Patología Anorrectal

Question 1

¿Cuál es la localización de las fisuras anales clásicamente y cuáles son las localizaciones sospechosas?

Answer 1

By applying traction on the buttocks, the fissure can be visualized radiating out from the anus, typically in the midline and usually posterior in orientation. Additionally, anal fissures with any lateral orientation (not in the midline) should prompt investigation into secondary causes such as anal cancer, human immunodeficiency virus (HIV), inflammatory bowel disease, syphilis, or tuberculosis

Question 2

Causas secundarias de fisuras anales:

Answer 2

Anal cancer, human immunodeficiency virus (HIV), inflammatory bowel disease, syphilis, or tuberculosis

Question 3

Cuáles son las terapias médicas de fisura anal?

Answer 3

Topical nitroglycerin 0.2%–0.4% ointment, apply 1 in to anus every 12 h for up to 3 wk
Adverse: Headache, should not be administered with PDE-5 inhibitors (eg, sildenafil)

Topical diltiazem 2% gel or ointment, apply small amount to anus 3 times daily
Adverse: Headache (less common than nitroglycerin)

Intrasphincteric botulinum toxin injection, 10–100 units once
Adverse: Temporary incontinence

Question 4

Desde qué grado de hemorroides internas requieren la opción de hemorroidectomía?
En qué circunstancias estos grados requieren cirugía?

Answer 4

III y IV.
Circunstancias:
-Falla al manejo médico
-Pacientes con componente externo importante
-Sangrado persistente en pacientes con coagulopatía

Question 5

Cuál es la clasificación de hemorroides internas?

Answer 5

1

Bleeding, often painless

Tx: Avoid constipation, increase fiber intake

2

Protrusion with spontaneous reduction

Tx: Avoid constipation, increase fiber intake Rubber band ligation Sclerotherapy

3

Protrusion requiring manual reduction

Tx: Avoid constipation, increase fiber intake Rubber band ligation Sclerotherapy Elective referral for hemorrhoidectomy

4

Protrusion with inability to manually reduce

Tx: Avoid constipation, increase fiber intake Elective referral for hemorrhoidectomy

Question 6

Clasificación anatómica de abscesos perianales

Answer 6

• Perianales
• Interesfintéricos
• Isquiorrectales
• Supraelevador

Question 7

¿Qué porcentaje de abscesos perianales desarrollan fístula?

Answer 7

50%

Question 8

Fístulas sospechosas de causas secundarias:

Answer 8

• Extensas
• Extraesfintéricas
• Crónicas

Question 9

Causa más común de absceso perianal

Answer 9

Criptoglandular

Question 10

Otras causas de absceso perianal

Answer 10

Cryptoglandular
Inflammatory bowel disease: Crohn disease
Infectious: Tuberculosis, Actinomycosis, Lymphogranuloma venereum
Traumatic: Impaling injury, foreign body, trauma
Surgery: including episiotomy, hemorrhoidectomy, prostatectomy
Malignancy: Carcinoma, leukemia, lymphoma
Radiation

Question 11

Indicaciones de imagen en absceso perianal

Answer 11

-Absceso supraelevador o extraelevador

Question 12

Tipo de fístula perianal más común y sus características:

Answer 12

Interesfintérica:
70% of all fistulas 
Arise from perianal abscess 
Variable amount of internal sphincter involved; no external sphincter involved 
May track cranially to above the levator

Question 13

Tipo de absceso del cual surge una fístula transesfintérica:

Answer 13

Absceso isquioanal o isquiorrectal.
Otras características de las transesfintéricas:
25% of fistulas
Arise from ischioanal abscess
Traverses portions of internal and external sphincters
May extend through levator into pelvis

Question 14

Con cuánto tiempo se define una fisura a la aguda y crónica?

Answer 14

6 semanas.
Most acute anal fissures of less than 6 weeks’ duration heal with dietary modifications and supportive care. In chronic fissures with duration more than 6 weeks, further therapy is indicated.