Anorectal/ peritoneal disorders

Question 1

Pruritis ani- Eti

Answer 1

• Due to local disease, lichen simplex, psoriasis, hemorrhoids, irritating secretions
• 1/3 due to nerve root impingements

Question 2

Pruritis ani- Sx

Answer 2

• Nocturnal itching in anogenital area

- Fissures, erythema, maceration, lichenification & excoriations may be present

Question 3

Pruritis ani- Dx

Answer 3

• Determine root cause: DM, tissue scrapings, pinworms, nerve root impingement

Question 4

Pruritis ani- Tx

Answer 4

• Pramoxine cream

- Cleaning pads

Question 5

Hemorrhoids-

Answer 5

• Internal- subepithelal vascular cushions of CT, sm much and rectal arteries & veins
• External- inferior hemrrhoidal veins
• Due to straining, constipation, sitting, obesity, fiber, pregnant

Question 6

Hemorrhoids- Sx

Answer 6

• Bright red blood per recturm
• Mucoid discharge
• Protuberant purple nodules
• External: Painful, visible, fistulas, fissures, tags
• Internal: pain unusual, may eventually protrude`

Question 7

Hemorrhoids- Dx

Answer 7

• Anoscopy

Question 8

Hemorrhoids- Tx

Answer 8

• Excision for stage IV
• Rubber band ligation
• Increase fiber, fluids, sitz baths, analgesics

Question 9

Fecal incontinence- Eti

Answer 9

• 10% elderly

- Due to collitis, local anal problems, obstetric trauma, spinal cord injury

Question 10

Fecal incontinence- Sx

Answer 10

• Incontinence of stool

Question 11

Fecal incontinence- Dx

Answer 11

• Confirm anocutaneous reflex
• DRE
• Anoscopt & sigmoidoscopy

Question 12

Fecal incontinence- Tx

Answer 12

• Fiber, bulking agents, antidiarrheals

- Sphincter exercises

Question 13

Rectal prolapse- Eti

Answer 13

• Protrusion of anus through rectum

Question 14

Rectal prolapse- Sx

Answer 14

• Prolapse reduces after defecation

- Progresses- mucous discharge, bleeding, incontinence, spincteric damage

Question 15

Rectal prolapse- Tx

Answer 15

Surgical correction

Question 16

Fissure in ano- Eti

Answer 16

• Trauma during defecation

- Straining, constipation or high sphincter tone

Question 17

Fissure in ano- Sx

Answer 17

Linear or rocket shaped ulcer

• <5 mm in length
• Severe tearing pain during defecation
• Hematochezia

Question 18

Fissure in ano- Tx

Answer 18

• Promote effortless BMs
• Fiber, sitz baths
• Topical anesthetics

Question 19

Perirectal abscess- Eti

Answer 19

• Infection of anal crypts

- Anal fissure or chrons

Question 20

Perirectal abscess- Sx

Answer 20

Throbbing, continuous perianal pain

- Erythema, flatuance, swelling

Question 21

Perirectal abscess- Tx

Answer 21

Incision & drainage

Question 22

Spontaneous bacterial peritonitis- Eti

Answer 22

• Hx of liver disease & ascites
• 20-30% cirrhotic pts
• Gram negatives- E. coli, klebsiella

Question 23

Spontaneous bacterial peritonitis- Sx

Answer 23

• Fever & abd pain
• Change in mental status
• Signs of chronic liver disease
• Abd tenderness

Question 24

Spontaneous bacterial peritonitis- Dx

Answer 24

• Ascitic fluid eval- WBCs, cultures

- CT

Question 25

Spontaneous bacterial peritonitis- Tx

Answer 25

• Thrid generation cefelosporin- ceftriaxone

Question 26

Ascites- Eti

Answer 26

• 80% due to portal HTN secondary to liver disease

- Pathologic accumulation of fluid in peritoneal cavity

Question 27

Ascites- Sx

Answer 27

• Increasing abd girth
• Abd pain
• Cephalad flow of abd veins
• Asterixis

Question 28

Ascites- Dx

Answer 28

• Abd paracentesis
• Phys exam
• US/ CT

Question 29

Ascites- Tx

Answer 29

• Diuretics
• Reduce sodium
• Large volume paracentesis

Question 30

Malignant ascites- Eti

Answer 30

• 2/3 due to Peritoneal carcinomatosis
• Adenocarcinoma of ovary, uterus, pancreas, stomach, colon
• Lymph obstruction or portal HTN

Question 31

Malignant ascites- Sx

Answer 31

• Wt loss associated with increased abd girth

- abd discomfort

Question 32

Malignant ascites- Dx

Answer 32

• Paracentesis

- Laproscopy

Question 33

Malignant ascites- Tx

Answer 33

• Paracentesis
• Indwelling catheter
• Intraperitoneal chemo