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ClinMed II Exam #4 GI > Anorectal Disorders > Flashcards

Anorectal Disorders Flashcards

1
Q

Red flags of colorectal cancers?

A
  1. Melana, hematochezia
  2. Altered bowel movements
  3. Unexplained weight loss
  4. Unexplained iron deficiency anemia
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2
Q

What are anal fissures?

A

Linear (longitudinal) or oval shaped ulcer or tear in the anal mucosa

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3
Q

What condition is among one of the main causes of anal pain?

A

Anal fissures

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4
Q

Usually, how long are anal fissures?

A

Usually <5mm in length

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5
Q

What are the two types of anal fissures?

A
  1. Acute (<8 weeks)
  2. Chronic (>8 weeks)
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6
Q

Most anal fissures occur where?

A

In the posterior midline of the anal canal (99% in men, 90% in women)

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7
Q

10% of anal fissures are located where?

A

In the anterior midline
*more common in females than males

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8
Q

Which anal fissures are atypical and should raise suspicion for secondary conditions?

A

Fissures that occur off midline (laterally)

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9
Q

Which secondary conditions should be considered if atypical lateral/off-midline fissures occur?

A

Crohn’s, HIV/AIDS, TB, Syphilis, malignancy (ex. anal carcinoma)

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10
Q

A majority of anal fissures are caused by what?

A

Local trauma: Straining, penetration/anal sex, constipation, diarrhea, vaginal delivery

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11
Q

Other causes of anal fissures are due to what?

A

Underlying disease: Crohn’s, STDs, HIV/AIDS, malignancy

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12
Q

Clinical manifestations of anal fissures?

A

-severe/sharp “passive knives/shards of glass” tearing pain w/ defecation followed by throbbing discomfort
-Can lead to constipation (fear of recurrent pain w/ defecation)
-Mild hematochezia (blood on outside of stool or on TP following BMs)

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13
Q

Physical exam findings of anal fissures?

A

-confirm by visual inspection of anal verge
-acute fissures look like cracks in epithelium
-anal tenderness
-digital/anoscopic exam may not be possible d/t pain (often deferred)

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14
Q

Chronic anal fissures can result in what?

A

Fibrotic changes, develop skin tag at fissure’s distal end (sentinel pile) & hypertrophied anal papilla at fissure’s proximal end

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15
Q

Anoscopy clock locations?

A

12 o’clock: Anterior
3 o’clock: Left
6 o’clock: Posterior
9 o’clock: Right

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16
Q

Dx of anal fissures based on what?

A

Hx and physical exam

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17
Q

When are no lab tests necessary for anal fissures?

A

If anal fissure is located in the posterior and anterior midline

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18
Q

If atypical lateral/off-midline fissures occur with suspicion of underlying conditions, which tests should be ordered?

A

ESR, Stool/viral cultures, HIV testing, Bx of lesion/fissure as warranted

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19
Q

Conservative treatment of anal fissures promotes what?

A

Effortless and painless bowel movements

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20
Q

Conservative tx for anal fissures?

A

High fiber diet/fiber supplements, stool softeners/laxatives, increased fluid intake, sitz baths for relief, topical anesthetics for sx relief, topical vasodilators

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21
Q

Topical anesthetics for conservative tx of anal fissures?

A

5% lidocaine, 2.5% lidocaine + 2.5% prilocaine
(sx relief)

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22
Q

Topical vasodilators for conservative tx of anal fissures?

A

0.4% nitroglycerin ointment, 2% diltiazem ointment, or 0.5% nifedipine ointment 2-3x/day x 4 weeks
*to the internal sphincter for healing

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23
Q

If symptoms of anal fissures continue after conservative treatment, what should be done?

A

Re-evaluate and continue w/ 4 more weeks of conservative tx

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24
Q

What should be performed if anal fissure sx continue after 8 weeks of conservative tx?

