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GI #1 > anorectal disorder > Flashcards

anorectal disorder Flashcards

1
Q

resting vs squeezing tone

A
  • resting– internal sphincter function; most important for continence
  • squeezing– voluntary/external sphincter & pelvic tone; gives info about constipation and defacation
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2
Q

test for rectal prolapse or prolapsing hemorrhoids

A

valsalva maneuver

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3
Q
  • when a vascular tissue covered by mucosa bleeds or enlarges & goes into anal canal
  • likely loss of connective tissue support making it more likely to be affected by straining or hard stools
  • risk factors includes pregnancy and lengthy periods on toilet
A

hemorrhoids

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4
Q

grade hemorrhoids from 1 to 4

A
  1. no proplapse
  2. prolapse w/ straining but retracts after
  3. needs manual reduction
  4. not manually reducible
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5
Q
  • painless bright red bleeding w/ bowel movements
  • sometimes feeling of protrusion/prolapse, mucus or fecal leaking
  • can be clotted blood
  • prolapse can cause aching pain if not reducible
  • can be soft & squishy
A

internal hemorrhoids

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6
Q
  • PAST dentate line– painful or more irritating/very tender w/ thrombosis (painful swelling)
  • can be purple or blue
  • hx of constipation, diarrhea, heavy lifting
  • thrombosed– sudden onset of pain, edema; can become strangulated
A

external hemorrhoids

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7
Q

which hemorrhoid is more likely to bleed more?

A

internal hemorrhoids

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8
Q

how are hemorrhoids treated

A
  • conservatively– more fluids, fiber, gentle hygiene; less time on toilet & straining
  • limited evidence for steroids and OTCs are mostly for sx relief only
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9
Q

for which hemorrhoid is banding procedure done?

A

internal hemorrhoids (grade 1& 2); especially if there is iron deficiency anemia or persistent bleeding

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10
Q

how are thrombosed external hemorrhoids treated? (2)

A

w/in 4 days of onset w/ clot excission, removal of skin over area
alternatively: conservative tx w/ pain control

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11
Q
  • tear to midline, mostly posterior, anal canal distal to dentate line so its very painful
  • feels like shard of glass w/ defecation & after; stools can be hard or loose
  • bright red blood w/ wiping or in toilet bowl but can be a LOT
  • sentinel skin tag– tender
A

anal fissures

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12
Q

if the anal fissure is not midline, list 5 ddx as the cause

A
  • TB
  • HIV
  • syphilis
  • psoriasis/skin condition
  • anal carcinoma
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13
Q

risk factors for anal fissures & differentiate acute from chronic

A
  • RF: anal intercourse, foreign object insertion, straining, hard stools
  • acute: clean edge like paper cut
  • chronic: more than 8-12 wks; heaped up, indurated
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14
Q

trauma + internal anal sphincter muscle spasm w/ relative ischemia + sentinel skin tag or hypertrophied anal papilla proximal to fissure

this describes the pathophys for what?

A

anal fissures

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15
Q

treatment of anal fissure (3) & if non healing (2)

A
  • sitz baths, fiber, fluids
    chronic– relax smooth muscle & get more blood flow with:
  • topical CCB (diltiazem, nifedipine)
  • nitroglycerin
    if non healing: botox or surgery
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16
Q
  • residual redundant skin from past inflammation and thrombosis
  • painless
  • can be from old thrombosed external hemorrhoids, pregnanct, chrons, etc.
A

skin tags

17
Q
  • itching caused by irritants, infections, cancer
A

perianal itching

18
Q

tx of perianal itching (3)

A

if at night: benadryl or hydroxyzine
if seepage: cotton ball w/ zinc ointment (desitin)
if ongoing: derm or colorectal referral

19
Q
  • caused by low risk HPV and transmitted via anal sex or other direct skin contact
  • asymptomamtic, bleeding w/ defecation, rectal leakage btwn bowel movement, anal pruritis
  • strong association btwn perianal and anorectal lesions
A

condyloma accuminata

20
Q

tx of condyloma accuminata (4)

A
  • if small– topical cytotoxins (podophyllin, trichloracetic acid)
  • topical immunomodulators (imiquimod)
  • cryotherapy
  • larger– surgical excision and fulguration

f/u every 6-12 mo d/t rik for anal intraepithelial neoplasia or cancer

21
Q

what is perirectal abcess?
what causes it?
how is it treated?

A
  • infected cavity w/ pus near anus or rectum; often involves anal glands
  • etiologies– infection, crohns
  • immediate surgery referral for I/D under anesthesia
22
Q
  • swelling, fluctuance, tenderness, induration, erythema
  • systemic sx of fever and malaise
  • persistent worsening pain

these are sx of what

A

perirectal abscess

23
Q
  • can progress from abscess- tunnel from infection to external skin
  • palpable cord between anus and abscess
  • sx– recurrent, progressive pain and increasing size followed by drainage
  • induration w/ thin epidermal coveral, drainage, tubelike firmness
A

perianal fistula

24
Q

how are perianal fistulas treated?

A

surgery– fistulotomy, seton placement

25
Q
  • risk factors include HIV, HPV women w/ anogenital component
  • diagnosed later; rare
  • hard, friable or ulcerating growth
  • referral to colorectal surgery for high resolution anal manometry
A

anal cancer

26
Q

what type of incontinence is this

  • reduced squeeze pressures & duration, less rectal capacity and sensitivity
A

urge incontinence– urgency presence– usually anorectal component

27
Q

no awareness of need to have bowel movement
lower resting pressures in rectum

A

passive incontinence

28
Q

typically in DM; isolated internal anal sphincter weakness; scleroderma

A

nocturnal incontinence

29
Q

3 steps to diagnose fecal incontinence

A
  1. rectal exam
  2. anorectal manometry
  3. endoanal US or MRI
30
Q

objective measure of anal sphincter– resting and squeezing pressures, rectal sensation

A

anorectal manometry

31
Q
  • difficulty evacuating stool from rectum in patients w/ chronic or recurring constipation
  • maladaptive learning of sphincter contraction including neglecting urge to defecate
  • sx similar to constipation; exam shows lack of relaxation w/ squeeze effort
  • associated conditions– parkinsons, IBD after ileal pouch
A

defecatory disorders

32
Q

diagnosis of defecatory disorders (4)

A

digital rectal exam
anorectal manometry w/ balloon expulsion test
barium or MRI defecography
anal EMG

33
Q

tx of defacatory disorders (4)

A
  • anorectal biofeedback theraoy
  • soluble fiber for hard stools
  • insoluble fiber for loose stools
  • squatty potty and toilet hygiene

GI #1 (10 decks)

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