Anus, Prostate, Rectum

Question 1

Risk factors: Prostate CA

Answer 1

>50
Black
North American/Northern European
Family history
BRCA1,2
High fat diet
Exposure of prostate to high levels of androgens
Physical inactivity

Question 2

Risk factors: Anal CA

Answer 2

HPV
Black
Multiple sex partners
Cigarettes 
Immonsuppression

Question 3

Intermittent pencil-like stools

Answer 3

Spasmodic contraction of rectum

Question 4

Persistent pencil-like stools

Answer 4

Malignancy

Question 5

Thin stools

Answer 5

Lower rectal stricture

Question 6

Small flecks of bloodstained mucus in liquid feces

Answer 6

Amebiasis

Question 7

Fatty stools

Answer 7

Pancreatic disorders, malabsorption syndromes (cystic fibrosis)

Question 8

Stools the color of aluminum

Answer 8

Mixture of melena and fat
Tropical sprue
Carcinoma of hepatopancreatic ampulla
Children treated with sulfonamides for diarrhea

Question 9

Causes of rectal bleeding

Answer 9

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

Question 10

Hemorrhoids in children

Answer 10

Rare

Portal hypertension

Question 11

Pilonidal cyst

Answer 11

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

Question 12

Anal warts (Condyloma acuminita)

Answer 12

Result of HPV, considered an STI
May be unaware
Pearly, filiform, fighting (ulcerating or necrotic) cauliflower or plaque-like

Question 13

Perianal and perirectal abscess

Answer 13

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

Question 14

Anorectal fissure

Answer 14

Tear in the anal mucosa following passage of large, hard stools
Internal sphincter is spastic
May have sentinel skin tag

Question 15

Anal fistula

Answer 15

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

Question 16

Pruritis ani

Answer 16

Itching
Fungal infection in children
Excoriation, thickening, pigmentation of anal and perianal tissue

Question 17

Hemorrhoids

Answer 17

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

Question 18

Polyps

Answer 18

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

Question 19

Anal CA

Answer 19

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

Question 20

Colorectal CA

Answer 20

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

Question 21

Prostatitis

Answer 21

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

Question 22

BPH

Answer 22

Men > 50
Urinary obstruction, hesitancy, dribbling, frequency, urgency, nocturne, dysuria
Smooth, rubbery prostate

Question 23

Prostate CA

Answer 23

99% adenocarcinomas from gland cells
Slow-growing usually
Symptoms of urinary obstruction
Hard irregular nodule on exam
Asymmetric prostate

Question 24

Imperforate anus

Answer 24

Rectum may end blindly, stenosed, fistulous connection to perineum, urinary tract (females vagina)
Dx within first 48 hours of life

Question 25

Enterobisis (Roundworm, pinworm)

Answer 25

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