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GI > Anorectal Disease > Flashcards

Anorectal Disease Flashcards

1
Q

Anorectal Disorders

A 
Anal fissures
Anal fistulas
Hemorrhoids
Rectal prolapse
Pilonidal disease
Pruritus ani
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2
Q

Define Anal Fissures

A

Painful linear tear or crack in the distal anal canal

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3
Q

Etiology of Anal Fissures

A

Trauma to anal canal: defecation, straining, constipation

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4
Q

Clinical Presentation of Anal Fissures

A

Complaint of severe tearing pain during defecation

Mild associated hematochezia

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5
Q

PE for Anal Fissures

A

Visual inspection of the anus

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6
Q

Appearance of Acute Anal Fissures

A

Cracks in the epithelium

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7
Q

Appearance of Chronic Anal Fissures

A

Fibrosis & development of a skin tag

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8
Q

First-Line Treatment of Anal Fissures

A

Fiber supplements
Stool softeners
Sitz baths

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9
Q

Second-line Treatment of Anal Fissures

A 
0.4% nitroglycerin ointment
Botulinum toxin (Botox)
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10
Q

SE of 0.4% Nitroglycerin Ointment

A

Headache

Dizziness

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11
Q

Last Option for the Treatment of Anal Fissures

A

Internal anal sphincterotomy

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12
Q

Location of Perianal Abscess

A

Anal glands at the base of the rectum become infected

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13
Q

Causes of Perianal Abscess

A

Anal fissure/fistulas
Hemorrhoids
Blocked anal glands

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14
Q

Risk Factors of Perianal Abscess

A 
Colitis
IBD
DM2
Mean age: 40 y.o.
Women > Men
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15
Q

Clinical Presentation of Perianal Abscess

A

Constant pain
Swelling & redness around the anus
Discharge of pus around the anus
Painful bowel movements

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16
Q

Deeper Perianal Abscess Clinical Presentation

A

Same as “normal” perianal abscess
Fever
Chills
Malaise

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17
Q

Laboratory Studies for Perianal Abscess

A

Wound Cultures

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18
Q

Treatment of Perianal Abscess

A

I&D
Pacing & return in 24 hours
Sitz baths TID & post BM
Follow up for inspection for possible fistula formation

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19
Q

Etiology of Anal Fistula

A

Anorectal abscess
Crohn’s
Radiation proctitis

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20
Q

Clinical Presentation of Anal Fistula

A

Hx of drained abscess
Anorectal pain
Purulent drainage & irritation from the skin

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21
Q

PE for Anal Fistula

A

Identification of external opening that drains pus, blood, or stool
DRE may express pus or stool from opening

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22
Q

Treatment of Anal Fistula

A

Fistulotomy
Complex fistulas: fibrin glue
fistula plug

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23
Q

Define Pruritus Ani

A

Perianal itching or discomfort

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24
Q

Causes of Pruritius Ani

A 
Idiopathic
Hygiene related
Fistulas/fissures
Fecal incontinence
Parasites
Lichens sclerosis
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25
Q

PE of Pruritus Ani

A

Inspection may reveal anal excoriations & erythema
Hygiene issues
Thickened or leathery skin
Anoscopy

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26
Q

Treatment & Prevention for Pruritus Ani

A

Treat underlying cause
Avoid spicy & acidic foods
After BM, clean with wipes
Place gauze or cotton ball next to anal opening
Talcum powder
Use zinc oxide or hydrocortisone ointment

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27
Q

Define Rectal Prolapse

A

Painless protrusion of the rectum through the anus

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28
Q

Most Common Individuals that have Rectal Prolapse

A

Women >50
Infants
CF patients

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29
Q

Symptoms of Rectal Prolapse

A

Feeling a bulge or appearance of reddish-colored mass outside the anus
Pain in the anus or rectum
Leakage of blood or stool

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30
Q

Causes of Rectal Prolapse

A 
Chronic constipation or diarrhea
Straining during BM
Weakness of anal sphincter
Damage to nerves
Pregnancy
Back surgery
Women >40
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31
Q

Diagnosis of Rectal Prolapse

A 
Anal EMG
Anal manometry
Anal ultrasound
Colonoscopy
Proctosigmoidoscopy
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32
Q

