Anal Disorders Flashcards
Patho Rectal Abscess
collection of purulent material in a glandular crypt
Where is a rectal abscess located?
in the perirectal area
Clinical rectal abscess
- sudden onset of severe pain and swelling
- fluctuant mass that feels like fluid inside
- fever
- cellulitis possible
Dx rectal abscess
H/ PE
Tx rectal abscess
- I&D
- ABX only if cellulitis
Patho Rectal Fistula
chronic manifestation of acute perirectal abscess that has ruptured or drained –> formation of an epithelialized track to anus or rectum from perirectal skin
Causes Rectal Fistula
- Perirectal abscess ruptured/drained
- crohn’s
- radiation proctitis
- rectal foreign bodies due to laceration
Clinical Rectal fistula
- pain
- purulent drainage
- perirectal skin lesion
Dx rectal fistula
- fistula probe
- CT, MRI, fistulography (shows air/ contrast in area)
- Non-healing anorectal abscess after drainage
Tx Rectal fistula
Surgery- eradicate fistula and preserve fecal continence with little rubber tubing tie that they use to tie and pinch off fistula
What is one of the most common anorectal conditions?
anal fissure
Patho of anal fissure
- due to high anal pressure
- sphincter spasms and anal mucosa tears
Tx Goals Anal fissure
- relax internal sphincter
- maintain less trauma with stooling
- pain relief
Medical tx anal fissure
- fiber
- cortisone
- topical nitro, diltiazem, bathanechol
- oral: nifedipine, diltiazem
- botulin toxin to paralyze the rectal spasm
Surgical tx anal fissure
- failure of other tx
- lateral sphincterotomy
- dilatation
Functional Constipation
1) 2 of the following with 25% of bowel movements:
- straining
- lumpy hard stools
- sensation of incomplete evacuation
- use of digital maneuvers
- sensation of anorectal obstruction/ blockage
2) less than 3 bowel movements a week
3) all of this lasting more than 3 months
What is the most common digestive complaint in the general population?
constipation
Causes of constipation
- Primary colorectal dysfunction
- inadequate fiber/ fluid intake
- pool bowel habits
- opioids
- iron supplementation
Explain primary colorectal dysfunction
- slow transit constipation
- dyssynergic defecation: pelvic walls don’t fxn correctly and sphincter muscles contract instead of relax
- IBS
Clinical constipation
- straining
- lumpy hard stools
- sensation of incomplete evacuation
- use of digital maneuvers
- sensation of anorectal obstruction/ blockage
- decreased frequency
- abdominal discomfort or pain
- abdominal distention
- nausea
Alarm symptoms for constipation
- Hematochezia
- obstructive symptoms
- acute onset of constipation
- severe persistent constipation that is unresponsive to tx
- weight loss more than 10 pounds
- change in stool caliber- pencil thin stool
- family hx of colon cancer or IBD
What lab tests can you do for constipation?
BMP
CBC
TSH
Tx constipation
Initial Management
- patient education
- dietary changes: more fiber and water
- bulk- forming laxatives (metamucil, citrucel, fibercon, benefiber)
PRN
- non-bulk forming laxatives (milk of magnesia, miralax, lactulose, senna, biscodyl)
- Enemas- (colace and mineral oil)
Post op give what for constipation
colace and senna
When to refer for constipation
- refractory constipation
- defacatory disorders
- alarm sx or over 50
Patho fecal impact
solid immobile bulk of stool in the rectum
Clinical fecal impact
- abdominal cramping & bloating
- leakage of liquid or sudden episodes of watery diarrhea when normally constipated
- rectal bleeding
- small, semi-formed stools
- straining when trying to pass stools
- bladder pressure/ loss of control
- lower back pain
- fluid leaks out but no evacuation of bowels
- pressure on bladder and urethra–> can’t void
Dx fecal impact
- digital rectal exam to look for firm or large amount of stool in rectal volt
- abdominal radiograph is DRE is normal but high suspicion
Tx fecal impact
- Disimpact and colon evacuation: manual fragmentation, mineral oil enemal to soften and lubricate, PEG after evactuate a little
- identify causes
- maintain bowel regimen
Patho Pilonidal Dz
- infection of skin and subcutaneous tissue at or near the upper part of the natal cleft of the buttocks
- irritation of skin–> pockets form where there are hair follicles–> pit forms–> tract forms due to continuous trauma–> infection and abscess
Are pilonidal cavities true cysts?
No because they lack fully epithelialized lining
Causes Pilonidal Dz
prolonged sitting and riding in a jeep
Pilonidal Dz occurs in what age
19yo women and 21yo men
RF Pilonidal Dz
- overweight/ obese
- local trauma
- sedentary lifestyle
- deep natal cleft
- family history
Clinical Pilonidal Dz
- painless cyst or sinus opening at the top of the natal cleft
Clinical Pilonidal Dz with acute abcess
- sudden onset of severe pain and swelling
- acutely inflamed and fluctuant mass overlying the sacrum or coccyx
- fever if cellulitis
Clinical Pilonidal Dz with chronic Pilonidal cyst
- painless cyst or sinus opening at the top of the natal cleft
- persistent drainage from a sinus track connected to the cyst
- mucoid/ purulent material
Tx Pilonidal Dz
- sitz bath
- I&D if abscess
- surgical excision of sinus tract and cysts
- ABX for cellulitis
- be careful shaving hair in gluteal area
- recurrent
