Anorectal Conditions - Sasek Flashcards
External Hemorrhoids
- below dentate or pectinate line
- covered by squamous epithelium
- sensory innervation
- acute pain when thrombosed
- if thrombosed typically bluish in color
- excise clot if necessary
- NSAIDs, analgeics, stool softeners, preparation H, Tucks
Anorectal Abscess
secondary to infection originating in the anal glands
presentation: anorectal, drainage of blood/pus
*early sepsis can result
physical exam: hot, red, tender area; adjacent to anus
treatment: I&D, broad spectrum antibiotics
Internal Hemorrhoids
- ABOVE dentate (pectinate) line
- covered by mucosa - no sensory innervation
- asymptomatic bleeding
- bright red spotting on toilet paper; dripping into toilet
Classification of Internal Hemorrhoids
First Degree: small size, bleeding only
Second Degree: medium size, prolapse under pressure, reduce spontaneously
Third Degree: large size, permanent prolapse, reduce manually
Fourth Degree: large size, proplaspe can’t be reduced - refer to colorectal surgeon
Management of Hemorrhoids
Conservative:
- decrease straining
- avoid prolonged sitting
- symptomatic treatment for pruitis/irritation
- steroid creams
- suppositories
- analgesic cream
- sitz bath
Office Based:
- rubber band ligation (1, 2, 3 degree)
- infrared coagulation (1, 2, 3 degree)
Surgery:
- when hemorrhoid is unreducable (4 degree)
Rectal Carcinoma
painless mass or palpable mass on rectal exam
Identify key history elements for anorectal disorders
HPI: OLD CHARTS + ICE
PMH:
- similar problems in past
- hx of IBD, IBS
- hx of radiation, cancer
- recent pregnancy
- chronic constipation
- bowel habits
- liver disease
- medications
FH:
- hemorrhoids
SH:
- sexual history
- anal intercourse (preferences, practices, protection)
- abuse
- drug use (cocaine)
Proctitis
inflammation of the lining of the rectum
causes:
- IBD
- infectious: C. dif salmonella, N. gonorohoeae, chlamydia trachomatis, HSV, HPV
- icschemia
- radiation
symtpoms:
- rectal pain
- mucopurulent discharge
- fecal urgency or tenesmus
- constipation
physical exam:
- DRE may be difficult
- HSV may have vesicles
diagnosis:
- CBC
- stool culture
- gonoccal swabs
- endoscopy
treatment:
- treatment based on underlying cause
Identify key physical exam findings and diagnostic tests for anorectal disorders
PHYSICAL EXAM
Age - peaks 45-65 years
GU Exam
- inspect rectal area
- DRE
- anoscopy
Abdominal Exam - if colonic etiology
DIAGNOSTICS
Laboratory - CBC for anemia, infection
Diagnostic Tests - anoscopy, colonoscopy
Pruritis Ani
causes:
- fecal soilage
- perspiration
- hemorrhoids
- infection, malignancy
treatment:
- bulk forming agent
- sitz baths
- witch hazel pads
- steroid creams
- good hygiene
Rectal Prolapse
- protrusion of mucosa or entire thickness of rectum
Anal Fissure
laceration or tear in anal canal distal to dentate line (posterior midline)
painful with defecation; usually due to passing hard stool
viewed on inspection
treatment: topical analgesia, soften stool, may need surgery
Pathophysiology &
Causes of Symptomatic Hemorrhoids
Pathophysiology: usually secondary to increased intra-abdominal pressure
Causes
- aging
- chronic diarrhea or constipation
- pregnancy/child birth
- prolonged sitting
- straining
- heavy lifting
- anal intercourse
- pelvic tumors
Condyloma Accuminata
- anogenital warts from HPV
Anal Skin Tag
- pervious thrombosed hemorrhoid