Treatment of Rectal Prolapse

A

Stool softeners
Pushing rectum back up into the anus
Abdominal repair
Rectal repair

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33
Q

Recovery of Surgery in Rectal Prolapse

A

Hospitalization 3-5 days

Complete recovery in 3 months

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34
Q

Define Pilonidal Cyst

A

Cyst near the natal cleft of the buttocks that often contain hair or skin debris

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35
Q

Risk Factors of Pilonidal Cyst

A 
Hair punctures skin & becomes embedded
Hairy young men
Prolonged sitting
Obesity
Local trauma/irritation
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36
Q

Clinical Presentation of Pilonidal Cyst

A

Pain
Erythema & swelling of the skin
Drainage of foul smelling pus or blood from the opening skin

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37
Q

Treatment & Prevention of Pilonidal Cyst

A

I&D
Surgical cyst removal
Antibiotics in the case of cellulitis

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38
Q

Antibiotic options in Pilonidal Cyst

A

1st generation cephalosporin (cefazolin) + metronidazole (Flagyl)

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39
Q

Define Hemorrhoids

A

Dilated veins of the hemorrhoidal plexus in the lower rectum

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40
Q

Define External Hemorrhoids

A

Below edentate line consisting of squamous cells

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41
Q

Define Internal Hemorrhoids

A

Internal edentate line consisting of anal mucosal

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42
Q

Classification of Hemorrhoids

A

Grade 1: hemorrhoids that do not prolapse
Grade 2: Hemorrhoids prolapse on defecation & reduce spontaneously
Grade 3: hemorrhoids prolapse on defecation & reduce manually
Grade 4: hemorrhoids are prolapse & cannot be reduce manually

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43
Q

Causes of Hemorrhoids

A 
Pregnancy
Frequency heavy lifting
Repeated straining during defecation
Constipation
Prolonged sitting
Obesity
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44
Q

Clinical Presentation of External Hemorrhoids

A 
Painful/purplish swelling
Rarely ulcerate & cause minor bleeding
Resolves in 2-3 days
Swelling lasts a few weeks
Itchiness around anus
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45
Q

Clinical Presentation of Internal Hemorrhoids

A

Bleeding after defecation
Mucous & fecal incontinence
Itchiness

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46
Q

Clinical Presentation of Strangulated Hemorrhoids

A

Very painful
Ulceration
Necrosis

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47
Q

Diagnosis of Hemorrhoids

A

Anoscopy

Sigmoidoscopy or colonoscopy

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48
Q

Treatment of Hemorrhoids

A 
Stool softeners/fiber
Sitz baths after BM
Anesthetic ointments
Banding
Surgical
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49
Q

Key Points of Hemorrhoids

A

External may thrombus & become painful
Internal often bleed and not painful
Stool softeners, topical treatments, & analgesics usually adequate for external
Bleeding internal may require injection or rubber band ligation
Surgery last resort

50
Q

Define Hernias

A

Protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it

51
Q

When does a hernia become a medical & surgical emergency?

A

When the blood supply is cut off at the hernia opening in the abdominal wall

52
Q

Types of Hernias

A 
Inguinal
Umbilical
incisional/Ventral
Epigastric
Femoral
Spigelian
53
Q

Where is an epigastric hernia?

A

Upper abdomen at midline

54
Q

Where is an incisional hernia?

A

At site of previous surgical incision

55
Q

Where is an umbilical hernia?

A

At the naval

56
Q

Where is a direct inguinal hernia?

A

Near the opening of the inguinal canal

57
Q

Where is an indirect inguinal hernia?

A

At the opening of the inguinal canal

58
Q

Where is a femoral hernia?

A

In the femoral canal

59
Q

What is the most common type of hernia?

A

Inguinal hernia

60
Q

Why are inguinal hernias so prominent?

A

Weak area occurs in the inguinal canal where the spermatic cord or round ligament exits the abdomen

61
Q

Risk Factors for Inguinal Hernia

A 
Hx of hernia or repair
Chronic cough or constipation
Abdominal wall injury
Smoking
Older age
62
Q

What are the 2 types of inguinal hernias?

