Anorectal Abscesses and Hernias Flashcards
Perianal abscess
patho, sxs, PE, labs, tx, complications
Patho:
- Originate at or just above the dentate line
- obstruction of cryptoglandular opening (anal glands and crypts of Morgagni) result in accumulation of glandular secretions
- this becomes infected (E. coli, enterococcus, bacteroides) with suppuration and formation of
Sxs:
- pruritis or pain
PE:
- fever
- red, fluctuant lesion usually evident at anal verge
Labs:
- Leukocytosis
Tx:
- I&D
- cruciate or elliptical incision–left open so pus doesn’t reaccumulate
- abx in pts with cellulitis, valvular heart disease, immunocompromise, diabetes, corticosteroids
Complications:
- fistulation formation
- necrotizing fasciitis
- perineal sepsi
Ischiorectal abscess
located outisde of anal sphincters
systemic sxs may be present (fever and leukocytosis)
I&D is tx of choice
abx for same indications
Intersphincteric abscess
much less comon than perianal or ischiorectal abscesses
occurs in potential space between the internal and external sphincters
dx confirmed only with digital rectal exam
fluctuant mass above anal verge
surgeons will perform I&D
Supralevator abscess
Rare
intraabdomina or pelvic source needs to be sought–MC are:
Diverticulitis
Appendicitis
PID
Indirect inguinal hernia
Only in men
Follows inguinal canal–begins at the internal inguinal ring and follows the canal down to the external inguinal ring
Direct inguinal hernia
weakness or defect in transversalis fascia
protrudes through abdominal wall in Hesselbach’s triange (just above inguinal ligament)
Femoral hernia
through the femoral canal
incarceration is more likely because it is a small opening
Umbilical Hernia
Usually self limited
Occurs more in kids–closes by age 2
Can occur in adults–women more likely
RF:
obesity
multiple pregnancies
protracted labor
abdominal tumors
Incisional hernia
post-operative
Spigelian hernia
defect in the spigelian fascia–lateral edge of the rectus muscle
AKA lateral ventral hernia
Reducible vs. Incarcerated vs. Strangulated
Reducible:
- reduce manually or can occur spontaneously
- may be uncomfortable but not usually painful
Incarcerated:
- hernia contents can’t be reduced
- blood supply not compromised
- may be painful
- signs of bowel obstruction may be present
Strangulated:
- incarcerated hernia with compromised blood supply
- sxs of ischemic bowel may be present
- may be toxic
Labs for hernias
None needed unless concern for strangulation or to assess hydration status
Imaging
Radiographs
- concern regarding free-air from perforation
US:
- differentiate b/w solid mass hernia
CT
- dx spigelian hernias
- if body habitus significantly limits PE
