office proctology Flashcards
CC: Bloody stool, (-) pain
Dx:
Dx: Hemorrhoids caused by a mass of distended veins enclosed in a sac of redundant rectal mucosa
If the patient has bloody stool and no pain, the lesions must be above what line?
Why is there no pain?
The lesions must be above the pectinate line (internal).
Above the pectinate line we have endoderm which has no pain fibers, therefore lesions in this area do not produce pain.
Below the pectinate line we switch to ectoderm which does have pain fibers. Lesions below the pectinate line do cause pain
What are the stages of hemorrhoids?
I: primary hemorrhoids- small, no distention, rare bleeding
II: protruding retractile
III: Protruding, Reducible
IV: Reducible, Re-protruding
V: Non-reducible
VI: Strangulated- protruding, congested, edematous
**Stage VI is an emergency. The veins will strangulate the arteries leading to necrosis
What are conservative treatments for hemorrhoids?
Increasing fiber and water intake
eliminate: beer, coffee, tea, soda, milk, chocolate, fried foods (basically anything good)
What are some in office proceedures that we can do to treat hemorrhoids and what stages do we use them on?
Ligation (I, II)
Injection (I-III)
Electro-therapy (I,II)
Infrared coagulation (I-III)
Laser
Surgery
CC: bloody stool + sharp pain
Dx:
what are other possible symptoms:
Anal Fissure- a tear of the peri-anal skin or mucosa
other symptoms may include burning and itching during the healing of the fissure.
On inspection you notice a lateral fissure. Is this normal?
Lateral fissures are abnormal. They are caused by trauma or abuse
A/P fissures are normal. They can be caused by somethign as simple as a hard BM.
How can we treat anal fissures?
what is a complication of an anal fissure?
We can treat medicaly with suppositories, diet changes or treating the underlying disease that is causing them. We can also treat anal fissures surgically by excision or with a partial internal spincterotomy.
A complication of a fissure is stenosis after healing wich can lead to future fissure development
CC: Pain, bleeding, and a palpable mass.
Dx:
This is a complication of what other condition?
External Thrombus. Its a mechanical obstruction resulting from forceful efforts to expel a constipated stool.
A clot forms within the distended segment of the superior hemorrhoidal vein and breaks through the tunica intima and tunica media. The outer layer is intact.
the mass is the clot. It will not be hot because there is no infection present
Tx: External Thrombus
conservative:
Surgical:
Conservative: sitz bath, suppositories
Surgical: Excision of thrombus, hemorrhoidectomy
CC: pain, (+) lump that is HOT to the touch
Dx:
Tx:
Perianal abcess
Incision and Drainage
CC: pain, bleeding, and puritis. Has noted some changes in bowel habits. Pt. says he “has a lump in the groin”
Inspection: Ulcerating, hard, tender mass with rolled, everted edges with central ulceration
Dx:
Squamous Cell Tumors
arises from the cutaneous part of the anal canal or peri-anal skin
You think a patient has a squamous cell tumor.
what do you do next?
Biopsy and stage
CC:
Hard, bluish/red nodule on the peri-anal skin
