ANORECTAL ABCESS

Question 1

Pertinent Anatomy of a patient with Anorectal Abscess.

Answer 1

(1) Anus

(2) Rectum

Question 2

The mechanism involves obstruction of an ____ that opens in the base of an _____ which normally drains into the anal canal

Answer 2

The mechanism involves obstruction of an anal gland that opens in the base of an anal
crypt which normally drains into the anal canal

Question 3

Anorectal disorders range from

Answer 3

simple to complex, may be varied and multiple, and at
times can manifest signs and symptoms of underlying serious local or systemic disorders
that may be life-threatening.

Question 4

Abscesses are frequently encountered in the _____ and _____ region

Answer 4

Abscesses are frequently encountered in the perianal and perirectal region

Question 5

Almost all begin with involvement of an

Answer 5

anal crypt and its gland.

Question 6

development of an anorectal abscess

Answer 6

obstruction occurs, the gland orifice is blocked, resulting in infection and abscess
formation.
(a) From there, the infection can progress to involve any of the potential spaces that are
normally filled with fatty tissue and have little inherent resistance to the progression
of infection.
(2) As they persist fistula formation may develop as a common chronic sequela.
(3) Anorectal abscesses are more common in young middle-aged males.

Question 7

Spaces which can become infected alone or in combination with each other***

Answer 7

1) The perianal space
2) The intersphincteric space
3) The ischiorectal space
4) The deep postanal space
5) The supralevator or pelvirectal space

Question 8

most common condition

least common

Answer 8

perianal abscess

supralevator abscess

Question 9

initial sxs of a patient with an anorectal abscess

Answer 9

(1) Initially, the patient notices a dull, aching, or throbbing pain that becomes worse
immediately before defecation, is lessened after defecation, but persists between bowel
movements.
(a) The pain, significantly increased by the increased pressure in the rectum, occurs just
before defecation.
1) As the abscess spreads, increases in size, and comes nearer to the surface,
the associated pain becomes more intense.

Question 10

Pain will be aggravated by

Answer 10

straining, coughing, or sneezing.
As the abscess progresses, pain and tenderness interfere with walking or
sitting

Question 11

are perianal abscesses usually accompanied by fever, leukocytosis,
and sepsis in the immunocompetent patient.

Answer 11

no

Question 12

what kind of anorectal abscesses are painful but

may express fewer outward signs upon examination

Answer 12

ischiorectal, intersphincteric, supralevator

*The patient often appears markedly
uncomfortable and may be febrile. Leukocytosis may be present.

Question 13

Differential Diagnosis

Answer 13

(1) Pilonidal Cyst
(2) Hemorrhoid
(3) Anorectal Fistula

Question 14

Lab

Answer 14

None

Question 15

RAD

Answer 15

Ultrasound for deep abscesses

Question 16

Treatment

Answer 16

surgical and should be performed as soon as the diagnosis is made, before
the abscesses become fluctuant (early and extensive)

Question 17

All perirectal abscesses (supralevator, intersphincteric, and complicated ischiorectal)
should be drained in the

Answer 17

operating room.

Question 18

Isolated, simple, fluctuant perianal abscesses that are not associated with the presence of
any deeper abscesses may be drained in the

Answer 18

ED or outpatient setting using local

anesthetics.

Question 19

If a simple, linear drainage incision is made, the abscess is more likely to reoccur or resolve

Answer 19

recur because

of premature closure of skin edges.

Question 20

Whenever linear drainage incision is made, the abscess cavity must be packed initially with
strips of gauze for at least

Answer 20

24 h

Question 21

To ensure adequate drainage, a ___ or ___ incision can be made over the
fluctuant part of the abscess. Trimming the flaps is suggested to
prevent closure

Answer 21

a cruciate or elliptical incision

Question 22

is packing required for a cruciate or elliptical incision is made

Answer 22

no

Question 23

The wound should be covered with a bulk dressing; sitz baths should be started the
next day (performed how many times a day).

Answer 23

3

Question 24

antibiotics if its been adequately drained?

Answer 24

not necessary

Question 25

antibiotics for patients with fever, leukocytosis, valvular heart disease, or those with
cellulitis should be given?

Answer 25

broad- spectrum antibiotics

Question 26

what broad- spectrum antibiotics should be used

Answer 26

(a) Cephalexin (Keflex) – is a 1st generation Cephalosporin antibiotic
1) Dose: 250mg PO four times daily (QID)
(b) Doxycycline – is in the Tetracycline family of antibiotics
1) Dose: 100mg BID for 7 days
(c) Clindamycin – is a Lincosamide antibiotic
1) Dose: 300 mg PO q 6 hours for 7 days
(d) Dicloxacillin – it is the Penicillin family of antibiotics
1) Dose: 125-500 mg PO q6 hours

Question 27

Initial Care

Answer 27

(1) Incision and drainage

(2) In more complicated cases, refer to general surgery.