
33
MC classification of anorectal fistula?
Intersphincteric
34
What is intersphincteric anorectal fistula?
fistula track passes within the intersphincteric plane to the perianal skin
35
MCC of anorectal fistula?
Nonspecific cryptoglandular infection (skin or intestinal flora)
36
Work up and tx for anorectal fistula?
digital rectal exam gentle probing anoscopy tx: surgical I and D w/ repair w/ antibiotics
37
What is a pilonidal abscess?
pus and a well of edematous fat | results from a rupture of an infected hair follicle into the fat
38
What is pilonidal cyst?
Develops from a chronic abscess, epithelium grows into the cavity from the skin surface
39
Clinical features of pilonidal disease?
hot, tender, fluctuant swelling | may exude pus through midline pit
40
Stage I of hemorrhoids?
no protrusion yet
41
Stage II of hemorrhoids?
protruding, spontaneously reduce
42
Stage III of hemorrhoids?
protruding, possible to push back manually
43
Stage IV of hemorrhoids?
protruding, cannot be pushed back in manually or otherwise.
44
What is pruritus ani?
intense chronic itching of the anus and surrounding skin
45
Test for pinworms (enterobius vermicularis)
scotch tape test
46
MC drugs that are a risk for constipation?
Anticholinergics (antipsychotics- benzos) | Opioids
47
What should you always keep in mind with regard to the cause of constipation?
CRC!
48
Two complications that result from hernias?
Incarcerated and strangulated hernia
49
What is an incarcerated hernia?
Irreducible Good blood supply but bowel obstruction can occur Very painful
50
What is a strangulated hernia?
Irreducible Compromised blood supply- risk for cirrhosis/ischemia Surgical emergencies
51
Where is indirect inguinal hernia located and MC in what sex??
Medial to inferior epigastric vessels | Elderly men
52
Where is direct inguinal hernia located MC in young or old??
Lateral to inferior epigastric vessels can descend into the scrotum MC in young children and adults
53
Femoral hernia MC in what sex?
women

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