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
Common causes of anal abscesses?
anal fissures and crohns disease
What is usually preceded by an anal abscess?
anal fistula
Continuous perianal pain, erythema, fluctuance, swelling?
perianal abscess
What may indicate a fistula versus a perianal abscess?
purulent discharge
epidermal manifestation attributed to HPV?
condyloma acuminatum
What has been related directly to increased neoplastic risk in men and women?
HPV infection
Painless bumps, pruritis, or discharge, lesions may appear spontaneously, remain fixed, or progress and be associated with a history of anal intercourse?
Anal condyloma
Is anal condyloma related to HPV infectious?
Yup even if lesions are not visible
Irregularity in shape, form, or color of anal condylomas may be suggestive of?
melanoma
Eruptions of anal condylomas may appear?
pearly, filiform, fungating, cauliflower, plaque-like
Condyloma acuminatum and anal fissure sare usually diagnosed?
visual exam/diagnosed clinically
What are some things you can do to further asses condyloma acuminatum?
pap smear
acetowhitening: subclinical lesions look like white papules
What next if you diagnose condyloma acuminatum?
assess for other STDs
Treatment for anal warts?
for immunocompetent it may resolve without treatment
Relapses are frequent and no TX is satisfactory
topicals are frequently ineffective
Surgical treatment for anal warts?
cryotherapy
electrodessication (smoke maybe infective)
carbon dioxide laser treatment (potentially infectious)
Surgical excision*
What has the highest success rate and lower recurrence rate to treat anal warts?
surgical excision
Prevention of anal warts?
Vaccines: Gardasil (6,11) Gardasil 9 (6,11), Cervarix
Anal cancer pathophysiology?
squamous cell cancers
Metastasis of anal cancer tends to go where?
lymphatics to inguinal lymph nodes
Risk factors for anal cancers?
HPV (90%) high risk 16
condyloma acuminata
chronic fistulas, etc.
What is teh most common initial symptom of anal cancer?
bleeding with defecation
What must be ruled out when anal bleeding occurs if hemorrhoids are obvious or diverticular disease dxg?
coexisting cancer
Typically what is done to diagnose anal cancer?
colonoscopy but askin one can be done as well
What is the primary treatment for SCC anal cancer?
CRT chemoradiotherapy
What is indicated if CRT did not resolve in anal tumor regression and there is no metastasis outside the radiation field?
abdominoperineal resection
(rectum, anus, sigmoid colon removed)
When the rectum falls and comes through the anal opening?
rectal prolapse (anal intussusception)
CVause of anal prolapse?
exact unclear but increased abdominal pressure or decreased pelvic floor pressure?
What bulges in a partial anal prolapse?
inner lining of rectum
Reddish-colored mass that sticks out the anus, especially after a bowel movement, may bleed, uncomfortable?
rectal prolapse
Rectal prolapse treatment?
at-home manual reduction
surgery
When is surgery urgently indicated for a rectal prolapse?
strangulated rectal prolapse that can lead to perforation
What is the only cure for rectal prolapse?
repair weakened anal sphicnter and pelvic muscles
