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GI 1 > Clin med: diseases of rectum and anus > Flashcards

Clin med: diseases of rectum and anus Flashcards

1
Q

Rectal Pain

- importance of PE

A
  • a MUST
  • women: lay on side and lift one side of buttocks
  • man: bend over end of exam table, examiner on a stool
  • both techniques acceptable
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2
Q

Two muscle spasm syndromes

A
  1. Levator Ani syndrome

2. Protalgia fugax

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3
Q

Muscle spasm syndromes

- sx

A
  • recurrent pain
  • difficult to localize
  • feels like pain is in anus
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4
Q

Levator Ani Syndrome

- defining sx

A
  • tenderness in a muscle group on rectal exam
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5
Q

Protalgia fugax

  • sx
  • common cause
  • tx
A
  • pain lasting >20 min
  • commonly occurs after intercourse (either sex)
  • usually requires no treatment
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6
Q

Rectal examination

- inspection

A
  • look for hemorrhoids, excoriations, fissures, abscesses

- look for tumors

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7
Q

T/F tumors present with pain

A

False

- seldom present with pain

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8
Q
  • Two types of hemorrhoids

- what is defining anatomical feature

A

External
Internal
- Dentate line

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9
Q

Internal hemorrhoids

A
  • superior hemorrhoidal veins
  • proximal to the dentate line
  • portal circulation
  • usually cause no pain
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10
Q

External hemorrhoids

A
  • inferior hemorrhoidal veins
  • distal to dentate line
  • systemic circulation
  • commonly cause pain
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11
Q

Risk factors for hemorrhoids

A
  • increased intra-abdominal pressure
  • Increased venous portal pressure
  • Increased venous systemic pressure
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12
Q

Examples of intra-abdominal pressure

A
  • chronic constipation
  • pregnancy
  • ascites
  • obesity
  • heavy lifting
  • space occupying lesion within the pelvis
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13
Q

What causes internal hemorrhoids

A

increased portal pressure

  • cirrhosis
  • liver disease
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14
Q

What causes external hemorrhoids

A

increased systemic pressure

  • CHF
  • chronic pulmonary disease
  • inferior venacaval obstruction
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15
Q

Hemorrhoids

  • geriatric
  • pediatric
A
  • Geriatric: more common

- Pediatric: uncommon in infants and children

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16
Q

Hemorrhoids in children

A
  • if discover, look for underlying cause in portal/systemic venous system
  • can be caused by chronic constipation
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17
Q

Hemorrhoids in pregnancy

A
  • common
  • usually resolve after delivery
  • no tx required unless painful
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18
Q

Hemorrhoid treatment

A
  • treat underlying cause

- goal: decrease cause of increased pressure in abdomen, portal venous system, systemic venous system

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19
Q

How to treat acute hemorrhoid pain

A
  • sitz bath
  • up fiber in diet
  • steroid cream or suppositories to decrease inflammation
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20
Q

Hemorrhoid tx

  • if steroids fail
  • final option
A
  • band ligation: cuts off blood supply and hemorrhoid tissue dies and falls off
  • hemorroidectomy
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21
Q

Hemorroidectomy indicatins

A
  • repeat blood clots
  • ligation fails
  • Protruding hemorrhoids that cannot be reduced
  • persistent bleeding
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22
Q

Thrombosed hemorrhoid

- definition

A

tissue that is a collection of veins develops a clot

23
Q

Thrombosed hemorrhoid

  • presentation
  • visibility of hemorrhoid
A
  • acute pain, painful to touch, hard
  • if external can’t be pushed back into anus
  • visible externally or with anoscope
24
Q

Anal fissure

- description

A
  • longitudinal tear in lining of anal canal distal to dentate line
  • most commonly at posterior midline
  • characterized by a knifelike tearing sensation on defecation
  • often associated with bright red blood per rectum
  • seen on exam when separate buttocks and see the anus
  • benign
25
Q

what is anal fissure often confused with

A

hemorrhoids

26
Q

Anal fissures

acute vs. chronic

A

Acute: <6 weeks
Chronic: >6 weeks

27
Q

Anal fissure

- epidemiology

A
  • all ages
  • common in infants 2-24 months (usually self limiting and usually related to constipation)
  • less common in elderly: usually only seek medical advice unless pain is severe
28
Q

