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GIT > Dse of the Anus > Flashcards

Dse of the Anus Flashcards

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1
Q

Appendicitis etiology or incidence? it occurs more on?

A
  • Most commonly occurs in 10- to 19 years old
  • Male > female
  • 70% occurs at age < 30 years old
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2
Q

20% of all patient with appendicitis present with perforation, at what percentage risk is much higher?

A
  • patients <5 or >65 years of age
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3
Q

what are the risk factor that causes appendicitis?

A
  1. Fecalith
  2. Incompletely digested food residues
  3. Lymphoid hyperplasia
  4. Intraluminal scarring
  5. tumor
  6. Bacteria
  7. Viruses
  8. IBD
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4
Q

what are the two categories of patient with appendicitis?

A
  1. with complicated disease like gangrene or perforation (poor prognosis)
  2. without complication
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5
Q

what are the common presenting symptoms of appendicitis?

A
  1. Abdominal pain (>95%)
  2. Anorexia (70%)
  3. Vomiting (50 -75%)
  4. Nausea (>65%)
  5. Migrating pain (50-60%)
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6
Q

most common appendix position and what is the maneuver utilized to diagnose this?

A
  • Retrocecal (11 oclock)
  • Iliopsoas sign
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7
Q

2nd most common position of appendix and what are the common presentation

A
  • Pelvic appendix (32%)
  • SSx: Dysuria, urinary frequency, diarrhea, or tenesmus
  • Obturator sign
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8
Q

what are conditions in female that could mimic appendicitis?

A
  1. Pelvic inflammatory disease\
  2. ectopic pregnancy
  3. Ovarian torsion
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9
Q

where does the pain of appendicitis begins and when will it starts to migrate?

A
  • Pain is characterized as intermittent crampy abdominal pain in the epigastric or periumbilical region
  • this migrates to the RLQ over 12 -24 H
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10
Q

what causes the tenderness in appendicitis?

A
  • Parietal peritoneal irritation which is associated with local muscle rigidity and stiffness
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11
Q

when is the expected time that predispose to perforation or development of other complication in appendicitis

A
  • Over 48 hrs
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12
Q

What are the symptoms of appendicitis in elderly

A
  • minimal pain
  • nausea
  • anorexia
  • emesis
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13
Q

what is most specific imaging use to detect appendicitis?

A
  • CT scan

Presence of:
1. dilation >6mm with wall thickening
2. lumen that does not fill with enteric contrast
3. fatty tissue stranding or air surrounding the appendix

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14
Q

What are seen in ultrasound in appendicitis?

A
  1. wall thickening
  2. Increased appendiceal diameter
  3. presence of free fluid
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15
Q

treatment for acute appendicitis?

A
  • Appendectomy
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16
Q

treatment for appendicitis with the presence of Phlegmon or abscess?

A
  1. broadspectrum antibiotics
  2. drainage of there is an abscess >3 cm in diameter
  3. Parenteral fluids and bowel rest

appendix should be safely removed after 6 - 12 weeks

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17
Q

is a circumferential, full-thickness protrusion of the rectal wall through the anal orificie

A
  • Rectal prolapse (procidentia)
  • most common in woman > 60 years old
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18
Q

what are the associated developing pelvic disorder of patient with rectal prolapse?

A
  1. Urinary incontinence
  2. rectocele
  3. cystocele
  4. enterocele
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19
Q

rectal prolapse is often associated with?

A
  1. redundant sigmoid colon
  2. pelvic laxity
    3, deep rectovaginal septum (pouch of douglas)
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20
Q

what is hte pathphysio of rectal prolapse

A
  • is the result of damage to the nerve supply to hte pelvic floor muscles or pudendal nerves from repeated stretching with straining to defecate
  • Thus, weaken the external anal sphincter muscles
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21
Q

what are common complaints of patient with rectal prolapse

A
  1. anal mass
  2. bleeding per rectum
  3. poor perianal hygiene
  4. Constipation occurs in 30 - 67%
22
Q

what are the presenting Ssx of internal rectal prolapse?

A
  • both constipation and incontinence
23
Q

what are other associated findings in rectal prolapse?

A
  1. outlet obstruction (anismus) 30%
  2. Solitary rectal ulcer syndrome
  3. colonic inertia
24
Q

what are used for evaluation of prolpse?

A
  1. cystoproctography
  2. colonoscopy

these evaluate for associated pelvic floor disordes and rule out a malignancy or a polyp

25
Q

what are the medical management of rectal prolapse?

A
  1. stool-bulking agent
  2. fiber supplement
26
Q

what is the mainstay treatment for rectal prolapse?

A
  • Surgical correction

2 approaches:
1. Transabodminal (lower recurrence rate)
2. Transperineal (patient with significant comorbids)

types of transperineal includes protectomy (altmeier procedure), mucosal protectomy (delorme procedure) or placement of Tirsch rire encircling the anus

27
Q

it is the involuntary passage of fecal material for at least 1 month in an individual with a developmental age of at least 4 yo

A
  • fecal incontinence
28
Q

fecal incontinence occurs more in?

