Chapter 29, Module 7; Rectal Pain, itching and bleeding Flashcards
Cutting or tearing pain during defecation and gnawing, throbbing discomfort afterward
Anal fissure
PHYSICAL FINDINGS OF Anal fissure?
Early fissures appear as superficial erosions; more advanced lesions are linear or elliptical breaks in skin; long-standing fissures are deep and indurated; internal fissures are seen when anal sphincter relaxes as examining finger is withdrawn; sentinel tag may be visible at anal verge
DIAGNOSTIC STUDIES OF Anal fissure?
Anoscopy
Swelling, throbbing, continuous progressive pain
Perirectal abscess
PHYSICAL FINDINGS OF Perirectal abscess?
Erythema and swelling in perirectal area; pain may preclude examination
DIAGNOSTIC STUDIES OF Perirectal abscess?
Anoscopy, CT SCAN
Sudden, severe, transient pain in rectum often occurring at night; may be accompanied by sweating, pallor, tachycardia; may occur once a year or in waves of 3-4 times/wk
Proctalgia fugax
PHYSICAL FINDINGS OF Proctalgia fugax?
Normal rectal examination
DIAGNOSTIC STUDIES OF Proctalgia fugax?
Diagnosed by clinical history and negative physical examination
Anorectal pain; mucopurulent discharge, tenesmus, constipation with proctitis; also diarrhea, abdominal pain, and fever with proctocoli¬ tis; history of anal intercourse, immunocompromised
Proctitis/proctocolitis
PHYSICAL FINDINGS OF Proctitis/proctocolitis?
Purulent discharge, inflamed mucopurulent rectal mucosa
DIAGNOSTIC STUDIES OF Proctitis/proctocolitis?
Cultures, DNA testing, Gram stain, syphilis testing; stool examination, stool O&P
Pain in sacrum, superior to rectum; history of sedentary occupation
Pilonidal disease
PHYSICAL FINDINGS OF Pilonidal disease?
Erythema, swelling over sacrum, which can be fluctuant
DIAGNOSTIC STUDIES OF Pilonidal disease?
NONE
History of GABHS, local itching, pain
Perianal streptococcal cellulitis
PHYSICAL FINDINGS OF Perianal streptococcal cellulitis
Erythema, proctitis, blood-streaked stool
DIAGNOSTIC STUDIES OF Perianal streptococcal cellulitis?
Culture of perianal area
History of abuse, perianal pain, itching
Sexual abuse
PHYSICAL FINDINGS OF Sexual abuse?
Large irregular anal fissures, bruising, rectal tone decreased, warts, presence of semen
DIAGNOSTIC STUDIES OF Sexual abuse?
Syphilis testing; culture (gonorrhea, Trichomonas vaginalis, herpes); DNA testing, (herpes, Chlamydia, gonorrhea)
Discomfort and itching exacerbated by friction; history of poor anal hygiene or overcleansing
Pruritus ani
PHYSICAL FINDINGS OF Pruritus ani?
MiId erythema and excoriationover perirectal skin; in laterstages red, raw, oozing, pale, lichenified perirectal skin
DIAGNOSTIC STUDIES OF Pruritus ani?
NONE
Itching, especially at night
Pinworms
PHYSICAL FINDINGS OF Pinworms?
Use flashlight to visualize white- yellow worms 8-13 mm long at night
DIAGNOSTIC STUDIES OF Pinworms?
Scotch tape test positive for eggs
Bright red rectal bleeding with defecation or blood on stool; burning or itching; straining at stool; prolonged sitting; pregnancy and childbirth
Hemorrhoids
PHYSICAL FINDINGS OF Hemorrhoids?
External hemorrhoids.- bluish, skin-covered lumps; internal hemorrhoids: may be visible when patient bears down
DIAGNOSTIC STUDIES OF Hemorrhoids?
FOBT or FIT; colonoscopy, fecal/stool DNA to exclude carcinoma
Painless hematochezia; may have mild abdominal discomfort and cramping often in LLQ; use of aspirin and NSAIDs and a low-fiber diet
Diverticular disease
PHYSICAL FINDINGS OF Diverticular disease?
Brisk rectal bleeding; red, or black stool
DIAGNOSTIC STUDIES OF Diverticular disease?
Colonoscopy
Few symptoms with small lesions;bleeding, discharge, itching, and pain with large lesions
Condylomaacuminata
PHYSICAL FINDINGS OF Condylomaacuminata?
Pink or white warty lesions withpapilliform surface; may extend into anal canal
DIAGNOSTIC STUDIES OF Condylomaacuminata?
Syphilis testing todistinguish from condyloma lata caused by syphilis
Feeling of lump; usually painless; may or may not bleed; may have family or personal history of polyps or colorectal cancer syndromes
Cancer of the colon, rectum, anus
PHYSICAL FINDINGS OF Cancer of the colon, rectum, anus?
Polyp, internal or external mass, ulcers, verrucous growths
DIAGNOSTIC STUDIES OF Cancer of the colon, rectum, anus?
Colonoscopy
Ingestion of maternalblood
Newborn
PHYSICAL FINDINGS OF Ingestion of maternalblood?
Hematemesis
DIAGNOSTIC STUDIES OF Ingestion of maternalblood?
APT test
Infant 0-6 mo, milk formula or breastfeeding mother who has intake of milk
Allergic colitis
PHYSICAL FINDINGS OF Allergic colitis?
Blood-streaked stool
DIAGNOSTIC STUDIES OF Allergic colitis?
NONE
Preterm newborn, infant
NEC
PHYSICAL FINDINGS OF NEC?
Ileus, abdominal distention, gastrointestinal bleeding, bilious vomiting
DIAGNOSTIC STUDIES OF NEC?
Immediate referral
Preschool child, painless Gl bleeding
Meckel diverticulum
PHYSICAL FINDINGS OF Meckel diverticulum?
Black or maroon stool
DIAGNOSTIC STUDIES OF Meckel diverticulum?
Technetium-99m scan and referral
Colicky abdominal pain, vomiting, currant jelly stool
Intussusception
PHYSICAL FINDINGS OF Intussusception?
Sausage-shaped mass may be felt in abdomen
DIAGNOSTIC STUDIES OF Intussusception?
Refer
Painless bleeding with stool, ages 2-5 yr
Juvenile polyps
PHYSICAL FINDINGS OF Juvenile polyps?
NONE
DIAGNOSTIC STUDIES OF Juvenile polyps?
Colonoscopy