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Clin Med 2 > Anal Disorders > Flashcards

Anal Disorders Flashcards

1
Q

Patho Rectal Abscess

A

collection of purulent material in a glandular crypt

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2
Q

Where is a rectal abscess located?

A

in the perirectal area

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3
Q

Clinical rectal abscess

A
  • sudden onset of severe pain and swelling
  • fluctuant mass that feels like fluid inside
  • fever
  • cellulitis possible
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4
Q

Dx rectal abscess

A

H/ PE

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5
Q

Tx rectal abscess

A
  • I&D

- ABX only if cellulitis

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6
Q

Patho Rectal Fistula

A

chronic manifestation of acute perirectal abscess that has ruptured or drained –> formation of an epithelialized track to anus or rectum from perirectal skin

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7
Q

Causes Rectal Fistula

A
  • Perirectal abscess ruptured/drained
  • crohn’s
  • radiation proctitis
  • rectal foreign bodies due to laceration
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8
Q

Clinical Rectal fistula

A
  • pain
  • purulent drainage
  • perirectal skin lesion
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9
Q

Dx rectal fistula

A
  • fistula probe
  • CT, MRI, fistulography (shows air/ contrast in area)
  • Non-healing anorectal abscess after drainage
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10
Q

Tx Rectal fistula

A

Surgery- eradicate fistula and preserve fecal continence with little rubber tubing tie that they use to tie and pinch off fistula

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11
Q

What is one of the most common anorectal conditions?

A

anal fissure

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12
Q

Patho of anal fissure

A
  • due to high anal pressure

- sphincter spasms and anal mucosa tears

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13
Q

Tx Goals Anal fissure

A
  • relax internal sphincter
  • maintain less trauma with stooling
  • pain relief
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14
Q

Medical tx anal fissure

A
  • fiber
  • cortisone
  • topical nitro, diltiazem, bathanechol
  • oral: nifedipine, diltiazem
  • botulin toxin to paralyze the rectal spasm
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15
Q

Surgical tx anal fissure

A
  • failure of other tx
  • lateral sphincterotomy
  • dilatation
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16
Q

Functional Constipation

A

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

17
Q

What is the most common digestive complaint in the general population?

A

constipation

18
Q

Causes of constipation

A
  • Primary colorectal dysfunction
  • inadequate fiber/ fluid intake
  • pool bowel habits
  • opioids
  • iron supplementation
19
Q

Explain primary colorectal dysfunction

A
  • slow transit constipation
  • dyssynergic defecation: pelvic walls don’t fxn correctly and sphincter muscles contract instead of relax
  • IBS
20
Q

Clinical constipation

A
  • 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
21
Q

Alarm symptoms for constipation

A
  • 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
22
Q

What lab tests can you do for constipation?

A

BMP
CBC
TSH

23
Q

Tx constipation

A

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)

24
Q

Post op give what for constipation

A

colace and senna

25
Q

When to refer for constipation

A
  • refractory constipation
  • defacatory disorders
  • alarm sx or over 50
26
Q

Patho fecal impact

A

solid immobile bulk of stool in the rectum

27
Q

Clinical fecal impact

A
  • 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
28
Q

Dx fecal impact

A
  • digital rectal exam to look for firm or large amount of stool in rectal volt
  • abdominal radiograph is DRE is normal but high suspicion
29
Q

Tx fecal impact

A
  • Disimpact and colon evacuation: manual fragmentation, mineral oil enemal to soften and lubricate, PEG after evactuate a little
  • identify causes
  • maintain bowel regimen
30
Q

Patho Pilonidal Dz

A
  • 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
31
Q

Are pilonidal cavities true cysts?

A

No because they lack fully epithelialized lining

32
Q

Causes Pilonidal Dz

A

prolonged sitting and riding in a jeep

33
Q

Pilonidal Dz occurs in what age

A

19yo women and 21yo men

34
Q

RF Pilonidal Dz

A
  • overweight/ obese
  • local trauma
  • sedentary lifestyle
  • deep natal cleft
  • family history
35
Q

Clinical Pilonidal Dz

A
  • painless cyst or sinus opening at the top of the natal cleft
36
Q

Clinical Pilonidal Dz with acute abcess

A
  • sudden onset of severe pain and swelling
  • acutely inflamed and fluctuant mass overlying the sacrum or coccyx
  • fever if cellulitis
37
Q

Clinical Pilonidal Dz with chronic Pilonidal cyst

A
  • 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
38
Q

Tx Pilonidal Dz

A
  • sitz bath
  • I&D if abscess
  • surgical excision of sinus tract and cysts
  • ABX for cellulitis
  • be careful shaving hair in gluteal area
  • recurrent

Clin Med 2 (25 decks)

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