Anorectal Disorder Flashcards
Anorectal disorders
occur in the perianal area, anal canal, and lower portion of the rectum.
Hemorrhoids are abnormally large, bulging, symptomatic conglomerates of hemorrhoidal vessels, supporting tissues, and overlying mucous membranes of skin in the anorectal region
should not treat
Potentially serious non-hemorrhoidal anorectal disorders, including abscesses, fistulas, fissures, neoplasms, polyps, pruritus ani, and inflammatory bowel disease (IBD), may present with hemorrhoid-like symptoms and SHOULD NOT be self-treated. Patients should be referred for medical evaluation if any of the conditions are suspected
Usually Self-Treatable
Itching (pruritus) Discomfort Irritation Burning Inflammation Swelling
Untreatable
Pain - internal hemorrhoids usually painless; external hemorrhoids often cause mild pain
Bleeding - hemorrhoids most common cause
Seepage- involuntary passage of fecal material or mucus caused by an anal sphincter not closed completely
Change in bowel pattern - Unexplained change in bowel frequency or in stool form; may signal serious underlying GI disorder (e.g. IBD, or colorectal cancer
Prolapse (protrusion) - protrusion of hemorrhoidal or rectal tissue of variable size into the anal canal
Thrombosis (blood clotting)- associated pain is most acute during the first 48-72 hours, but usually resolves after 7-10 days. Minimal pain with thrombosed internal hemorrhoids
Nonpharmacologic Therapy
Dietary modification
Improvement of hygiene practices
Surgical intervention
Avoid lifting heavy objects
Discontinue foods that irritate or aggravate symptoms
Increased dietary fiber or adding in fiber supplements can prevent further irritation
Proper bowel habits
Sitting in warm water in the bathtub for 10-20 min for 2-4 times/day
Local Anesthetics
Benzocaine Benzyl alcohol Dibucaine Lidocaine Pramoxine hcl Tetracaine
Benzocaine Benzyl alcohol Dibucaine Lidocaine Pramoxine hcl Tetracaine
Provide relief of itching, burning, discomfort, and pain by reversibly blocking transmission of nerve impulses
Contact dermatitis- may produce allergic reactions that are indistinguishable from the anorectal symptoms
avoid on open sores
Vasoconstrictors
*Ephedrine sulfate
Epinephrine HCL
*Phenylephrine HCL
*Ephedrine sulfate
Epinephrine HCL
*Phenylephrine HCL
Stimulates alpha-adrenergic receptors in the vascular beds causing the arterioles to vaso-constrict = reduction of swelling/slight anesthetic effect
AVOID rectally administered vasoconstrictors inpatients with the following: diabetes, thyroid disease, heart disease, HTN (hypertension), enlarged prostate.
*Skin Protectants
*Aluminum hydroxide gel, cocoa butter, hard fat, kaotin, lanolin, mineral oil, white petrolatum, calamine, shark liver oil, zinc oxide, cod liver oil
Glycerin
*Aluminum hydroxide gel, cocoa butter, hard fat, kaotin, lanolin, mineral oil, white petrolatum, calamine, shark liver oil, zinc oxide, cod liver oil
Glycerin
Provide a physical protective barrior and soften the anal canal by preventing fecal matter from irritating the perianal mucosa
Glycerin is for external use only (all others are approved for internal and external)
Apply to clean and dry skin
*Astringents
*Calamine
*Zinc Oxide
Witch Hazel
*Calamine
*Zinc Oxide
Witch Hazel
Promote coagulation of surface protein in the anorectal skin cells to protect the underlying tissue; decrease cell volume, drying the area; create a thin protective layer
Corticosteroids
Hydrocortisone
Hydrocortisone
Acts as a vasoconstrictor and antipruritic
- Onset of action:up to 12 hours
- Duration of action: much longer than other agents