A

Endoscopy to exclude Crohn’s
If IBD is excluded: refer to colorectal surgeon

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25
Q

When is lateral internal sphincterectomy indicated when conservative tx is unsuccessful for anal fissures?

A

If patient has low risk of fecal incontinence

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26
Q

What is recommended for patients with high fecal incontinence risk when conservative tx for anal fissures fails?

A

Outpatient procedure w/ injection of botox (20 units) into internal anal sphincter to relieve spasm
or
Anal advancement flap

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27
Q

Anorectal abscess and fistulae represent what?

A

Different stages of the same anorectal infectious process

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28
Q

What is an anorectal abscess?

A

Acute manifestation of purulent infection most commonly developing from infected anal crypt gland –> 90% of cases (Anal crypts of Morgani)

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29
Q

How does an anal crypt gland become infected?

A

Gland becomes obstructed w thickened debris, permitting bacterial growth & abscess formation

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30
Q

What is a perianal fistula?

A

A tract (ductal connection) between the anorectal abscess and the anal canal or perianal skin
*chronic manifestation

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31
Q

Other causes of formation of anorectal abscesses/fistulae?

A

Crohn’s (IBD), infected anal fissures, secondary to trauma (obstetric, FB), Carcinoma, Radiation therapy, Actinomycoses bacterial infection (rare), Rectal TB, STIs (chlamydia, lymphogranuloma venerum)

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32
Q

Anorectal abscesses are a result of what?

A

Infection (aerobic and anaerobic bacteria)

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33
Q

Obstruction of anal glands by thick debris triggers what?

A

Stasis and bacterial overgrowth (E. coli, Proteus mirabilis, S. aureus) –> Abscess formation–>abscesses may extend into perirectal spaces –> possible fistula formation

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34
Q

When do anal fistulas form?

A

When abscesses ruptures/drains and forms and epithelial tract between anorectal abscess and perianal skin or rectum

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35
Q

Extension of anal abscess/fistula infection can involve what areas?

A

Intersphincteric, ischiorectal, or even supralevator space

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36
Q

The _______ and _______ of abscesses can vary

A

Severity and depth

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37
Q

Major types of anorectal abscesses are based according to what?

A

Anatomical location

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38
Q

Major types of anorectal abscesses?

A
  1. Perianal (MC)
  2. Ischiorectal (ischioanal)
  3. Intersphincteric (in between internal/external sphincters)
  4. Supralevator
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39
Q

What are the 4 types of fistula tracts (Parks’s Classification)?

A

I. Intersphinctereric fistula (MC)
II. Transsphincteric fistula
III. Suprasphincteric fistula
IV. Extrasphincteric fistula

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40
Q

Clinical manifestations of perianal abscesses?

A

Throbbing, continuous pain around the anus, erythematous palpable mass near anus, rectal pain worse w/ sitting/coughing/defecation, +/- fever

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41
Q

Clinical manifestations of perirectal (deeper) abscesses?

A

Buttock or coccyx pain, fever/chills more likely, rectal pain worse w/ sitting/coughing/defecation

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42
Q

Physical external exam in perianal regions for anorectal abscesses may have what characteristics?

A

Localized tenderness, erythema/warmth, swelling, fluctuant mass, purulent discharge if abscess is draining

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43
Q

Physical exam of deeper anorectal abscesses may cause what?

A

DRE showing rectal fullness/palpable mass, Boggy area of tenderness/fluctuance, EUA if clinical exam cannot be performed in office

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44
Q

Clinical manifestations of anal fistulae?

A

Perianal/anal canal discharge (bloody, purulent, malodorous/smelly), painful defecation, anal itching/pruritus

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45
Q

Physical exam of anal fistulae may show what?

A

Perianal skin may be excoriated/inflamed, external opening may be visualized or palpated as indurated just below skin, external opening may be inflamed/tender/draining fluid, palpable cord leading from external opening to anal canal

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46
Q

What is a EUA?