What causes anal fissure

A
  • high pressure in anal canal (usually result of straining) leads to ischemia of anoderm
  • splits anal mucosa dring defecation and spasm of exposed internal sphincter
  • can also be a sign of trauma
  • very hard to reduce inflammation due to proximity to bacteria
29
Q

Risk factors for anal fissures

A
  • passage of hard/large stool
  • high-resting pressure (prolonged sitting at a stool or obesity)
  • trauma (anal intercourse)
  • IBD (Crohn’s disease)
  • Infection: chlamydia, syphilis, herpes, TB
30
Q

Conditions associated with anal fissure

A 
constipation
IBS
Crohn's 
TB
Leukemia (immunocompromised)
HIV (immunocompromised)
31
Q

Presentation of Anal Fissure

A
  • pain of defecation
  • bright red blood
  • tearing sensation on passing stool
  • anal spasm
32
Q

Treatment of anal fissure

A
  • avoid repeated tearing
  • wash gently with warm water and soap
  • high fiber diet
  • stool softener
  • medical therapy: nitrates, CCB, botulin toxin
33
Q

Anal fistula description

A
  • open communication between anal abscess and perirectal skin
  • anorectal fistulas typically form from an abscess of the anal crypt glands
34
Q

Anal fistula

- classification

A
  • based on anatomy
  • submucosal or superficial
  • four types in the sphincteric
35
Q

Anal fistula

- pathophysiology

A
  • debris in obstructed anal crypt gland results in suppuration and abscess formation
  • abscess rupture/drainage leads to epithelialized track or fistula formation
36
Q

Risk factors for anal fistula

A
  • IBD
  • Pelvic radiation
  • perianal trauma
  • pelvic carcinoma or lymphoma
  • abscess formation due to acute appendicitis, salpingitis, diverticulitis
  • immunocompromised states
37
Q

Anal fistula

- PE

A
  • look for redness and expression of pus
  • Rectovaginal
  • pus from vagina
  • Stool from vagina
  • Flatulus from vagina
  • Rectovesicle fistula
  • frequent UTI
38
Q

Anal fistula

- dx

A
  • US
  • Fistulogram
  • CT of pelvis
  • MRI of pelvis
39
Q

Anal fistula

- treatment

A
  • bowel rest (??)
  • skin care
  • surgical intervention
40
Q

Anorectal abscess

- symptoms

A
  • presents with pain
  • high fever, high WBC (infection)

** pt looks very sick

41
Q

Anorectal abscess

- location

A
  • perianal (outside the canal in the soft tissue, hasn’t yet created a fistula tract)
  • small percentage are complicated
42
Q

Anorectal abscess

history

A
  • perirectal pain, esp during defecation
  • constipation, fever, chills
  • spontaneous foul smelling drainage
43
Q

Anorectal abscess

PE: what to do

A
  • do inspection and palpation
  • C&S
  • possible endoscopy and fistulography
44
Q

Anorectal abscess treatment

A

drain

puss under pressure must be drained

45
Q

Fecal impaction

- description

A
  • incomplete evacuation of feces leading to the formation of a large, firm, immovable mass of stool in the rectum or distal sigmoid colon
  • resultant partial or complete obstruction
46
Q

Fecal impaction

- causes

A
  • hypercalcemia
  • hypermagnesemia
  • narcotics
  • immobility
47
Q

Fecal impaction

- history

A
  • constipation
  • rectal discomfort, pain
  • n/v anorexia
  • fecal incontinence - paradoxical diarrhea (overflow around impaction)
48
Q

Fecal impaction

- dx

A
  • rectal exam
  • plain x-ray
  • possibly CT scan
49
Q

Fecal impaction

- treatment

A
  • disimpaction (scoop it out)
  • further workup
  • help pt with increasing frequency of bowel movements
  • possible surgery depending on what finds
50
Q

Anal neoplasm

A
  • rare

- anal canal or anal margin

51
Q

Anal neoplasm risk factors

A
  • anogenital warts (HPV)
  • hx of pelvic cancer
  • Paget’s dz
  • Bowen’s dz
52
Q

Paget’s and Bowen’s

A

lesions in epithelium that are mostly benign. Dx via biopsy, generally dermatologist will care for these patients

53
Q

Anal neoplasms

- dx and tx

A
  • biopsy is essential

- tx usually sx followed by radiation or chemo

GI 1 (16 decks)

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