Benign anorectal disease Flashcards
what is dentate/pectinate line
transition from colonic mucosa to squamous mucosa of the anus
what is hintons line
change from squamous mucosa of the anus to the perianal skin
symptoms of perianal disease
- bleeding
- pattern change in BMs
pain protruding mass on straining seepage and soilage straining urgency incomplete evacuation itching
signs of perianal disease
*mass tenderness fluctuance erythema discharge anal tone/squeeze prolapse
how should yo evaluate patients with anorectal complaints
all should undergo some time of proctosigmoioscopy at some point during eval and treatment
rule out proximal malignancy
what are you looking for on anal palpation/exam
inspect anal argin and perianal margin
ID lesions/tags/hemorrhoids
ID rectal/pelvic masses, fistulae, abscesses
assess anal tone and squeeze
eval prostate
which is better for anal disease–CT or MRI
MRI though its less accessible
what causes hemorrhoids
hemorrhoidal tissue –> vascular cushions that are supposed to help reduce trauma to anal canal during defectation
increased intraabdominal pressure
pregnancy
constipation
weight lifting
chronic straining
what are external hemorrhoids
distal to dentate line
squamous epithelium, skin
have nerve endings and thus are PAINFUL
what are internal hemorrhoids
proximal to dentate line
columnar epithelium/mucosa
no nerve endings… PAINLESS
grade I hemorrhoid
no prolapsing
grade II hemorrhoid
spontaneously reduces
grade III hemorrhoid
reduce manually
grade IV hemorrhoid
irreducible
how do you do a physical exam for hemorrhoids
prep with fleet enema
position in left lateral decubitus
perianal inspection–> do valsalva to cause prolapse
DRE
anoscopy
what is the difference between hemorrhoids and anal prolapse
prolapse is a circumferential invagination of the bowel lining whereas hemorrhoids are the vascular cushions
conservative therapy for internal hemorrhoids
**works for vast majority of people
high fibre diet (25-30 g/day)
plenty of fluids
stool lubricants
no reading on toilet
minimize straining
sitz bath
indications for surgical tx of hemorrhoids
failure of conservative measures
continues symptoms-- bleeding protrusion pruritis/irritaiton seepage and soilage difficulty with hygiene
surgical procedures for internal hemorrhoids
excisional hemorrhoidectomy
stapled anoplexy
officed based procedures for internal hemorrhoids
rubber band ligation–over time the hemorrhoid becomes ischemic and resolves/scars
injection sclerotherapy–try to get it to fibrose
infrared coagulation
symptomatic relief of external hemorrhoids
sitz bath
stool softeners
pain meds
excision
thrombectomy if within 48-72 hours
where are anal fissures found
distal to dentate line
causes of anal fissures
trauma–large stool, diarrhea
hypertonic/hyperspastic internal sphincter
diminished blood flow/ischemia (inability to heal)
symptoms of anal fissure
pain
spasm
bleeding
seepage/soilage
difficult evacuation