A
  • woman aged > 65, higher among parous women

1/2 suffer from urinary incontinence

29
Q

what is the majority cause of fecal incontinence?

A

. obstetric injury to the pelvic floor, either while carrying a fetus or during the delivery

  • this result in tearing the muscle fibers anteriorly. This could result also from stretching of the pudendal nerves during pregnancy
30
Q

what are the risk factors for delivery fecal incontinence?

A
  1. prolonged labor
  2. use of forceps
  3. episiotomy
31
Q

Neurological cause of fecal incontinence

A
  1. dementia
  2. brain tumor
  3. stroke
  4. multiple sclerosis
  5. tabers dorsalis
  6. cauda equina lesions
32
Q

Skeletal muscle cause of fecal incontinence

A
  1. myasthenia gravis
  2. myopathies
  3. muscular dustrophy
33
Q

Miscellaneous cause of fecal incontinence

A
  1. hypothyroidism
  2. IBS
  3. Diabetes
  4. severe diarrhea
  5. scleroderma
34
Q

what is the presentation of minor and major incontinence?

A

Minor: incontinence of flatus and seepage of liquid stool

Major: inability to control solid waste

35
Q

what are laboratory studies helpful in diagnosing fecal incontinence?

A
  1. anal manometry
  2. pudendal nerve terminal motor latency (PNTML)
  3. endoanal ultrasound
36
Q

medical treatment for fecal incontinence

A
  1. fiber supplement
  2. loperamide
  3. diphenoxylate
  4. bile acid binders

these hardens the stool

37
Q

what is the gold standard treatment for fecal incontinence?

A
  • overlapping sphincteroplasty
38
Q

what are the alternative therapies for fecal incontinence?

A
  1. sacral nerve stimulation (SNS) - long term result - adaption result for urinary incontinence
  2. collagen-enhancing injectables
  3. magnetic “fenix” ring
39
Q

what are the 3 main hemorrhoidal complexes

A
  1. Left lateral
  2. Right anterior
  3. Right posterior

Engorgement and straining lead to prolapse of this tissue into the anal canal or below the pectinate

40
Q

What are the 2 classification of hemorrhoids?

A
  1. External hemorrhoids - originate below the dentate line and are covered with squamous epithelium. PAINFUL when THROMBOSED
  2. Internal hemorrhoids - originate ABOVE the dentate line and are covered with mucosal and transitional zone epithelium and REPRESENT THE MAJORITY OF HEMORRHOIDS
41
Q

what is the significance of hemorrhoidal cushions?

A
  • Contains vascular structures that help aid in the continence by preventing damage to the sphincter muscle.
42
Q

What are the 4 staging of hemorrhoids? and their treatment

A
  1. Enlargement with bleeding
  2. Protrusion with spontaneous reduction
  3. Protrusion requiring manual reduction
  4. Irreducible protrusion

Stage 1 & 2 = Fiber supplement, Cortisone, Sclerotherapy, infrared coagulation

Stage 3 = Fiber supplement, cortisone, RUBBER BAND LIGATION, operative hemorrhoidectomy

stage 4= fiber supplement, cortisone operative hemorrhoidectomy

43
Q

what is the most clinical presentation of hemorrhoids

A
  • bleeding and protrusion

Bleeding is less common

Severe pain indicate thrombosed hemorrhoids (External)

44
Q

what is the characteristics of hemorrhoidal bleeding?

A
  • described as a painless bright red blood seen either in the toilet or upon wiping
45
Q

Diagnosis of hemorrhoidal disease?

A
  • Made on PE

. Evidence of thrombosis
- Anoscopy to detect the position hemorrhoidal disease

46
Q

what is the indication for treating acutely thrombosed hemorrhoid?

A
  • should be excised with the first 72 h by performing an elliptical excision
47
Q

what are the medication prescribes for hemorrhoidal disease?

A
  1. sitz baths
  2. fiber
  3. stool softener
48
Q

how does bands in hemorrhoidal works?

A
  • it causes ischemia and fibrosis
  • fixing proximal anal canal
  • patient may complain of a dull ache for 24 following band`
49
Q

what are the surgical management for hemorrhoidal

A
  1. excisional hemorrhoidectomy, trans hemorrhoidal
  2. transmorrhoidal dearterialization
  3. stappled hemorrhoidectomy - less discomfort; does not remove anal skin tags

all surgical methods of management are equally effective in symptomatc 3rd and 4th edgree hemorrhoids

50
Q

what are the acute complications associated with the treatment

A
  1. pain
  2. infection
  3. recurrent bleeding
  4. urinary retention
51
Q
A

GIT (6 decks)

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