A

Indirect

Direct

63
Q

Indirect Inguinal Hernia

A

Protrudes through internal inguinal ring
Hearnia sac located lateral to inferior epigastric artery
May protrude into the scrotum
Mor common as people age

64
Q

Direct Inguinal Hernia

A

Protrude medial to inferior epigastric vessels
Result of weakness in the floor of the inguinal canal
Rarely protrude into scrotum
Almost always in older individuals

65
Q

Boundaries of Hesselbach Triangle

A

Laterally: inferior epigastric artery
Medially: lateral border or rectus abdominis
Inferiorly: inguinal ligament

66
Q

Femoral Hernia

A

Located inferior to the inguinal ligament & protrudes through femoral ring
More common in women
Least common type of groin hernia
High chance of strangulation

67
Q

Clinical Presentation of an Inguinal Hernia

A 
Painless bulge in groin or scrotum
Groin discomfort or pain
Swelling or tugging in the groin
Sudden pain (strangulated)
N/V (strangulated)
68
Q

PE for an Inguinal Hernia

A

Bulge in groin
Patient standing and Valsava
Reducible vs. irreducible
Strangulation

69
Q

Clinical Manifestation of a Strangulated Hernia

A

Irreducible
Painful to palpation
N/V
Appear ill with or without fever

70
Q

Diagnosis of Inguinal Hernia

A

H&P
Ultrasound
CT/MRI

71
Q

Treatment of Inguinal Hernia

A

Watchful waiting
TRUSS
Surgical (open or lap repair)

72
Q

Define Umbilical Hernia

A

Outward bulging of the lining of the abdomen or abdominal organs around the umbilicus

73
Q

Causes of Umbilical Hernias

A 
Muscle through which the umbilical cord passes doesn't close completely after birth
Obesity
Multiple pregnancies
Ascites
Previous abdominal surgery
74
Q

Clinical Presentation of an Umbilical Hernia

A

Soft swelling or bulge near umbilicus
Infant: noticeable when baby cries, coughs, or strains
Adults: abdominal discomfort, bulging with straining or coughing
Can become strangulated

75
Q

PE for Umbilical Hernia

A

Found on exam

76
Q

Treatment of an Umbilical Hernia

A

Surgery with or without mesh

77
Q

Define Incision or Ventral Hernia

A

Abdominal surgery causes a flaw in the abdominal wall that must heal on its own

78
Q

Define Epigastric Hernia

A

Hernia that develops int he epigastrium between the breast bone and belly button

79
Q

Risk Factors for an Epigastric Hernia

A

Obesity

Pregnancy

80
Q

Define Spigelian Hernia

A

Hernia through the spigelian fascia

81
Q

Risk of Strangulation in a Spigelian Hernia

A

High due to small size

82
Q

Clinical Presentation of Spigelian Hernia

A

Intermittent mass
Localized pain
N/V

83
Q

Diagnostics of Spigelian Hernia

A

Ultrasound

84
Q

Treatment of Spigelian Hernia

A

Surgery

85
Q

Differential Diagnosis of Acute Abdominal Pain

A 
AAA
Mesenteric ischemia
Perforation of GI tract
Acute bowel obstruction
Volvulus
Ectopic pregnancy
MI
Splenic rupture
86
Q

Pathophysiology of an Acute Abdomen

A

Visceral pain
Somatic pain
Referred pain
Peritonitis

87
Q

Visceral Pain in an Acute Abdomen

A

Respond to sensations of dissension & muscular contraction
Pain typically vague, dull, & nauseating

88
Q

Somatic Pain in an Acute Abdomen

A

Respond to irritation from infection, chemical, & inflammatory process
Pain sharp & well localized

89
Q

Referred Pain in an Acute Abdomen

A

Perceived distant from source

Results from convergence of nerve fibers at spinal cord

90
Q

Define Peritonitis

A

Inflammation of the peritoneal cavity

91
Q

Most Common Cause of Peritonitis

A

Perforated GI tract

92
Q

Common Conditions of an Acute Abdomen

A 
Appendicitis
Biliary disease
Pancreatitis
Diverticular disease
PUD
Incarcerated hernia
IBD
IBS
93
Q

Appendicitis

A 
Anorexia
Vague periumbilical discomfort that radiates to RLQ
N/V
Urinary symptoms
Diarrhea
94
Q

What is the most common extrauterine cause for abdominal pain in pregnant women?

