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Clin Med 3 > E2: Anorectal Disease > Flashcards

E2: Anorectal Disease Flashcards

1
Q

What are the red flag anorectal complaints that should prompt referral to GI or a colorectal specialist?

A
  • Unintentional weight loss
  • IDA
  • Personal or family history of IBD or CRC
  • Persistent anorectal bleeding or anorectal symptoms despite adequate treatment of a suspected benign condition
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2
Q

What are the possible etiologies of hemorrhoids?

A
  • prolonged sitting and straining
  • chronic constipation
  • diarrhea
  • pregnancy
  • advancing age
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3
Q

What is the difference between external and internal hemorrhoids?

A

External are distal to the dentate line and are painful.

Internal are proximal to the dentate line and are painless.

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4
Q

What is a grade 1 hemorrhoid?

A

A bulge in the anal canal without prolapse

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5
Q

What is a grade II hemorrhoid?

A

Prolapse that reduces spontaneously

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6
Q

What is a grade III hemorrhoid?

A

A prolapse that requires manual reduction

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7
Q

What is a grade IV hemorrhoid?

A

Chronic prolapse, irreducible

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8
Q

What is the clinical presentation of hemorrhoids?

A
  • bleeding with BM, usually bright red
  • sensation of perianal fullness (prolapse)
  • fecal incontinence/mucous discharge
  • pruritis
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9
Q

What diagnostic study should you order if a patient has hemorrhoid pattern bleeding?
What if you are concerned for IBD or malignancy?

A
  • Sigmoidoscopy

- Colonoscopy

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10
Q

What are the lifestyle modifications that can help treat hemorrhoids?

A
  • Fluid and fiber
  • toilet habits
  • sitz baths
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11
Q

What are the conservative medical therapies that can be used for hemorrhoids?

A
  • Stool softeners
  • Topical agents to provide symptomatic relief (tucks pads or a short course of corticosteroid creams or suppositories)
  • antispasmodic agents
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12
Q

What are the non surgical management options to treat hemorrhoids?

A
  • internal hemorrhoids: rubber band ligation, infrared coagulation, and sclerotherapy
  • External hemorrhoids: excision of thrombosis external hemorrhoid

Appropriate for patients refractory to conservative medical therapies

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13
Q

What is the most commonly used technique for the treatment of symptomatic bleeding internal hemorrhoids?

A

Rubber band ligation

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14
Q

When should you contact surgery for a hemorrhoidectomy?

A
  • persistent symptoms despite conservative measures or office based procedures
  • symptomatic grade II hemorrhoids
  • grade IV internal hemorrhoids
  • patients with extensive pain from thrombosis external hemorrhoids
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15
Q

What are some of the mechanical factors that can cause pruritis ani?

A

Prolapsing tissue, fecal incontinence/soiling, inadequate hygiene resulting in excess sweat, mucus, or stool between the buttocks

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16
Q

What is the clinical presentation of pruritis ani?

A

Intense itching and burning

Circumferential erythematous and irritated perianal skin

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17
Q

What is the management of pruritis ani?

A
  • eliminate offending agent
  • proper hygiene (gentle cleansers, avoid aggressive wiping, sitz baths)
  • keep region dry
  • eliminate tight clothing
  • short course of topical steroid cream appropriate for severe skin eruptions
18
Q

What commonly causes perianal skin tags?

A

Sequelae of thrombosed external hemorrhoids, Crohn’s disease

19
Q

What is the treatment of perianal skin tags?

A

-treatment is usually not indicates, however pts seek referral for excision if tags interfere with hygiene or cause perianal discomfort

20
Q

What is the most common cause of severe anorectal pain?

A

Anal fissures

21
Q

What is an anal fissure?

A

A linear tear, or split, in the lining of the anal canal distal to the dentate line that causes spasm of the anal sphincter

22
Q

What are the primary and secondary causes of anal fissures?

A

Primary: local trauma to the anal canal, passage of large hard stools, FB
Secondary: Crohn’s disease, malignancy, HIV/AIDs

23
Q

What is the clinical presentation of anal fissures?

A
  • severe pain during and often persistent after defecation, often described liked “passing glass” or “sitting on a knife”
  • bright red blood on TP or streaking in stool
24
Q

What is the most common spot for an anal fissure to occur?

A

Posterior midline, lowest blood supply

25
Q

What is the management of an anal fissure?

A
  • adequate fiber and fluid
  • proper anal hygiene
  • Sitz baths
  • stool softeners
  • Topical analgesics (lidocaine gel)
  • Topical vasodilators (nifedipine or Nitro ointment to reduce spasm and increase blood flow)
  • Surgery if chronic or refractory
26
Q

What is the pathophysiology of an perianal abscess?

A
  • Originates from obstructed or infected anal crypt gland
  • chronically can progress to form a fistula
  • can be a/w perianal Crohn disease
27
Q

How do you diagnose and manage a perianal abscess?

A
  • Possible CT or MRI to determine extent
  • I&D
  • possible ABX in appropriate pt
  • postoperative treatment of sitz baths and adequate fluid and fiber
28
Q

What is an anorectal fistula?

A

An abnormal communication between the anal canal and the perianal area

  • can be a chronic manifestation of a perianal abscess
  • can be see with Crohns, radiation proctitis, and diverticulitis
29
Q

What is the Clinical presentation of an anorectal fistula?

A
  • Chronic drainage of blood or pus and occasionally stool from the fistula, rectal pain, itching, swelling fever
  • perianal skin may be excoriated or inflamed
  • palpable cord beneath the skin between the anus and abscess opening
30
Q

How is an anorectal fistula diagnosed?

A
  • MRI pelvis for complex or recurrent fistula

- Colonoscopy if concerned about IDB

31
Q

What is the management of an anorectal fistula?

A
  • Surgical (fistulotomy) is mainstay therapy

- Fistulotomy is unroofing the fistula tract to allow healing

32
Q

What causes anal condyloma?

A

HPV

33
Q

A patient presents with a Cauliflower like appearance in clusters on the anus. What are you concerned about?

A

Anal condyloma

34
Q

What is the management of anal condyloma?

A
  • Removal or destruction of visible lesions
  • topical podofilox
  • topical lmiquimoid cream
  • Office treatment with trichloroacetic acid
  • surgical removal
35
Q

The majority of anal cancers are ** cancers?

A

Squamous cell

36
Q

What populations are at increased risk of anal cancer?

A
  • practicing receptive anal intercourse
  • history of anorectal condyloma
  • history of HPV/HIV
37
Q

On PE, you see a protruding circumferential mucosa tissue per rectum. On DRE, the mucosa of the rectum feels floppy with redundant tissue. What is the diagnosis?

A

Rectal prolapse

38
Q

How is rectal prolapse diagnosed?

A
  • Clinical presentation

- defecography and anorectal manometry

39
Q

How is a rectal prolapse treated?

A
  • surgical repair is mainstay

- prevent constipation, increased fluids and fiber

40
Q

How does a rectocele occur?

A

When fascia weakened and allows the rectum to bulge into the vagina

41
Q

Patient presents feeling as though they need to apply pressure to the vagina, rectum, or perineum in order to defecate. Patient also complains of pelvic pressure, constipation, fecal incontinence, and sexual dysfunction. On rectaovaginal exam, upon asking the pt to bear down, you see a bulge of the rectum into the vagina. What is the most likely diagnosis?

A

Rectocele

Clin Med 3 (17 decks)

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