Anorectal Disorders Flashcards
anorectal anatomy
*internal sphincter
*external sphincter
*perianal spaces
perianal spaces
*intersphincteric space
*perianal space
*ischioanal space
*supralevator space
anal suppurative diseases - etiology
*obstruction, then infection of anal glands (cryptoglandular)
*process invades structures external to anal canal
*extent of invasion dictates site of abscess
anal suppurative disease - perianal abscess
*invasion into intersphincteric plane, then down to skin
*presents at anal verge
anal suppurative disease - ischioanal abscess
*invasion through sphincter into ischioanal fossa
*presents further from anal verge
*deeper
*aka perirectal abscess (inaccurate)
anal suppurative disease - supralevator abscess
*invasion upward above sphincter
*no obvious outward presentation
anal suppurative disease - intersphincteric abscess
*invasion just into intersphincteric groove
*pain in anal canal, no outward presentation
ED management of perianal abscess
*easily drained in ambulatory setting
*wick for few days
*follow-up within few days
*education
fistula en ano
*a connection from the outside to the inside that results after/was created by an abscess but persists due to epithelialization of the tract
hemorrhoids
*submucosal arteriovenous connection
*normal “vascular cushion” in all humans (we all have them)
*when pathologic:
-bleed (arterial in nature)
-prolapse
-cause pain only if ACUTELY THROMBOSED
treatment algorithm for hemorrhoids
*1st degree: stool bulking, occasionally banding
*2nd degree: stool bulking, banding (also sclerotherapy, laser, cryo, infrared photocoagulation)
*3rd and 4th degree: operative hemorrhoidectomy
thrombosed external hemorrhoid
*ED emergency
*excision, not incision, is best therapy:
-most effective if done in first 48-72 hrs
-less persistent pain, bleeding
-more complete resolution of tag
acute fissures
*simple linear ulcer
*granulation base
*like a split or tear in the anus
chronic fissures
*thickened, rolled edges
*exposed internal sphincter
*sentinel tag and/or hypertrophied papilla
etiology of anal fissures
*increased pressure in the anal canal leads to less delivery of blood to the posterior & anterior aspects of the anus
*overall increased tone may lead to ischemia