Chapter 29, Module 7; Rectal Pain, itching and bleeding

Question 1

Cutting or tearing pain during defecation and gnawing, throbbing discomfort afterward

Answer 1

Anal fissure

Question 2

PHYSICAL FINDINGS OF Anal fissure?

Answer 2

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fissures are deep and indurated; internal fissures are seen when anal sphincter relaxes as examining finger is withdrawn; sentinel tag may be visible at anal verge

Question 3

DIAGNOSTIC STUDIES OF Anal fissure?

Answer 3

Anoscopy

Question 4

Swelling, throbbing, continuous progressive pain

Answer 4

Perirectal abscess

Question 5

PHYSICAL FINDINGS OF Perirectal abscess?

Answer 5

Erythema and swelling in perirectal area; pain may preclude examination

Question 6

DIAGNOSTIC STUDIES OF Perirectal abscess?

Answer 6

Anoscopy, CT SCAN

Question 7

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

Answer 7

Proctalgia fugax

Question 8

PHYSICAL FINDINGS OF Proctalgia fugax?

Answer 8

Normal rectal examination

Question 9

DIAGNOSTIC STUDIES OF Proctalgia fugax?

Answer 9

Diagnosed by clinical history and negative physical examination

Question 10

Anorectal pain; mucopurulent discharge, tenesmus, constipation with proctitis; also diarrhea, abdominal pain, and fever with proctocoli¬ tis; history of anal intercourse, immunocompromised

Answer 10

Proctitis/proctocolitis

Question 11

PHYSICAL FINDINGS OF Proctitis/proctocolitis?

Answer 11

Purulent discharge, inflamed mucopurulent rectal mucosa

Question 12

DIAGNOSTIC STUDIES OF Proctitis/proctocolitis?

Answer 12

Cultures, DNA testing, Gram stain, syphilis testing; stool examination, stool O&P

Question 13

Pain in sacrum, superior to rectum; history of sedentary occupation

Answer 13

Pilonidal disease

Question 14

PHYSICAL FINDINGS OF Pilonidal disease?

Answer 14

Erythema, swelling over sacrum, which can be fluctuant

Question 15

DIAGNOSTIC STUDIES OF Pilonidal disease?

Answer 15

NONE

Question 16

History of GABHS, local itching, pain

Answer 16

Perianal streptococcal cellulitis

Question 17

PHYSICAL FINDINGS OF Perianal streptococcal cellulitis

Answer 17

Erythema, proctitis, blood-streaked stool

Question 18

DIAGNOSTIC STUDIES OF Perianal streptococcal cellulitis?

Answer 18

Culture of perianal area

Question 19

History of abuse, perianal pain, itching

Answer 19

Sexual abuse

Question 20

PHYSICAL FINDINGS OF Sexual abuse?

Answer 20

Large irregular anal fissures, bruising, rectal tone decreased, warts, presence of semen

Question 21

DIAGNOSTIC STUDIES OF Sexual abuse?

Answer 21

Syphilis testing; culture (gonorrhea, Trichomonas vaginalis, herpes); DNA testing, (herpes, Chlamydia, gonorrhea)

Question 22

Discomfort and itching exacerbated by friction; history of poor anal hygiene or overcleansing

Answer 22

Pruritus ani

Question 23

PHYSICAL FINDINGS OF Pruritus ani?

Answer 23

MiId erythema and excoriationover perirectal skin; in laterstages red, raw, oozing, pale, lichenified perirectal skin

Question 24

DIAGNOSTIC STUDIES OF Pruritus ani?

Answer 24

NONE

Question 25

Itching, especially at night

Answer 25

Pinworms

Question 26

PHYSICAL FINDINGS OF Pinworms?

Answer 26

Use  flashlight  to  visualize  white- yellow  worms  8-13  mm  long  at night

Question 27

DIAGNOSTIC STUDIES OF Pinworms?

