Exam 4 - Anorectal Disorders

Question 1

What are the most common anorectal disorders?

Answer 1

Hemorrhoids
Anal fistula, fissures, or abscesses
Pruritus

Question 2

Non-hemorrhoidal anorectal disorders

Answer 2

Anal abscesses, fistulas, fissures, and carcinomas

May manifest w/ hemorrhoid like symptoms

Question 2

It is estimated that ____% of the US population has hemorrhoids

Answer 2

4.4%

Question 3

What are hemorrhoids?

Answer 3

Inflamed, swollen blood vessels (and other tissues) that project into the bowel lumen during defecation

Question 4

Why do hemorrhoids occur?

Answer 4

Muscle fibers weaken w/ poor bowel habits like prolonged sitting or straining - also due to age

Downward pressure during defecation and high resting anal pressure

Question 4

Hemorrhoids can be found…

Answer 4

Both internal and external

Question 4

Risk factors for hemorrhoids

Answer 4

• Poor bowel habits (prolonged sitting and straining)
• Males (assigned male at birth)
• Diarrhea
• Increasing age (> 45)
• Pregnancy

(Putting My Dick In Places)

Question 5

Clinical presentations of anorectal disorders that are usually self treatable

Answer 5

Discomfort
Itching
Irritation
Inflammation
Burning
Swelling

(Don’t Invite In IBS)

*said specifically to know this slide

Question 6

Which anorectal disorders can be self-treated

Answer 6

ONLY hemorrhoids

All others require referral

Question 7

Clinical presentation of anorectal disorders that require referral

Answer 7

Bleeding
Seepage
Thrombosis
Prolapse
Change in bowel pattern
Pain

(Butt Starts To Prolapse = Call Physician)

*said specifically to know this slide

Question 8

Exclusions for self treatment of anorectal disorders

Answer 8

Minor anorectal symptoms that do not respond to 7 days of self treatment

Diagnosed GI diseases associated w/ colorectal bleeding (ie ulcerative colitis, Crohn’s disease)

Anorectal signs/symptoms such as: acute onset of severe pain, bleeding, seepage, prolapse, thrombosis, swelling, discomfort

Potentially serious anorectal disorders such as abscess, fistula, fissure, neoplasm, or malignancy (or anorectal disorders previously diagnosed by PCP)

Family history of colon cancer

Anorectal disorders (including hemorrhoids) in patients younger than 12 years

(My Damn Ass Pain Fucking Aches)

Question 9

General approach/goals of treatment

Answer 9

• Maintain soft stools to prevent straining
• Alleviate and maintain remission of symptoms
• Prevent complications

(MAP)

Question 10

Non-pharmacologic therapy

Answer 10

Avoid lifting heave objects
Dietary modifications
Surgical intervention
Proper bowel habits

Question 11

Dietary modifications

Answer 11

Discontinue foods that aggravate symptoms

Increased fiber intake may help Grade 1 or 2:
- reduce straining & prevent irritation
- increase fiber intake slowly
- increase fluid (water) intake

Question 12

Surgical intervention

Answer 12

For large or prolapsed grade 3 and 4 hemorrhoids

Question 12

Bathtub or sitz bath instructions

Answer 12

Warm water for 10-20 min BID to QID

Question 13

Proper bowel habits

Answer 13

• Try not to delay defecation
• Avoid sitting on toilet for long periods of time
• Bathtub or sitz bath
• Avoid excessive scrubbing
• Clean w/ moistened, unscented toilet paper or wipe
• Proper hygeine

(Take A Bath = Alleviate Crappy Pain)

Question 14

Sitz bath purpose

Answer 14

Relieve discomfort in perineal region

Helps reduce swelling and increases blood flow through anal tissues

Can be used to aid in cleanliness