3.08 Anorectal Conditions Flashcards
What distinguishes internal from external hemorrhoids?
pectinate/dentate line
general symptoms and signs of hemorrhoids include?
bright red blood per rectum
protuberant purple nodoled covered by mucosa?
internal hemorrhoids
discomfort and pain are unusual and occur only when there’s extensive inflammation and thrombosis or irreducible tissue.
internal hemorrhoids
readily visible on perianal inspection, covered with skin, and usually asymptomatic but can be thrombosed that are exquisitely painful?
external hemorrhoids
Differential for hemorrhoids?
other things that cause structural, pain, itching, or bleeding
a condition that can lead to rectal discomfort due to perianal spasms that can last up to 20 minutes?
levator ani syndrome or proctalgia fugax
procedure to visualize internal hemorrhoids?
anoscopy
What is the 1-IV grading for internal hemorrhoids?
I: no prolapse
II: spontaneously reduces
III: requires manual reduction
IV: permanently prolapsed
general hemorrhoid countermeasures?
high fiber diets, increased fluid intakes, symptomatic relief via suppositories, warm sitz baths
What kind of suppositories for symptomatic relief of hemorrhoids?
Anusol NO hydrocortisone
What should you consider for treatment for thrombosed external hemorrhoids?
warm sitz bath
analgesics
incision to remove the clot (if over 48 hours and shrinking may not be necessary)
For grade I-III hemorrhoids and recurrent bleeding, you could consider what surgical options?
rubber band ligation *
injection sclerotherapy
electro or infrared coagulation
Surgical option for Grade IV hemorrhoids that are persistently bleeding or cause discomfort?
stapled haemorrhoidectomy
Where do anal fissures most commonly occur?
posterior midline
A common cause of anal fissures?
trauma due to defecation
Severe tearing pain during defecation and throbbing discomfort that may lead to constipation, mild, associated hematochezia?
anal fissure
Anal fissures that are off the midline may suggest? “CATHS”
crohns disease
anal carcinoma
TB
HIV/AIDs
syphilis
What are some interesting TX considerations for anal fissures?
topical lidocaine
topical vasodilators
Chronic fissures can be treated with?
topical nitroglycerin or diltiazem
botox
internal sphincterotomy
Where are anal abscesses usually located?
anal glands at the base of anal crypts