A

Exam performed under anesthesia

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47
Q

What does EUA avoid?

A

Probing in the office

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48
Q

Process of EUA?

A

Injection of H2O2 or povidone iodine allowing for visualization of bubbles at internal opening of anal fistulas

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49
Q

EUA must be done for anal fistulas before what?

A

Any surgical intervention

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50
Q

Digital rectal exam for anal fistulas hold what purpose?

A

Check sphincter tone before surgical intervention (for both abscess & fistulae), internal opening may be palpated in some cases

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51
Q

Anoscopy for anal fisulas allows for viewing of what?

A

Internal opening in the anus (but EUA often necessary)

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52
Q

Proctosigmoidoscopy inspection can be used to inspect for what with anal fistulas?

A

Underlying disease processes, can view opening in the rectum

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53
Q

If the anorectal abscess is deep, and cannot be palpated, then what imaging can be used to confirm dx?

A

CT of pelvis, Endorectal US, MRI of pelvis

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54
Q

Preferred imaging for fistula tract and extent of anal sphincter involvement?

A

MRI of pelvis w/ and w/o contrast and endosonography

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55
Q

Other indications for MRI of pelvis w/ and w/o contrast and endosonography?

A

If primary opening hard to find, recurrent fistulas, complex fistulas, esp. if associated w perianal Crohn’s

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56
Q

What test can be used to determine other pathology (malignancy, IBD) related to anorectal abscess symptoms?

A

Colonoscopy

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57
Q

DDX for anorectal pain and perirectal skin lesions?

A

Hemorrhoids (thrombosed), anal fistulas, anal fissures, IBD, rectal prolapse, Acute proctitis (STDs), Anal abscesses, Hidradenitis suppurativa, infected inclusion cysts, pilodonal cyst, Bartholin gland abscess in females

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58
Q

Treatment of acute perianal abscess requires what?

A

Incision and drainage (I&D)

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59
Q

I&D for simple perianal abscesses?

A

May be treated in ED under local anesthesia

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60
Q

I&D for complex perianal abscesses?

A

By a surgeon in the OR under general anesthesia

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61
Q

Which perirectal abscesses should be referred to surgical service for I&D?

A

Ischiorectal, intersphincteric, supralevator

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62
Q

American Society of Colorectal Surgery guidelines suggest what for the role of abx for anorectal abscesses?

A

A course of empiric abx after I&D ONLY in patients with: Systemic infection/sepsis, Extensive perianal/perineal cellulitis, Diabetes, Immunosuppression, Heart valve abnormalities/prostheses

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63
Q

UpToDate suggestion for abx follwing I&D of anorectal abscesses?

A

Course of empiric abx for ALL patients after I&D (evidence that such may reduce rate of fistula formation)

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64
Q

What is Goodsall’s rule for surgical planning of anorectal fistulas?

A

-All fistula tracks w/ external openings within 3cm of anal verge and posterior to a line drawn through the ischial spines travel in a curvilinear fashion to the posterior midline
-All tracks w/ external openings anterior to this line enter the anal canal in a radial fashion
-line of demarcation is depicted as transverse anal line

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65
Q

Do fistula tracks longer than 3 cm from the anal verge necessarily follow Goodsall’s rule?

A

No, often have an internal opening in the posterior midline regardless of the location of the external opening

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66
Q

If Crohn disease of the perineum is present w/ multiple or complex fistulas, what tx is required?

A

Surgical tx + additional management with Abx & immunosuppressants

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67
Q

Surgical incision or excision of anal fistulae is indicated for which cases?

A

Symptomatic cases

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68
Q

Standard surgical treatment for symptomatic anal fistulae?

A

Fistulotomy/Fistulectomy

69
Q

Other surgical interventions for symptomatic anal fistulae?

A

Seton placement, Fibrin glue injection, Fistula plug, Colostomy, Endorectal mucosal advancement flap, LIFT procedure

70
Q

What is the postoperative WASH regimen post I&D or surgical procedure for anorectal fistulae/abscesses?

