E2: Anorectal Disease Flashcards
(41 cards)
What are the red flag anorectal complaints that should prompt referral to GI or a colorectal specialist?
- Unintentional weight loss
- IDA
- Personal or family history of IBD or CRC
- Persistent anorectal bleeding or anorectal symptoms despite adequate treatment of a suspected benign condition
What are the possible etiologies of hemorrhoids?
- prolonged sitting and straining
- chronic constipation
- diarrhea
- pregnancy
- advancing age
What is the difference between external and internal hemorrhoids?
External are distal to the dentate line and are painful.
Internal are proximal to the dentate line and are painless.
What is a grade 1 hemorrhoid?
A bulge in the anal canal without prolapse
What is a grade II hemorrhoid?
Prolapse that reduces spontaneously
What is a grade III hemorrhoid?
A prolapse that requires manual reduction
What is a grade IV hemorrhoid?
Chronic prolapse, irreducible
What is the clinical presentation of hemorrhoids?
- bleeding with BM, usually bright red
- sensation of perianal fullness (prolapse)
- fecal incontinence/mucous discharge
- pruritis
What diagnostic study should you order if a patient has hemorrhoid pattern bleeding?
What if you are concerned for IBD or malignancy?
- Sigmoidoscopy
- Colonoscopy
What are the lifestyle modifications that can help treat hemorrhoids?
- Fluid and fiber
- toilet habits
- sitz baths
What are the conservative medical therapies that can be used for hemorrhoids?
- Stool softeners
- Topical agents to provide symptomatic relief (tucks pads or a short course of corticosteroid creams or suppositories)
- antispasmodic agents
What are the non surgical management options to treat hemorrhoids?
- internal hemorrhoids: rubber band ligation, infrared coagulation, and sclerotherapy
- External hemorrhoids: excision of thrombosis external hemorrhoid
Appropriate for patients refractory to conservative medical therapies
What is the most commonly used technique for the treatment of symptomatic bleeding internal hemorrhoids?
Rubber band ligation
When should you contact surgery for a hemorrhoidectomy?
- persistent symptoms despite conservative measures or office based procedures
- symptomatic grade II hemorrhoids
- grade IV internal hemorrhoids
- patients with extensive pain from thrombosis external hemorrhoids
What are some of the mechanical factors that can cause pruritis ani?
Prolapsing tissue, fecal incontinence/soiling, inadequate hygiene resulting in excess sweat, mucus, or stool between the buttocks
What is the clinical presentation of pruritis ani?
Intense itching and burning
Circumferential erythematous and irritated perianal skin
What is the management of pruritis ani?
- eliminate offending agent
- proper hygiene (gentle cleansers, avoid aggressive wiping, sitz baths)
- keep region dry
- eliminate tight clothing
- short course of topical steroid cream appropriate for severe skin eruptions
What commonly causes perianal skin tags?
Sequelae of thrombosed external hemorrhoids, Crohn’s disease
What is the treatment of perianal skin tags?
-treatment is usually not indicates, however pts seek referral for excision if tags interfere with hygiene or cause perianal discomfort
What is the most common cause of severe anorectal pain?
Anal fissures
What is an anal fissure?
A linear tear, or split, in the lining of the anal canal distal to the dentate line that causes spasm of the anal sphincter
What are the primary and secondary causes of anal fissures?
Primary: local trauma to the anal canal, passage of large hard stools, FB
Secondary: Crohn’s disease, malignancy, HIV/AIDs
What is the clinical presentation of anal fissures?
- severe pain during and often persistent after defecation, often described liked “passing glass” or “sitting on a knife”
- bright red blood on TP or streaking in stool
What is the most common spot for an anal fissure to occur?
Posterior midline, lowest blood supply
