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GI > Anorectal Disease > Flashcards

Anorectal Disease Flashcards

1
Q

Bright red blood per rectum.

Protrusion, discomfort.

Characteristic findings on external anal inspection and anoscopic examination.

A

Hemorrhoids

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2
Q

Normal vascular structures in anal canal arising from a channel of arteriesvenous connective tissues that drains into sup/inf hemorrhoidal veins

A

Hemorrhods

Contribute to normal anal pressures and ensure a water tight closure of the anal canal

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3
Q

External hemorrhoids are where?

Arise from…?

A

Below the dentate/pectinate line

Covered in squamous epithelium

Arise from… superior hemorrhoidal veins

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4
Q

External hemorrhoids are more painful because?

A

Below the dentate line, there are somatic pain receptors

Inferior hemorroidhal veins

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5
Q

Most common complaint of hemorrhoids

A

Bright red rectal bleeding… streaks on TP or dripping into toilet

Other ssx include perianal itching, mucoid discharge

(external hemorrhoids = pain)

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6
Q

COvered w/ columnar epithelium leading to mucous deposition on the perianal skin (causes pruritits)

Prolapse may permit leakage of rectal contents

A

Internal hemorroihds

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7
Q

Skin tags associated may be difficult to clean resulting in n prolonged contact w/ fecal material

A

ExternalHemorrhodis

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8
Q

On PE, hemorrhoids are often really visible. Also check for?

And what else is necessary?

A

Check for skin tags, fissures, fistulas, condylomata, dermatitis

DRE (though uncomplicated hemorrhoids will not be palpable or painful)!

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9
Q

GRade 1?

Grade 2?

Grade 3?

Grade 4?

Grade 5?

A

1 - bleeding only, no prolapse

2 - prolapse w/ defecation, but spontaneous reduction

3 - prolapse w/ defecation that requires manual reduction

4 - prolapsed, incarcerated; CANNOT be reduced

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10
Q

Acute unrelenting pain presentation… means?

A

Thrombosed external hemorrhoid that requires surgical evacuation of the clot

(Internal can also thombose, not as common)

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11
Q

Method for hemorroidectomy?

A
  1. Lidocaine infiltration
  2. Elliptical incision
  3. Evacuation of clot
  4. Packing
  5. Sitz baths, stool softeners, hemorrhoid donut
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12
Q

General tx measures for hemorrhoids?

A

Increase fiber

INcreae fluid

Wet wipes for hygiene/pain

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13
Q

Medical tx for hemorrhoids?

A

Topical astringents

Topical hydrocortisone

Topical anesthetics

Hydrocortisone suppositories

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14
Q

If topical agents don’t work, what are some option for tx of hemorrhoids?

A

Rubber band ligation

Sclerotherpay

Electrocoagulation

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15
Q

Surgical hemorrhoidectomy is an option… butttt…..

A

High risk of fecal inconinence

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16
Q

Anal fissure is a tear in the?

A

Anoderm distal to the dentate line (so, external)

17
Q

Most anal fissures arise from?

A

Trauma to the anal canal during defection (straining, constipation, high internal sphincter tone)

18
Q

Anal fissures most commonly cur midline. If they occur elsewhere consider?

A

Crohn, HIV, TB, syphilis, anal carcinoma

19
Q

Anal fissures may be acute or chronic…

A

Chronic develops due to spasm of internal sphincter and may impair healing

20
Q

How do anal fissures clinically present?

A

Acute onset of severe tearing pain during defecation

Hematochezia (typically mild — some blood on TP)

(Pain may lead to self induced constipation)

21
Q

Examination reveals small tear in epithelium

Spreading buttocks may be painful

DRE not tolerable

May observe sentinel pile, which is?

A

Anal fissure

Sentinel pile = skin tag at outermost edge

22
Q

Anal fissure tx?

A

Sitz baths

Increase fiber/fluid

Stool softener

topical anesthetic (lidocaine jelly)

23
Q

Chronic fissures can be treated w/ topical vasodilator such as?

A

Nifedipine

Nitro

Diltiazem

(Or, Botulinum)

24
Q

Chronic fissures maybe treated surgically if refractory…

A

Fissurectomy

Lateral internal sphincerotomy

25
Q

Collection of purulent material that arises from glandular crypts in the anus or rectum

NOT directly associated with defecation

A

Perianal abscess

26
Q

Severe pain that is NOT directly associated w/ defecation

A

perianal abscess (Unlike fissures/hemorrhoids)

Fever and malaise are common

27
Q

Perianal abscess on PE?

A

Ertytherma , edema, fluctuant

W/ surrounding induration

28
Q

WHat is DEFINITELY indicated for perianal abscess… because they might not be readily apparent?

A

DRE!

29
Q

Tx for perianal abscess?

A

Simple = outpatient mgmt (Incision and drainage)

Complex = Inpatient mgmt (surgical drainage)

30
Q

Complications of perianal abscess?

And what’s it require?

A

Fistula formation (epitheliazed track connecting abscess to perirectal skin)

Leads to chronic purulent discharge, pruritis, pain

SURGERY

31
Q

Anorectal discomfort

Tenesmus

Constipation

Mucus/blood discharge

A

Infectious prostitis

32
Q

Etiology of infectious prositits?

A

STI, usually

Gonorrhea
Syphilis
Chlamydia
Herpes

33
Q

Infectious prostitis presentation…

  1. Syphilis ->
  2. Herpes ->
  3. Gonorrhea ->
  4. Chlamydia ->
A
  1. Chancre
  2. Grouped vesicles
  3. Mucopurulent discharge
  4. Slight discharge (maybe asymptmatic)

(Lab test for suspected pathogen)

34
Q

Itching/bleeding/pain

May coalesce and obscure anal opening

HAVE TO DISTINGUISH FROM CANCER!

A

Anal warts

Condylomata acuminata

35
Q

Carcinoma of the anus is rare… MOst common type?

Higher risk in whom?

A

Squamous cell

High risk = anoreceptive intercourse, anal warts

36
Q

Anal Carcinoma often confused for (so must be distinguished from)?

TEst how?

A

Confused for hemorrhoids (because it presents w/ bleeding, pain, local mass)

CT or MRI to diagnose

GI (9 decks)

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