A

Warm water/cleansing sitz baths
Analgesics
Stool softeners
High fiber diet/bulking agents (bran, psyllium, metamucil)

71
Q

What is a pilonidal cyst?

A

Abscess in the sacrococcygeal cleft associated w/ subsequent sinus tract development

72
Q

Pilonidal cysts are uncommon in what ages?

A

Individuals under 40

73
Q

Cause of pilonidal cysts?

A

Ingrown hair (one of the MC causes)

74
Q

Risk factors for pilonidal cysts?

A

Male sex (4x more likely than females), Hirsute individuals, Obese individuals, Family hx

75
Q

Signs and symptoms of pilonidal abscesses?

A

Painful/swollen fluctuant area ar sacrococcygeal cleft about 4-5 cm posterior to anal orifice, +/- loose hair projecting from site, +/- spontaneous purulent mucoid or bloody drainage, Afebrile

76
Q

Treatment for pilonidal abscesses?

A

Surgery: I&D preferred, complete excision if recurrent/chronic
*possible abx if cellulitis is present

77
Q

What is perianal pruritus?

A

Perianal itching and discomfort

78
Q

Causes of perianal pruritus?

A

Poor anal hygiene, overzealous cleansing w/ soaps, topical irritants from soap/laundry detergent (contact derm), skin conditions (psoriasis, paget’s, liche sclerosis, atopic derm), Bacterial infection, Parasites (pinworms, scabies), Candidal infections (DM), STDs

79
Q

Signs and symptoms of perianal pruritus?

A

Perianal itching, erythema, excoriations, lichenified eczematous skin

80
Q

Tx for perianal pruritus?

A

-Diet: avoid spicy, chocolate, coffee, tomatoes
-Avoid perfumes
-After BMs: wash w/ unscented pre-moistened wipes or warm water w/o soap, pat gently
-Tuck a piece of cotton ball to anal opening to absorb perspiration/fecal seepage
-High potency topical corticosteroid
-Tx underlying cause

81
Q

Definition of Hemorrhoids (piles)?

A

Engorgement of venous plexus in anal canal (swollen BV in anus and lower rectum)

82
Q

How many people in the US affected by hemorrhoids?

A

10 million+

83
Q

What gender is more likely to seek treatment for hemorrhoids?

A

Male

84
Q

Which hemorrhoids occur more commonly occur in young and middle aged adults?

A

External hemorrhoids

85
Q

Prevalence of hemorrhoids increases with what?

A

Age

86
Q

Are hemorrhoids common in pregnancy?

A

Yes

87
Q

Causes of hemorrhoids?

A

-Higher intra-abdominal pressure (pregnancy, ascites, portal HTN, obesity, heavy lifting)
-Constipation, straining, diarrhea, coughing
-Low fiber diet
-Alcoholism
-Anal sex/trauma
-Standing/sitting for prolonged time periods
-Aging

88
Q

How does aging cause hemorrhoids?

A

Weakening of the support structures leads to prolapse

89
Q

Where are internal hemorrhoids located?

A

Above the dentate (pectinate) line

90
Q

Where are external hemorrhoids located?

A

Below the dentate (pectinate) line

91
Q

Where do internal hemorrhoids originate?

A

Superior hemorrhoid plexus

92
Q

Where do external hemorrhoids originate?

A

Inferior hemorrhoidal plexus

93
Q

How do internal hemorrhoids develop?

A

Develop from endoderm, covered with columnar epithelium of anal mucosa

94
Q

How do external hemorrhoids develop?

A

Develop from ectoderm, covered by squamous epithelium

95
Q

What are mixed hemorrhoids?

A

Combined internal and external hemorrhoids

96
Q

Internal hemorrhoids have how many main venous cushions?

A

3

97
Q

Common positions of internal hemorrhoids (when patient is in lithotomy position)?

