anal disease Flashcards
anal fissure define, causes, symptoms?
linear tear in anal canal.
causes by chronic constipation or diarrhea, IBD
symptoms: painful defecation, bright red blood on toilet paper, perianal pruritis
anal fissure diagnosis and treatment?
diagnosis is by history and physical exam (visibly see the fissure) DRE not recommended
anoscopy is done for atypical presentations. endoscopy and/CT is done if suspect IBD or colorectal/anal cancer
treatment: increase fiber intake, sitz bath, topical CCB, topical lidocaine, nonopiod analgesic, topical hydrocortisone, botulinum toxin injection into internal anal sphincter, if conservative management is unsuccessful in 8-12 wks then do lateral internal sphincterotomy
perianal abscess etiology, symptoms, diagnosis, treatment?
causes by IBD or infection of anal crypt glands
symptoms: pruritis, perianal pain, maybe fever and leukocytosis, swollen mass with erythema
diagnosis: clinical
treatment: incision and drain and give ABs
anorectal fistula etiology, symptoms, diagnosis, treatment?
abnormal connection btw two epithelial or endothelial surfaces.
etiology: IBD
symptoms: purulent drainage from anal canal or perianal skin, painful defecation if one of the openings become occluded
diagnosis: clinical
treatment: fistulotomy
causes of hemorrhoids? define?
internal vs external in terms of origin and symptoms? grading?
dilated vascular cushions
chronic constipation, IBD, old age, pregnancy, heavy lifting, COPD
internal: originates above the dentate line which isn’t innervated -> painless bright red bleeding, feeling of a mass, pruritis
external: originates below the dentate line which is innervated by cutaneous nerves -> painful (if thrombosed) bright red bleeding, feeling of mass, pruritis
grades:
1: bleeding without prolapse
2: prolapse when straining and spontaneously reduced
3. prolapse when straining and manually reduced
4: irreducible and may become strangulated and thrombosed
hemorrhoids diagnosis and treatment
diagnosis by examination, anoscopy for ALL PATIENTS, DRE. if suspect colorectal cancer then refer for colonoscopy
internal hemorrhoids may be difficult to palpate and only visualized by anoscopy.
treatment: high fiber diet, sitz bath, topical steroid/lidocaine, stool softeners.
refractory to medical treatment: do rubber band ligation or sclerotherapy.
refractory to bedside procedures: do hemorrhoidectomy
anal cancer most common type?
causes?
symptoms?
diagnosis?
treatment?
most common type is squamous cell carcinoma.
causes: multiple sexual partners, anal sex, HPV (16,18 pts with condyloma acuminata), HIV
symptoms: bleeding, pruritis, feeling of mass
diagnosis: DRE, anoscopy with biopsy, colonoscopy to rule out colorectal cancer, examine for genital warts, HIV tests and HPV
treatment: chemoradiation is primary for SCC and curative. or surgery
