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GI > Colorectal Pathologies > Flashcards

Colorectal Pathologies Flashcards

1
Q

External hemorrhoids are arising from?

A

Dilated veins arising from inferior hemorrhoid plexus

Distal to the dentate line (sensate area)

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2
Q

Are external hemorrhoids painful or painless?

A

PAINFUL

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3
Q

Internal hemorrhoids are arising from?

A

Dilated submucosal veins of superior rectal plexus

Above the dentate line (insensate area)

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4
Q

Are internal hemorrhoids painful or painless?

A

PainLESS

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5
Q

List some risk factors of hemorrhoids?

A 
Low fiber 
High-fat diet
Pregnancy 
Straining 
Prolonged sitting 
Obesity
Portal HTN-liver issues (cirrhosis)
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6
Q

List some clinical features of hemorrhoids?

A

Bleeding and rectal prolapse (MC)
BRBPR
Anemia (rare)

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7
Q

List some clinical features of external hemorrhoids?

A

usually asymptomatic

when sxs are present: thrombosed and pain for several days

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8
Q

Does external hemorrhoids subside or constant?

A

Gradually subside

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9
Q

List some clinical features of internal hemorrhoids?

A

Painless

Mass is present when they prolapse

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10
Q

What are some management options for hemorrhoids?

A 
Sitz bath
Ice packs 
Stool softeners
High fiber, high fluid diet
Topical steroids (hydrocortisone suppositories or topical cream)
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11
Q

Surgical management options for hemorrhoids?

A

Rubber band ligation for internal hemorrhoids

Hemorrhoidectomy

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12
Q

Indications for hemorrhoidectomy?

A 
not responsive to conservative tx
severe/chronic prolapse (stage IV)
hemorrhoid strangulation
very large anal tags
fissure present
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13
Q

Rectal prolapse is MC in what sex and what age?

A

6x more common in females

> 60 yrs old

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14
Q

Women with rectal prolapse have higher incidence of what?

A

pelvic floor disorders

- urinary incontinence, rectocele, cystocele, enterocele

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15
Q

Children with rectal prolapse will have what?

A

CF

-get sweat chloride test

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16
Q

What is rectal prolapse?

A

circumferential full-thickness protrusion of rectal wall through the anal orifice

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17
Q

Rectal prolapse is associated with?

A

Redundant sigmoid colon
Pelvic laxity
Deep rectovaginal
Chronic constipation

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18
Q

What nerve is affected by rectal prolapse?

A

pudendal nerve

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19
Q

What are some clinical features of mucosal prolapse?

A

radial grooves around the anus

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20
Q

What causes a mucosal prolapse?

A

connective tissue laxity between submucosa and underlying musculature of the anal canal

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21
Q

What is anismus?

A

attempting to defecate against closed pelvic floor

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22
Q

Tx for rectal prolapse?

A

Recognize and refer

Stool bulking agents, hydrate, fiber supplement

23
Q

What are anal fissures?

A

linear lesions (tear) in the rectal wall

24
Q

MC location of anal fissures?

A

posterior midline

25
Q

MCC of anal fissures?

A

Constipation-passage of large, hard stool

26
Q

Abnormal location of anal fissures?

A

Lateral

- consider infectious dx or Crohns

27
Q

Clinical features of anal fissures?

A

Tearing pain on defecation
Hematochezia
Bright red blood on the toilet paper

28
Q

Chronic anal fissure clinical features

A

Sentinel tag at the caudal aspect of fissure
Pruritus ani
intermittent bleeding
pain

29
Q

What is an anorectal abscess?

A

Localized inflammatory process associated with soft tissue and anal gland

30
Q

Clinical features of anorectal abscess?

A 
Pain - worsens with movement/strain
Erythema
Cellulitis
Mass by inspection and palpation
Fever sxs of sepsis-w/ deep abscess
Urinary retention
31
Q

Anorectal abscess is polymicrobial how many antibiotics do you need to tx?

A

Multiple antibiotis are needed

32
Q

The procedure of thrombosed external hemorrhoid

A

Excision

  • anesthetize
  • elliptial incision of skin overlying clot
  • remove clot
33
Q

MC classification of anorectal fistula?

A

Intersphincteric

34
Q

What is intersphincteric anorectal fistula?

A

fistula track passes within the intersphincteric plane to the perianal skin

35
Q

MCC of anorectal fistula?

A

Nonspecific cryptoglandular infection (skin or intestinal flora)

36
Q

Work up and tx for anorectal fistula?

A

digital rectal exam
gentle probing
anoscopy
tx: surgical I and D w/ repair w/ antibiotics

37
Q

What is a pilonidal abscess?

A

pus and a well of edematous fat

results from a rupture of an infected hair follicle into the fat

38
Q

What is pilonidal cyst?

A

Develops from a chronic abscess, epithelium grows into the cavity from the skin surface

39
Q

Clinical features of pilonidal disease?

A

hot, tender, fluctuant swelling

may exude pus through midline pit

40
Q

Stage I of hemorrhoids?

A

no protrusion yet

41
Q

Stage II of hemorrhoids?

A

protruding, spontaneously reduce

42
Q

Stage III of hemorrhoids?

A

protruding, possible to push back manually

43
Q

Stage IV of hemorrhoids?

A

protruding, cannot be pushed back in manually or otherwise.

44
Q

What is pruritus ani?

A

intense chronic itching of the anus and surrounding skin

45
Q

Test for pinworms (enterobius vermicularis)

A

scotch tape test

46
Q

MC drugs that are a risk for constipation?

A

Anticholinergics (antipsychotics- benzos)

Opioids

47
Q

What should you always keep in mind with regard to the cause of constipation?

48
Q

Two complications that result from hernias?

A

Incarcerated and strangulated hernia

49
Q

What is an incarcerated hernia?

A

Irreducible
Good blood supply but bowel obstruction can occur
Very painful

50
Q

What is a strangulated hernia?

A

Irreducible
Compromised blood supply- risk for cirrhosis/ischemia
Surgical emergencies

51
Q

Where is indirect inguinal hernia located and MC in what sex??

A

Medial to inferior epigastric vessels

Elderly men

52
Q

Where is direct inguinal hernia located MC in young or old??

A

Lateral to inferior epigastric vessels can descend into the scrotum
MC in young children and adults

53
Q

Femoral hernia MC in what sex?

GI (16 decks)

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