A

L lateral (3 o’clock), R anterior (11 o’clock), R posterior (7 o’clock)

98
Q

Stage 1 of internal hemorrhoid prolapse?

A

Occasional bleeding only, no prolapse below dentate line, confined to anal canal

99
Q

Stage 2 of internal hemorrhoid prolapse?

A

Prolapse out of anal canal with defecation but spontaneously reduces, bleeding, seepage

100
Q

Stage 3 of internal hemorrhoid prolapse?

A

Prolapses but needs to be replaced manually, bleeding, seepage

101
Q

Stage 4 of internal hemorrhoid prolapse?

A

Permanent prolapse that cannot be reduced, may strangulate

102
Q

Signs and symptoms of internal hemorrhoids?

A

Usually painless unless extensive inflammation, intermittent bright red rectal bleeding w/ defecation (on TP, dripping in bowl, coating stool), rectul fullness/discomfort, pruritus ani (itch), mucus discharge
May prolapse into anal canal/cause pain w/ increased size

103
Q

Signs and symptoms of external hemorrhoids?

A

Perianal pain aggravated by defecation, usually do not bleed, +/- tender palpable mass around anus, may have skin tags, Thrombosis (perianal hematoma) may develop/cause significant pain

104
Q

What is a perianal hematoma?

A

Thrombosis of the external hemorrhoidal plexus (contains blood clot)

105
Q

What is a perianal hematoma precipitated by?

A

Coughing, heavy lifting, straining

106
Q

Onset of perianal hematoma?

A

Acute onset w/ severe pain
*pain most severe w/in first few hours and subsides over 2-3 days

107
Q

Perianal hematoma examination?

A

Palpable, tender, dark red to purple nodule at anal verge/just within anal canal

108
Q

Perianal hematoma may leave what?

A

Skin tags

109
Q

Visual inspection for dx of hemorrhoids?

A

Left lateral decubitus w/ patient’s knee flexed toward chest
-examine entire perianal area, gently spread buttocks for easy visualization

110
Q

DRE for dx of hemorrhoids?

A

Checks for induration/ulcerated areas, masses, tenderness, discharge, rectal tone

111
Q

Are internal hemorrhoids usually palpable on DRE?

A

Not usually palpable (unless dilitated/enlarged), soft vascular structures

112
Q

Anoscopy is useful for examining which type of hemorrhoid?

A

Internal

113
Q

Proctosigmoidoscopy or colonoscopy for hemmorrhoids is indicated for what?

A

Evaluate for any bright red bleeding, inconclusive initial eval, concern for malignancy

114
Q

DDX for hemorrhoids?

A

Anorectal fistula, Anorectal fissures, Rectal abscess, Colorectal cancer/neoplasm, Anal warts, Rectal prolapse, Rectal polyps, IBD (UC & Crohns)

115
Q

Lifestyle modifications recommended for all patients with hemorrhoids?

A

Dietary and education on defecation habits to reduce strain
-High fiber, avoid fatty foods, inc. fluid intake, regular physical activity, avoid excessive strain, limit time spent on toilet

116
Q

Conservative treatment for hemorrhoids (initial management)?

A

Sitz baths, Stool softeners (ex. docusate) or laxatives (ex. Miralax) prn, topical creams/ointments/foams (topical anesthetics: lidocaine, steroids: hydrocortisone)

117
Q

When are non-surgical procedures indicated for hemorrhoids?

A

Stage 1-3 internal hemorrhoids unresponsive to conservative tx

118
Q

Non-surgical procedures for stage 1-3 internal hemorrhoids unresponsive to conservative tx?

A

Injection sclerotherapy, infrared coagulation, rubber band ligation*

119
Q

When is surgery indicated for hemorrhoids?

A

Stage 4 hemorrhoids with chronic bleeding, thrombosis, strangulation, gangrene, and those unresponsive to medical and conservative tx

120
Q

Surgicial options for stage 4 internal hemorrhoids?

