3.08 Anorectal Conditions Flashcards

1
Q

What distinguishes internal from external hemorrhoids?

A

pectinate/dentate line

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2
Q

general symptoms and signs of hemorrhoids include?

A

bright red blood per rectum

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3
Q

protuberant purple nodoled covered by mucosa?

A

internal hemorrhoids

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4
Q

discomfort and pain are unusual and occur only when there’s extensive inflammation and thrombosis or irreducible tissue.

A

internal hemorrhoids

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5
Q

readily visible on perianal inspection, covered with skin, and usually asymptomatic but can be thrombosed that are exquisitely painful?

A

external hemorrhoids

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6
Q

Differential for hemorrhoids?

A

other things that cause structural, pain, itching, or bleeding

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7
Q

a condition that can lead to rectal discomfort due to perianal spasms that can last up to 20 minutes?

A

levator ani syndrome or proctalgia fugax

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8
Q

procedure to visualize internal hemorrhoids?

A

anoscopy

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9
Q

What is the 1-IV grading for internal hemorrhoids?

A

I: no prolapse
II: spontaneously reduces
III: requires manual reduction
IV: permanently prolapsed

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10
Q

general hemorrhoid countermeasures?

A

high fiber diets, increased fluid intakes, symptomatic relief via suppositories, warm sitz baths

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11
Q

What kind of suppositories for symptomatic relief of hemorrhoids?

A

Anusol NO hydrocortisone

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12
Q

What should you consider for treatment for thrombosed external hemorrhoids?

A

warm sitz bath
analgesics
incision to remove the clot (if over 48 hours and shrinking may not be necessary)

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13
Q

For grade I-III hemorrhoids and recurrent bleeding, you could consider what surgical options?

A

rubber band ligation *
injection sclerotherapy
electro or infrared coagulation

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14
Q

Surgical option for Grade IV hemorrhoids that are persistently bleeding or cause discomfort?

A

stapled haemorrhoidectomy

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15
Q

Where do anal fissures most commonly occur?

A

posterior midline

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16
Q

A common cause of anal fissures?

A

trauma due to defecation

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17
Q

Severe tearing pain during defecation and throbbing discomfort that may lead to constipation, mild, associated hematochezia?

A

anal fissure

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18
Q

Anal fissures that are off the midline may suggest? “CATHS”

A

crohns disease
anal carcinoma
TB
HIV/AIDs
syphilis

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19
Q

What are some interesting TX considerations for anal fissures?

A

topical lidocaine
topical vasodilators

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20
Q

Chronic fissures can be treated with?

A

topical nitroglycerin or diltiazem
botox
internal sphincterotomy

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21
Q

Where are anal abscesses usually located?

A

anal glands at the base of anal crypts

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22
Q

Common causes of anal abscesses?

A

anal fissures and crohns disease

23
Q

What is usually preceded by an anal abscess?

A

anal fistula

24
Q

Continuous perianal pain, erythema, fluctuance, swelling?

A

perianal abscess

25
Q

What may indicate a fistula versus a perianal abscess?

A

purulent discharge

26
Q

epidermal manifestation attributed to HPV?

A

condyloma acuminatum

27
Q

What has been related directly to increased neoplastic risk in men and women?

A

HPV infection

28
Q

Painless bumps, pruritis, or discharge, lesions may appear spontaneously, remain fixed, or progress and be associated with a history of anal intercourse?

A

Anal condyloma

29
Q

Is anal condyloma related to HPV infectious?

A

Yup even if lesions are not visible

30
Q

Irregularity in shape, form, or color of anal condylomas may be suggestive of?

A

melanoma

31
Q

Eruptions of anal condylomas may appear?

A

pearly, filiform, fungating, cauliflower, plaque-like

32
Q

Condyloma acuminatum and anal fissure sare usually diagnosed?

A

visual exam/diagnosed clinically

33
Q

What are some things you can do to further asses condyloma acuminatum?

A

pap smear
acetowhitening: subclinical lesions look like white papules

34
Q

What next if you diagnose condyloma acuminatum?

A

assess for other STDs

35
Q

Treatment for anal warts?

A

for immunocompetent it may resolve without treatment
Relapses are frequent and no TX is satisfactory
topicals are frequently ineffective

36
Q

Surgical treatment for anal warts?

A

cryotherapy
electrodessication (smoke maybe infective)
carbon dioxide laser treatment (potentially infectious)
Surgical excision*

37
Q

What has the highest success rate and lower recurrence rate to treat anal warts?

A

surgical excision

38
Q

Prevention of anal warts?

A

Vaccines: Gardasil (6,11) Gardasil 9 (6,11), Cervarix

39
Q

Anal cancer pathophysiology?

A

squamous cell cancers

40
Q

Metastasis of anal cancer tends to go where?

A

lymphatics to inguinal lymph nodes

41
Q

Risk factors for anal cancers?

A

HPV (90%) high risk 16
condyloma acuminata
chronic fistulas, etc.

42
Q

What is teh most common initial symptom of anal cancer?

A

bleeding with defecation

43
Q

What must be ruled out when anal bleeding occurs if hemorrhoids are obvious or diverticular disease dxg?

A

coexisting cancer

44
Q

Typically what is done to diagnose anal cancer?

A

colonoscopy but askin one can be done as well

45
Q

What is the primary treatment for SCC anal cancer?

A

CRT chemoradiotherapy

46
Q

What is indicated if CRT did not resolve in anal tumor regression and there is no metastasis outside the radiation field?

A

abdominoperineal resection
(rectum, anus, sigmoid colon removed)

47
Q

When the rectum falls and comes through the anal opening?

A

rectal prolapse (anal intussusception)

48
Q

CVause of anal prolapse?

A

exact unclear but increased abdominal pressure or decreased pelvic floor pressure?

49
Q

What bulges in a partial anal prolapse?

A

inner lining of rectum

50
Q

Reddish-colored mass that sticks out the anus, especially after a bowel movement, may bleed, uncomfortable?

A

rectal prolapse

51
Q

Rectal prolapse treatment?

A

at-home manual reduction
surgery

52
Q

When is surgery urgently indicated for a rectal prolapse?

A

strangulated rectal prolapse that can lead to perforation

53
Q

What is the only cure for rectal prolapse?

A

repair weakened anal sphicnter and pelvic muscles