Ch. 17 - Anorectal Disorders (Exam 3 Cut Off) Flashcards
1
Q
Anorectal Disorders
A
- Involve perianal area, anal canal, an lower rectum
- Hemorrhoids - self-treat
- Anorectal disorders - see medical professional
- Affects 45 y.o.+ more, equal between genders
2
Q
Anorectal Disorder Pathophysiology
A
- 2 epithelial tissue types separated by denate line, squamous and columnar, also delinates where sensory pain fibers are in anal canal (pain below line)
- Columns of morgagni near line have many crypts with ducts and glands, if obstructed could cause an infection
- Rectum, last part of colon, is highly vascular (3 hemorrhoid arteries/veins), semipermeable
- Above denate line = internal arteries, below = external
- Veins go directly to heart from the rectum, bypasses first pass metabolism in liver
- Hemorrhoids are a collection of large, bulging, symptomatic vessels that are inflammed
- Increased age and poor bowel habits cause muscles in hemorrhoid cushions to weaken, this allows the cushions to slide, congest, bleed, and eventually protrude
- Internal hemorrhoids originate from superior hemorrhoidal vein; columnar, lacks sensory
3
Q
Grading Hemorrhoids
A
- Done by amount of prolapse
- 1st degree: enlarged but doesn’t prolapse into anal canal
- 2nd degree: protrude and returns spontaneously upon defecation
- 3rd degree: protrudes with defecation and can be returned to original position manually
- 4th degree: permanent prolapse, can’t return into anus
- External hemorrhoids develop form inferior hemorrhoid vein below dentate line; squamous, ranges from discomfort to severe pain
- Seen as bluish lumps, possible thrombosed blood vessels
4
Q
Nonhemorrhoidal Anorectal Disorders
A
- Potentially serious
- May present hemorrhoid like symptoms
- Immediate medical referral
5
Q
FDA Symptoms for Treatable ARD
A
- Itching
- Discomfort
- Irritating
- Burning
- Soreness
- Inflammation
- Pain
- Dry anal tissue
- Perianal swelling
6
Q
FDA Symptoms of Serious ARD
A
- Abdominal pain
- Bleeding
- Seepage
- Bowel pattern change
- Prolapse
- Thrombosis
7
Q
ARD Treatment Goals
A
- Maintain soft stools to prevent strain
- Alleviate and maintain remission
- Prevent complications
8
Q
ARD General Treatment
A
- Recommend nonpharmacologics and OTC if not excluded
- Maintain adequate fluid and balanced, high fiber diet
- Good perianal hygiene
- Avoid prolonged toilet seating
9
Q
ARD Nonpharmacologics
A
- Diet modification, surgery intervention, nonoperative methods
- Avoid lifting weights, discourage foods that aggravate symptoms, increase dietary fiber
- Avoid NSAIDs and aspirin
- Dietary fiber softens stools and can help decrease complaints, improves symptom relief in 1st and 2nd degree hemorrhoids
- Increase fiber slowly to 20-30g per day, take with sufficient fluids, use supplements if needed
- Don’t ignore defecation urges, prolonged sitting, clean area after each poop with wet wipes, don’t excessively scrub
- Sitting in warm water for 10-20 minutes 2-4 times a day can debatably help with hemorrhoid pain/general relief
- Large, prolapsed hemorrhoids often require surgery
- Nonoperative - injecting sclerosing agents, rubber band ligation, cryosurgery, electrocoagulation, infared photocoagulation, and local anal hypothermia
10
Q
ARD Pharmacologic
A
- Local anesthetics, vasoconstrictors, protectants, astringents, keratolytics, analgesics, anesthetics, antipruritics, and corticosteorids are commonly used
- Astringents, protectants, and vasoconstrictors are only for internal use and require an applicator
- All other are external and not recommended for more serious symptoms
11
Q
ARD - Local Anesthetics
A
- Temporary relieve external anal symptoms by blocking nerve impulses
- Use with caution, could mask more severe pain
- May product allergic reaction indistinguishable from symptoms, use agent with completely different structure if this occurs
- Keep out of children’s reach (toxic)
- Don’t put on open sores
12
Q
ARD - Vasoconstrictors
A
- Related to EPI and Norepi.
- Stimulate alpha adrenergic receptors to cause constriction and reduce swelling
- Relieve external anal symptoms by shrinking tissue size
- Ephedrine sulfate and phenylephrine HCl - external and internal use
- Epi. HCl ONLY for external use
- ASE: increase HR/contraction, bronchodilation (if systemic) for ephedrine and EPI
- Phenylephrine has minimal effects on heart and CNS
- SE: nervous, tremors, sleeplessness, nausea, appetite loss
- Serious ASE are less likely with topicals
- Prolonged use could cause vasodilation, anxiety, and rarely paranoia
- May increase BP when used rectally, increased with TCAs and MAOIs (don’t use together)
- Consult doctor first if on antidepressants, antihypertensives, or cardiac medications
13
Q
ARD - Protectants
A
- Physical protective barrier and softening of anal canal
- Includes absorbents, adsorbents, demulcants, and emollients
- Temporarily relief of anal symptoms (burning, discomfort, itching, pain) with external/internal hemorrhoids
- Glycerin - external use only
- Kaolin and aluminum hydroxide gel for moist anorectal conditions
- Lanolin may cause allergic reactions, chemically modified version may be less sensitizing
- Remove petrolatum or greasy ointments before applying products with aluminum hydroxide or kaolin
14
Q
ARD - Astringents
A
- Promotes surface protein coagulation to protect underlying tissue
- Decreased cell volume and make drier environments
- Make thing, protective layer to decrease irritaion
- Approved for relieving anal symptoms
- Witch hazel: external use; calamine and zinc - internal or external use
- ASE are uncommon
- Witch hazel may slightly sting upon administration and can cause contact dermatitis
- If calamine or zinc are used for a long time, zinc toxicity is possible
15
Q
ARD - Keratolytics
A
- Cause desquamentation and debridement of epidermal surface cells
- Expose underlying tissue and can decrease itching/inflammation when used with other ingredients
- ONLY use externally
- Repeated use: methemoglobinemia, exfoliative dermatitis, death of infants, myxedema in adults
- ASE: tinnitus, increased pulse, diaphoresis, SOB, circulatory collapse, unconscious, convulsions
- Products with resorcinol must list warnings about possible allergic reactions and to see a doctor if symptoms don’t stop or worsen; also don’t use it on open wounds near anus
