Anorectal Disorders Flashcards

1
Q

anorectal anatomy

A

*internal sphincter
*external sphincter
*perianal spaces

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2
Q

perianal spaces

A

*intersphincteric space
*perianal space
*ischioanal space
*supralevator space

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3
Q

anal suppurative diseases - etiology

A

*obstruction, then infection of anal glands (cryptoglandular)
*process invades structures external to anal canal
*extent of invasion dictates site of abscess

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4
Q

anal suppurative disease - perianal abscess

A

*invasion into intersphincteric plane, then down to skin
*presents at anal verge

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5
Q

anal suppurative disease - ischioanal abscess

A

*invasion through sphincter into ischioanal fossa
*presents further from anal verge
*deeper
*aka perirectal abscess (inaccurate)

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6
Q

anal suppurative disease - supralevator abscess

A

*invasion upward above sphincter
*no obvious outward presentation

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7
Q

anal suppurative disease - intersphincteric abscess

A

*invasion just into intersphincteric groove
*pain in anal canal, no outward presentation

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8
Q

ED management of perianal abscess

A

*easily drained in ambulatory setting
*wick for few days
*follow-up within few days
*education

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9
Q

fistula en ano

A

*a connection from the outside to the inside that results after/was created by an abscess but persists due to epithelialization of the tract

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10
Q

hemorrhoids

A

*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

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11
Q

treatment algorithm for hemorrhoids

A

*1st degree: stool bulking, occasionally banding
*2nd degree: stool bulking, banding (also sclerotherapy, laser, cryo, infrared photocoagulation)
*3rd and 4th degree: operative hemorrhoidectomy

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12
Q

thrombosed external hemorrhoid

A

*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

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13
Q

acute fissures

A

*simple linear ulcer
*granulation base
*like a split or tear in the anus

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14
Q

chronic fissures

A

*thickened, rolled edges
*exposed internal sphincter
*sentinel tag and/or hypertrophied papilla

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15
Q

etiology of anal fissures

A

*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

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16
Q

pharmacologic therapy for anal fissures

A

*nitric oxide
*botox injections
*surgical = lateral internal sphincterotomy

17
Q

anal cancer - 2 classifications by location

A
  1. anal margin: perianal skin cancer
    -treatment similar to other body locations (i.e. excision)
  2. anal canal: above anal verge, up to anorectal ring
    -tx: combined chemo/radiation
    -surgery reserved for failures of above
18
Q

epidemiology of anal cancer

A

*relative risk for HIV infected persons is extremely higher risk
*older female & younger male prevalence
*risk factors: HPV, hx of anoreceptive intercourse, hx of STD, > 10 sexual partners, hx of cervical, vaginal, vulvar cancer, immunosuppression after transplantation

19
Q

condyloma acuminata

A

*HPV-related
*warty growths
*can be external, internal, or both
*more common in AIDS patients/immunosuppressed individuals