Anorectal Flashcards
Resection in low vs. high rectal tumors
Low anterior resection in high tumor. Abdominoperineal resection in low tumor
Diagnosis of rectal cancer
palpable on DRE (maybe), biopsy on colonoscopy or anoscopy, endorectal US or CT/MRI for staging
Anal canal cancer associated with…
HPV. also cervical, vaginal cancer hx, immunosuppression, long-term steroids, cigarette smoking
Tumor is internal, aggressive biologic behavior, non-keratinizing, and associated with HPV infection-
tumor of anal canal
External tumor, well differentiated, keratinizing
tumor of anal margin
Workup of anal and perianal cancer
DRE, anoscopy, palpation of inguinal nodes
Tumors of the anal canal (internal cancers)
Epidermoid, melanoma, small cell
Tumors of the anal margin (external cancers)
basal cell, bowen disease, paget disease, squamous cell
Bowen’s disease aka
intraepithelial squamous cell carcinoma
Paget disease aka
Intraepithelial adenocarcinoma
Which of the anal margin tumors can crossover and involve both anal margin and anal canal?
Bowen’s disease
Bowen’s disease associated with…
condyloma
split or rip in the anoderm at midline…
anal fissure
Patient presents with severe burning and ripping pain that is worst right after BM. It usually lasts 1-3 hours. Bleeding occurs that makes water in toilet red. Sentinel pile seen on PE. Also see hypertrophied papilla and fissure. Dx?
anal fissure
triad in anal fissure
fissure, sentinel pile, and hypertrophied papilla
Anal fissure tx
sitz baths, lidocaine, vidodin, fiber, milk of magnesia, hydrocortisone cream, nitroglycerine, nifedipine ointment, botulinum toxin injection
origin of anorectal abscess
cryptoglandular
types of anorectal abscess
perirectal, ischiorectal, perianal, intersphicteric
Perianal abscess tx
drained under local anesthesia
intersphincteric abscess tx
drained in OR under anesthesia
Ischiorectal and perirectal abscess
drained by catheter placement or I&D under anesthesia
Fistuala in ano usually result from…
abscess in adults
fistula in ano emergency?
No
Tx of fistula in ano if internal sphincter involved
internal sphincterotomy
tx of fistula in ano if external sphincter involved
Collagen fistula plug, mucosal advancement flap, seton placement
When do hemorrhoids become pathologic?
When they are chronically engorged with blood
causes of hemorrhoids
pregnancy, obesity, straining. lifting, cirrhossi
Locations of hemorrhoids
3 major pedicles- L lateral, R anterior and posterior. And 3 minor pedicles- R lateral, L anterior and posterior
patient presents with painless rectal bleeding,mucus discharge, rectal fullness or discomfort. Cannot be palpated on DRE. ORder anoscopy- see…
internal hemorrhoid
Grade 1 -IV internal hemorrhoid
1- do not come out. 2- come out but spontaneously reduce. 3- come out but can be pushed back in. 4- cannot push back in
Tx of Grade 1 and II internal hemorrhoids
fiber, cathartics, hydrocortisone. otherwise rubber band ligation, or sclerotherapy
tx of Grade III and IV internal hemorrhiods
excised, removed with PPH- removes a ring of tissue above dentate line
tx of thrombosed external hemorrhoids and anal fissure
sitz baths, lidocaine, vicodine, mild of magnesia, hydrocrotisone
Thrrombosed external hemorrhoids have severe pain that peaks at
48-72 hours, then subsides over a week
Thrombosed external hemorrhoid turns into…
skin tag
patient presents with severe perianal itching that is worse at night. Skin white and leathery. Dx?
pruritis ani
Pruritis ani causes
poor hygiene/seepage, excessive hygiene, moisture, yeaast, pinworms- in children
Pruritis ani tx
keep area dry, baby wipes for hygiene, avoid soap, too much hygiene not good either
Proctalgia fugax aka
levator ani syndrome
L-sided, short lived pain that awakens person from sleep.Pain relieved by heat, defecation, muscle relaxants. Migraines history, and stress can set it off
Proctalgia fugax
cyst full of hair in the intragluteal fold, single or multiple sinuses in midline of intragluteal fold (in chronic form)
pilonidal disease
tx of pilonidal disease
phase 1- abscess I&D, oral abs. Phase 2- remove focus, excise cyst and contents.
Pilonidal disease associated with
poor hygiene and hairiness
