Anal Diseases Flashcards
What are some history to take from patient suspected of an anal disease
Presenting complaint - bleeding, perianal discharge, anorectal pain, pruritus, prolapse of tissue
Bowel movements - movements/day, straining, duration per defecatory period
Unintentional weight loss
Abdominal pain & distension
Diarrhea alternating with constipation
Anaemia
Family history of IBD
Hx of TB, Amoebiasis, Schistosomiasis
Prior endoscopy
Mention some symptoms based on differential diagnosis
Perianal pain:
Generalized perianal pain
Pruritus ani (hypersensitivity of cutaneous nociceptive nerves)
Less likely to be of malignant origin
Localized perianal pain
Skin trauma
External hemorrhoids
Perianal abscess
Perianal neoplasms
Anal canal pain:
Anal fissure
Anal cancer
Anal ulcers (STIs)
Internal hemorroids are usually painless
Bleeding:
Bleeding from anal canal
Anal fissures
Internal hemorroids
Anal neoplasms
Prolapsing tissue:
Swelling that presents as a continously or “comes and goes
Internal hemorrhoids (clusters within quadrants surrounding the anal orifice
Rectal prolapse (concentric folds involving tissue that occupies the circumference of the anal canal
Pruritus:
Difficult complaint to deal with
Associated with idiopathic causes in a significant proportion of patients
Laterality and exact location necessary
When skin appears grossly normal – hypersensitivity of cutaneous nociception nerves
?Helminthiasis
?Diet
?Skin irritation
Perianal discharge:
Anal fistula
Fecal incontinence
Perianal hidradenitis
Perianal skin cysts (sebaceous cyst)
What are some conditions which could cause anal canal pain
Anal fissure
Anal cancer
Anal ulcers (STIs)
Internal hemorroids are usually painless
What are some examples of perianal pain
Generalised perianal pain
Pruritus ani (hypersensitivity of cutaneous nociceptive nerves)
Less likely to be of malignant origin
Localized perianal pain
Skin trauma
External hemorrhoids
Perianal abscess
Perianal neoplasms
Just list some symptoms based differential diagnosis
Perianal pain
Anal canal pain
Bleeding
Prolapsing tissue
Pruritus
Perianal discharge
What are some physical examinations you should do for anal diseases
Critical as symptoms are non specific for benign or malignant
Terminology:
Anal canal lesion – lesion not visible on parting gluteal cheeks
Perianal lesion – completely visible on parting gluteal cheeks and is within 5cm of the anal orifice
Any lesion > 5cm is unrelated to the anorectum and is managed as a skin lesion
Complete anorectal exam consists of Inspection, Digital Rectal Examination & Anoscopy, Proctoscopy or Colonoscopy
What are the two positions a patient can lie when a digital recital examination is ongoing
Left lateral position
Prone jack knife position
Talk about an endoscopy/rectoscopy/proctoscopy
Anorectal examination is not complete without an endoscopy. Scopes are usually rigid with a built in light source. Ensure scopes are lubricated adequately. Anoscopes and proctoscopes – particularly useful for anal condylomata, neoplasms, internal hemorrhoids & anal fissures
Note location of lesion, nature
What is the length of an anoscope
10 cm
What is the length of an proctoscope
13 cm
What is the length of a rectoscope
25 cm
Talk about a digital rectal exam
Lubricate finger
Clinician must communicate throughout procedure to ensure patient comfort
Note sphincter tone, pelvic floor muscle tone masses, strictures, discharges
Tenderness - may necessitate suspension for EUA
Anorectal complaints are common
True or false
True
A complete anorectal exam consists of
Inspection, Digital Rectal Examination & Anoscopy, Proctoscopy or Colonoscopy
What are some structures to note for when your hands are in the rectum during a DRE
Sphincter tone, pelvic floor muscle tone masses, strictures, discharges
Tenderness - may necessitate suspension for EUA
