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Gastroenterology > Disorders of the Anus and Rectum > Flashcards

Disorders of the Anus and Rectum Flashcards

1
Q

What are the two types of hemorrhoids?

A

Internal
External

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2
Q

Which type of hemorrhoids is described below?

Located above dentate line, subepithelial vascular cushions; contribute to normal anal pressures and water tight closure of anal canal

Arise from the normal vascular entities that communicate between rectal arteries and veins

Arise from superior hemorrhoidal cushion

Viscerally innervated columnar epithelium

Not sensitive to pain, touch, or temperature

Not palpable on PE

Painless bleeding after defecation

A

Internal hemorrhoids

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3
Q

Which type of hemorrhoids is described below?

Located below the dentate line

Arise from inferior hemorrhoidal plexus

Covered by modified squamous epithelium (anoderm)

Contains multiple somatic pain receptors (i.e. painful)

Rarely bleed

Visible, can poke out

A

External hemorrhoids

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4
Q

What grading of internal hemorrhoids is described below?

The hemorrhoids do not prolapse

A

Grade I

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5
Q

Are part of normal anatomy

Become symptomatic from distension and
engorgement secondary to increased venous pressure

A

Hemorrhoids

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6
Q

What grading of internal hemorrhoids is described below?

The hemorrhoids prolapse upon defecation but reduce spontaneously

A

Grade II

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7
Q

What grading of internal hemorrhoids is described below?

The hemorrhoids prolapse upon defecation and must be reduced manually

A

Grade III

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8
Q

What grading of internal hemorrhoids is described below?

The hemorrhoids are prolapsed and cannot be reduced manually

A

Grade IV

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9
Q

Which type of hemorrhoids are not graded?

A

External hemorrhoids

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10
Q

What are some predisposing factors for hemorrhoids?

A

Straining/Constipation
Prolonged Sitting
Pregnancy
Obesity
Low fiber diet

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11
Q

What is the clinical presentation of hemorrhoids?

A

Pruritis
Dull, aching pain (external more than internal)
BRBPR (bright red blood per rectum)
Fissure
prolapse

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12
Q

What are the treatment options for hemorrhoids?

A

Mild = conservative
Fiber supplements
Fluid increase
Sitz baths
Anusol with or without HC

Mod/Severe: more invasive
Banding
Photocoagulation
Cryosurgery
Surgery

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13
Q

Rupture of a vein at the anal margin 🡪 clot in the SC tissue

Patients typically complain of a painful lump (severe pain)

PE - Tense, tender, bluish mass covered with skin

A

Thrombosed External Hemorrhoid

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14
Q

What is the treatment for thrombosed external hemorrhoids?

A

Excision of hemorrhoid: removes clot and hemorrhoidal tissues

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15
Q

A split in anal mucosa

Occur midline, just distal to dentate line

Sometimes you can see it, sometimes you cannot (deeper)

A

Anal Fissure

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16
Q

List some causes of anal fissures

A

Vigorous stretching of anal canal during defecation of large, firm bowel movement

Digital insertion

Sexual trauma

Foreign body insertion

17
Q

List some predisposing factors for the development of anal fissures

A

Previous anorectal surgery (leads to scarring of anoderm and loss of
elasticity)

Anodermal tearing exposures internal sphincter muscle which leads to muscle spasms

Spasm can prevent the sphincter from relaxing 🡪 further tearing, fissure deepening and further spasms

Persistent spasm also creates a degree of ischemia that further prevents healing

18
Q

What are some signs/symptoms of an anal fissure?

A

Severe pain, especially during bowel movements (tearing, burning, throbbing)

Bleeding with defecation

Constipation (pain is so severe they are afraid to have a bowel movement)

Unable to do anal/rectal exam

Linear tear in anoderm

Anal spasm with limited DRE

19
Q

What are some treatment options for anal fissures?

A

Stool softeners
High fiber diet
Bulking agents
Sitz baths
Medications: NTG, hydrocortisone suppository, hydrocortisone cream
Surgery

20
Q

What percentage of anal abscesses will result in a fistula?

A

30-40%

21
Q

Develops when anal crypt gland becomes infected

Gland is obstructed with debris permitting bacterial overgrowth and abscess formation

A

Anal abscess

22
Q

Communication between an abscess with an identifiable opening within the anal canal

Frequently at dentate line

A

Anal fistula

23
Q

If you have a patient with an anal fistula, what condition do you need to rule out?

A

Need to rule out IBD when you see a fistula

24
Q

Anal abscesses/fistulas are associated with what other conditions?

A

Constipation
Diarrhea
Infection
Perianal trauma
Crohn’s disease
Immunocompromised patients
Malignancy
Prior radiation

25
Q

What are some signs/symptoms of anal abscesses/fistulas?

A

Severe anal or rectal pain
Mass
Fever
Malaise
With fistula: Purulent drainage

26
Q

What is the treatment for anal abscesses/fistulas?

A

Surgical I&D
Broad spectrum antibiotics
Sitz baths

27
Q

Abscess in the sacrococcygeal cleft with resultant sinus tract
development

“jeep rider’s disease”

Highest incidence in white males; peak incident 16-20 year olds

Male:female is 3:1

Were once believed to be congenital, now believed to be acquired

A

Pilonidal Disease

28
Q

What is the pathophysiology of pilonidal disease?

A

Natal cleft hair follicle becomes infected 🡪 rupture into surrounding
tissues 🡪 abscess 🡪 surrounding hair is pulled into the cavity

29
Q

What are some signs/symptoms of pilonidal disease?

A

Painful, fluctuant area at sacrum/coccyx

Chronic draining sinuses with hair protruding from pits

30
Q

What is the treatment for pilonidal disease?

A

Surgical I&D: Unroofing, cure rate of 60-80%

For chronic draining cysts or failure to heal after 3 months: Excision of midline pits and hair removal

31
Q

Most common viral STD in the United States

A

HPV

32
Q

Condylomata acuminate or genital warts

Highest prevalence: 16-25 year olds

Highly transmissible

A

anal warts

33
Q

Condylomata acuminate or genital warts are caused by what?

A

HPV

34
Q

What is the pathophysiology of anal warts?

A

HPV invades superficial layers of anogenital region during sexual contact

35
Q

What is the incubation period for HPV and the development of anal warts?

A

Incubation period of approximately 4 months

36
Q

What are some treatment options for anal warts?

A

Topical podofilox 0.5% cream
Topical Imiquimod 5% cream
Topical sinecatechins 15%
Cryotherapy
Podophyllin
Surgery (including laser surgery)

37
Q

What is the most concerning aspect about anal warts?

A

Malignant transformation is possible

Gastroenterology (9 decks)

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