A

Appendicitis

95
Q

Biliary Disease

A 
Acute cholecystitis
RUQ or epigastric pain
Radiate to right shoulder or back
N/V
Anorexia
Murphy's sign
Progress to septic shock
Jaundice
96
Q

Pancreatitis

A

Pain in LUQ
Band-like radiation to back
Maximum pain intensity within 10-20 minutes
N/V common

97
Q

Diverticular Disease

A

LLQ pain
N/V
+/- change in bowel habits

98
Q

PUD

A

Epigastric pain
Indigestion
Reflux symptoms

99
Q

Complications of PUD

A

Bleeding

Perforation

100
Q

Incarcerated Hernia

A

Inguinal most common
Severe pain
Require immediate surgical consultation

101
Q

Acute Complications of IBD

A 
Pain
Bleeding
Perforation
Bowel obstruction
Fistula
Abscess formation
Toxic megacolon
102
Q

IBS

A

Persistent symptoms for >3 months in 1 year
Pain associated with change in stool frequency of consistency
Pain received by BM

103
Q

Evaluation of an Acute Abdomen

A

H&P will exclude all but a few causes
Labs & imaging give final diagnosis
Rule out life-threatening causes

104
Q

Features of High Risk Abdominal Pain

A 
>65 years old
Immunocompromised
Alcoholism
CV disease
Major comorbidities
Prior surgery or recent GI instrumentation
Early pregnancy
Sudden onset pain
Pain maximal at onset
Pain + vomiting
Constant pain
105
Q

Important History

A 
Age
Sex
PMHx
SHx
Meds
Location of pain
HPI
Pregnancy test
106
Q

Causes of RUQ Abdominal Pain

A 
Hepatitis
Cholecystitis
Cholangitis
Biliary colic
Pancreatitis
Budd-Chiari syndrome
Pneumonia/empyema pleurisy
Sub-diaphragmatic abscess
107
Q

Causes of RLQ Abdominal Pain

A 
Appendicitis
Salpingitis
Ectopic pregnancy
Inguinal hernia
Nephrolithiasis
IBD
Mesenteric adenitis
108
Q

Causes of Epigastric Abdominal Pain

A 
PUD
GERD
Gastritis
Pancreatitis
MI
Pericarditis
Ruptured aortic aneurysm
109
Q

Causes of Peri-umbilical Abdominal Pain

A

Early appendicitis
Gastroenteritis
Bowel obstruction
Rupture aortic aneurysm

110
Q

Causes of LUQ Abdominal Pain

A 
Splenic abscess
Splenic infarct
Gastritis
Gastric ulcer
Pancreatitis
111
Q

Causes of LLQ Abdominal Pain

A 
Diverticulitis
Salpingitis
Ectopic pregnancy
Inguinal hernia
Nephrolithiasis
IBS
IBD
112
Q

Causes of Diffuse Abdominal Pain

A 
Gastroenteritis
Mesenteric ischemia
Metabolic
Malaria
Familial Mediterranean fever
Bowel obstruction
Peritonitis
IBS
113
Q

PE of an Acute Abdomen

A

General appearance important
Inspection, auscultation, palpation, & percussion of abdomen
Rectal/pelvic exam
Surgical scars should be palpated

114
Q

Red Flags of an Acute Abdomen

A

Severe pain
Signs of shock
Signs of peritonitis
Abdominal distention

115
Q

Acute Abdomen Diagnostics

A 
Urine pregnancy test
Serum lipase
Serum amylase
Plain x-rays
Ultrasound
CT
116
Q

Diagnostic Test of Choice in RUQ Pain

A

Ultrasound

117
Q

Diagnostic Test of Choice in RLQ Pain

A

Ultrasound with IV contrast

118
Q

Diagnostic Test of Choice in LLQ Pain

A

CT with oral & IV contrast

119
Q

Diagnostic Test of Choice in LUQ Pain

A

Endoscopy
Ultrasound
CT

120
Q

Diagnostic Test of Choice in Suprapubic Pain

A

Ultrasound

121
Q

Key Points of an Acute Abdomen

A

Look for life-threatening causes first
Rule out pregnancy
Seek signs of peritonitis, shock, obstruction
Lipase/amylase on good blood tests

GI (20 decks)

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