A

Hemorrhoidectomy (open/closed), Stapled hemorrhoidectomy

121
Q

Treatment for external hemorrhoids?

A

Conservative tx
If symptomatic and refractory to conservative tx: refer to surgery

122
Q

Treatment for thrombosed external hemorrhoids?

A

-Excision within 48-72 hours of sx onset
-Delayed presentation (>72 hours): conservative management

123
Q

Conservative management for thrombosed external hemorrhoids?

A

-Analgesia: warm sitz baths, antispasmodic agents (topical nitroglycerin, nifedipine), analgesic creams (lidocaine)
-Topical anti-inflammatories: Hydrocortisone cream
-Improve passage of stool w/ stool softeners (docusate), increased fluid/fiber intake

124
Q

Definition of rectal prolapse?

A

Medical condition where walls of rectum have lost their attachments and protrude through anus/become visible outside the body

125
Q

3 types of rectal prolapse?

A

Full thickness **MC, Mucosal prolapse/partial prolapse, Internal prolapse (internal intussusception)

126
Q

What is a full thickness rectal prolapse?

A

Entire rectum (all layers) protrude through anus manifesting as concentric rings/folds of rectal mucosa **MC type

127
Q

What is a mucosal prolapse/partial prolapse?

A

Only the rectal mucosa (not entire wall) prolapses, radial folds in the mucosa

128
Q

What is an internal prolapse (internal intussusception)?

A

Rectal wall collapses but does not exit the anus, “telescoping” of the bowel on itself internally

129
Q

Are rectal prolapses common?

A

No

130
Q

80-90% of rectal prolapses happen in which gender?

A

Female

131
Q

Peaks of rectal prolapse happens in which decades of life?

A

4th and 7th decades

132
Q

Causes of rectal prolapse?

A

Weakness of pelvis floor muscles and ligaments that hold the rectum in place

133
Q

Causes of weakness in pelvic floor leading to rectal prolapse?

A

Age >40, chronic straining/constipation/diarrhea, pregnancy (muliparous), vaginal delivery, previous pelvic surgery, cytsic fibrosis (kids), COPD/chronic cough, anal sex, neurolgic disorders (dementia, stroke), pelvid floor defects (rectocele, cytocele)

134
Q

Signs and symptoms of rectal prolapse?

A

Painless mass protruding through anus, pain not a typical presenting feature (suggests another dx), +/- rectal bleeding, possible associated uterine/bladder prolapse or cystocele, possible constipation/diarrhea/fecal incontinence

135
Q

Rectal prolapse progression characteristics?

A

Initially produces after BM (usually retracts w/ standing), as dz progresses: mass protrudes more often (w/ straining, valsalva, sneezing, coughing), Eventually will prolapse with daily activities (walking) and does not retract (must be manually replaced), May progress even further to continuous prolapse immediately after manual replacement

136
Q

Examination of peritoneum for rectal prolapse exam?

A

Should be examined w/ pt squatting or straining

137
Q

Physical signs of rectal prolapse include what?

A

Protruding rectal mucosa, thick concentric mucosal ring in complete prolapse (stacked coin appearance), radial mucosal folds in mucosal prolapse, Sulcus (groove) between walls of anal canal & rectum (emerging mass), possible solitary rectal ulcer on prolapse, dec. anal sphincter tone w/ DRE

138
Q

DDX for rectal prolapse?

A

Hemorrhoids, intussusception, proctitis

139
Q

Rectal prolapse is primarily what kind of dx?

A

Clinical

140
Q

What can be used to differentiate between full thickness & mucosal rectal prolapse when dx is unclear from exam alone?

A

Video defecography

141
Q

What should be performed with anal prolapse before any surgical therapy to rule out malignancy?

A

Colonoscopy or proctoscopy

142
Q

What test should be done for rectal prolapse if fecal incontinence is present?

