Anus, Prostate, Rectum Flashcards
Risk factors: Prostate CA
>50 Black North American/Northern European Family history BRCA1,2 High fat diet Exposure of prostate to high levels of androgens Physical inactivity
Risk factors: Anal CA
HPV Black Multiple sex partners Cigarettes Immonsuppression
Intermittent pencil-like stools
Spasmodic contraction of rectum
Persistent pencil-like stools
Malignancy
Thin stools
Lower rectal stricture
Small flecks of bloodstained mucus in liquid feces
Amebiasis
Fatty stools
Pancreatic disorders, malabsorption syndromes (cystic fibrosis)
Stools the color of aluminum
Mixture of melena and fat
Tropical sprue
Carcinoma of hepatopancreatic ampulla
Children treated with sulfonamides for diarrhea
Causes of rectal bleeding
Anal fissures Anaphylactoid purpura Aspirin Bleeding disorders Coagulation disorders Colitis Dysentery Esophageal varices Familial talangiectasia Foreign body trauma Hemorrhoids Hiatal hernia Hookwork Intussusception Iron poisoning Meckel diverticulum Neoplasms Oral steroids Peptic ulcers Polyps Regional enteritis Strangulated hernia Swallowed blood Thrombocytopenia Volvulus
Hemorrhoids in children
Rare
Portal hypertension
Pilonidal cyst
Cyst or sinus near cleft of buttocks
Loose hair penetrates skin in sacrococcygeal area or trauma causes a local inflammatory reaction and cyst formation
Asymptomatic or pain with sitting
Anal warts (Condyloma acuminita)
Result of HPV, considered an STI
May be unaware
Pearly, filiform, fighting (ulcerating or necrotic) cauliflower or plaque-like
Perianal and perirectal abscess
Infection of anal tissue or glands
Perianal: Infection of soft tissues surrounding the anal canal, forms a discrete abscess cavity
Perirectal: infection of mucus-secreting anal glands, drain into anal crypts; abscess formation in deeper tissues; indurated, fluctuant, draining
Pain, tenderness, fever, pain on defecation
R/F: Chrohn, immunosupression
Anorectal fissure
Tear in the anal mucosa following passage of large, hard stools
Internal sphincter is spastic
May have sentinel skin tag
Anal fistula
Inflammatory tract, runs from anus or rectum and opens onto surface of perianal skin or other tissue
Chills, fever, N/V, malaise
External opening pink, red, elevated
Palpable indurated tract maybe present on digital rectal examination
Serosanguinous or purulent drainage
Pruritis ani
Itching
Fungal infection in children
Excoriation, thickening, pigmentation of anal and perianal tissue
Hemorrhoids
Swollen veins in lower portion of rectum or anus
External - varicose veins originate below anorectal line and are covered by anal skin
Internal - varicose veins that originate above anorectal junction and are covered by rectal mucosa
Pressure on veins from straining, diarrhea, constipation, prolonged sitting, pregnancy
Thrombosed hemorrhoids - blue, shiny masses at the anus
Internal are not visible unless they prolapse
Polyps
Abnormal growth of tissue projecting from mucous membrane
Anywhere in intestinal tract
Malignant or benign
Asymptomatic or rectal bleeding
May protrude through rectum (prolapse)
Soft nodules may be stalk-like or adhere to wall
Colonoscopy or proctoscopy with biopsy is required to diagnose
Anal CA
CA of anal skin, mucosa, or glands
Sqamous cell carcinoma, associated with HPV
15% adenocarcinomas originate in glands near anus
Remainder are basal cell and malignant melanoma
Asymptomatic or anal/rectal bleeding, pain, pressure, itching, lump near anus, constipation, diarrhea, thin stools
Raised erythematous mucosa, white scaling mucosa, mucusal ulceration, verrucous lesion
Colorectal CA
CA of large intestine or rectum
Mostly adenocarcinomas
Commonly have bleeding, change in bowel habits, abdominal pain, or asymptomatic
Feel sessile polypod mass with nodular raised edges and areas of ulceration
Polyps or lesions on colonoscopy or flexible sigmoidoscopy
Prostatitis
Inflammation and infection of the prostate
Acute: bacterial infection (E. Coli, Klebsiella, Proteus)
Pain, dysuria, sexual dysfunction, fever, chills, shakes
Large prostate, tender, abscess, fibrosis
Bacturia
Chronic: bacterial or non
Asymptomatic, bladder infections, frequency, low back pain
Normal or large/boggy prostate
May be STI or infection of adjacent organ or follow prostate biopsy
May have unexplained fever
BPH
Men > 50
Urinary obstruction, hesitancy, dribbling, frequency, urgency, nocturne, dysuria
Smooth, rubbery prostate
Prostate CA
99% adenocarcinomas from gland cells Slow-growing usually Symptoms of urinary obstruction Hard irregular nodule on exam Asymmetric prostate
Imperforate anus
Rectum may end blindly, stenosed, fistulous connection to perineum, urinary tract (females vagina)
Dx within first 48 hours of life
Enterobisis (Roundworm, pinworm)
Small, thin, white roundworm, Enterobius vermicularis
Emerges onto perianal skin to lay eggs while child sleeps
Intense itching, irritability
Scotch tape test: sticky side of tape against perianal folds, then press tape on a glass slide; see nematodes on slide