Answer 27

Scotch  tape  test positive  for  eggs

Question 28

Bright red rectal bleeding with defecation or blood on stool; burning or itching; straining at stool; prolonged sitting; pregnancy and childbirth

Answer 28

Hemorrhoids

Question 29

PHYSICAL FINDINGS OF Hemorrhoids?

Answer 29

External hemorrhoids.- bluish, skin-covered lumps; internal hemorrhoids: may be visible when patient bears down

Question 30

DIAGNOSTIC STUDIES OF Hemorrhoids?

Answer 30

FOBT or FIT; colonoscopy, fecal/stool DNA to exclude carcinoma

Question 31

Painless hematochezia; may have mild abdominal discomfort and cramping often in LLQ; use of aspirin and NSAIDs and a low-fiber diet

Answer 31

Diverticular disease

Question 32

PHYSICAL FINDINGS OF Diverticular disease?

Answer 32

Brisk rectal bleeding; red, or black stool

Question 33

DIAGNOSTIC STUDIES OF Diverticular disease?

Answer 33

Colonoscopy

Question 34

Few symptoms with small lesions; bleeding, discharge, itching, and pain with large lesions

Answer 34

Condyloma acuminata

Question 35

PHYSICAL FINDINGS OF Condyloma acuminata?

Answer 35

Pink or white warty lesions with papilliform surface; may extend into anal canal

Question 36

DIAGNOSTIC STUDIES OF Condyloma acuminata?

Answer 36

Syphilis testing to distinguish from condyloma lata caused by syphilis

Question 37

Feeling of lump; usually painless; may or may not bleed; may have family or personal history of polyps or colorectal cancer syndromes

Answer 37

Cancer of the colon, rectum, anus

Question 38

PHYSICAL FINDINGS OF Cancer of the colon, rectum, anus?

Answer 38

Polyp, internal or external mass, ulcers, verrucous growths

Question 39

DIAGNOSTIC STUDIES OF Cancer of the colon, rectum, anus?

Answer 39

Colonoscopy

Question 40

Ingestion of maternal blood

Answer 40

Newborn

Question 41

PHYSICAL FINDINGS OF Ingestion of maternal blood?

Answer 41

Hematemesis

Question 42

DIAGNOSTIC STUDIES OF Ingestion of maternal blood?

Answer 42

APT test

Question 43

Infant 0-6 mo, milk formula or breastfeeding mother who has intake of milk

Answer 43

Allergic colitis

Question 44

PHYSICAL FINDINGS OF Allergic colitis?

Answer 44

Blood-streaked stool

Question 45

DIAGNOSTIC STUDIES OF Allergic colitis?

Answer 45

NONE

Question 46

Preterm newborn, infant

Answer 46

NEC

Question 47

PHYSICAL FINDINGS OF NEC?

Answer 47

Ileus, abdominal distention, gastrointestinal bleeding, bilious vomiting

Question 48

DIAGNOSTIC STUDIES OF NEC?

Answer 48

Immediate referral

Question 49

Preschool child, painless Gl bleeding

Answer 49

Meckel diverticulum

Question 50

PHYSICAL FINDINGS OF Meckel diverticulum?

Answer 50

Black or maroon stool

Question 51

DIAGNOSTIC STUDIES OF Meckel diverticulum?

Answer 51

Technetium-99m scan and referral

Question 52

Colicky abdominal pain, vomiting, currant jelly stool

Answer 52

Intussusception

Question 53

PHYSICAL FINDINGS OF Intussusception?

Answer 53

Sausage-shaped mass may be felt in abdomen

Question 54

DIAGNOSTIC STUDIES OF Intussusception?

Answer 54

Refer

Question 55

Painless bleeding with stool, ages 2-5 yr

Answer 55

Juvenile polyps

Question 56

PHYSICAL FINDINGS OF Juvenile polyps?

Answer 56

NONE

Question 57

DIAGNOSTIC STUDIES OF Juvenile polyps?

Answer 57

Colonoscopy