A

Anal-rectal manometry to assess sphincter function

143
Q

What test should be done for rectal prolapse if rectal ulcer is present?

A

Biopsy

144
Q

What test should be done for rectal prolapse if pelvic floor weakness is present?

A

Dynamic pelvic floor MRI

145
Q

What test should be done for rectal prolapse present in children to rule out cystic fibrosis?

A

Sweat chloride test

146
Q

A prolapsed rectum can be reduced with what?

A

Gentle digital pressure

147
Q

Tx of rectal prolapse in adults?

A

Surgery

148
Q

Maneuvers to help reduce prolapse include what?

A

Sedation, field block w/ local anesthetic, reduction of edema by applying sugar or salt, reduction and confirmation w/ DRE, covering perineum with tight pad to prevent recurrence

149
Q

Tx of rectal prolapse in children?

A

Nonsurgical tx by managing underlying condition and performing manual reduction if spontaneous reduction does not occur

150
Q

Tx for rectal prolapse in patients w/ comorbidites that preclude sugery or patients that refuse surgery?

A

Medical management: adequate fluid intake, high fiber food/supplements, enemas or suppositories for constipation if present, biofeedback or pelvic floor exercises (kegels) to alleviate sx

151
Q

Fecal incontinence includes involuntary loss of what?

A

Solid or liquid stool, gas

152
Q

What is true anal incontinence?

A

Loss of anal sphincter control leading to inability to control passage of stool or gas (flatus)

153
Q

What is fecal urge incontinence?

A

Incontinence that occurs despite awareness and active effort to retain stool suggesting sphincteric damage

154
Q

Causes of sphincteral damage in fecal urge incontinence?

A

Childbirth, rectal prolapse, prior pelvic radiation, episiotomy, prior anal surgery, physical trauma

155
Q

What is passive fecal incontinence?

A

Incontinence that occurs without awareness from loss of central awareness or peripheral nerve injury

156
Q

Loss of central awareness causes for passive fecal incontinence?

A

Dementia, CVA, MS

157
Q

Peripheral nerve injury causes for passive fecal incontinence?

A

Spinal cord injury, Cauda equine syndrome, pudenal nerve injury, aging, diabetes

158
Q

Important history inquiry for fecal incontinence?

A

Surgical and obstetric hx, hx of Dm or neurologic dz, hx of hemorrhoids or rectal prolapse

159
Q

Clinical features of fecal incontinence?

A

Chronic or recurring fecal leakage with possible flatus, abdominal discomfort, bloating

160
Q

Physical exam for fecal incontinence?

A

Abdominal exam for masses, perianal inspection for hemorrhoids/prolapse/fistulae/fissures, Check anocutaneous “Wink” reflex is intact, DRE for rectal masses and rectal tone, anoscopy for eval of possible hemorrhoids/fissures/fistulas

161
Q

Lab studies for fecal incontinence?

A

Stool tests, endoscopy, anorectal manometry, balloon expulsion test, other studies if indicated

162
Q

When are stool studies indicated for fecal incontinence?

A

pts with diarrhea to assess for underlying pathogen

163
Q

What type of endoscopy is indicated for fecal incontinence in pts </=40 and w/ average risk for colon cancer?

A

flexible sigmoidoscopy to exclude mucosal inflammation/masses

164
Q

What type of endoscopy is indicated for fecal incontinence in pts >40 w/ persistent or chronic diarrhea or risk for colon cancer or IBD?

A

Colonoscopy

165
Q

1st diagnostic test for fecal incontinence to assess for functional sphincter weakness?

A

Anorectal manometry

166
Q

What test is performed to diagnose refractory cases of fecal incontinence?

A

Balloon expulsion test
Possible Barium or MRI defecography

167
Q

What test is performed if structural abnormalities of anal sphincters are present in fecal incontinence?

A

Endorectal US or MR imaging

168
Q

Slide 67

A

ClinMed II Exam #4 GI (7 decks)

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