Gallbladder disorders + Anal disorders Flashcards
what is obstructed in cholecystitis
cystic duct
sx cholecystitis
RUQ pain (> 6 hours)
fever
dx cholecystitis
US first
then HIDA scan / cholescintigraphy
tx cholecystitis
IV fluids first
then abx (Cef + Metro)
then cholecystectomy (definitive)
RF cholecystitis
Obesity
female
advancing age
pregnancy
RF for acalculous cholecystitis
critically ill
cause of acalculous cholecystitis
no stones - stasis and ischemia of bile
will pts a acalculous cholecystitis be jaundiced
yes
where does infection from ascending cholangitis ascend from
duodenum - e coli
what is ascending cholangitis
infection/inflammation in common bile duct
MC cause ascending cholangitis
choledocholithiasis
sx cholangitis
charcots triad - fever, RUQ pain, jaundice
Reynold’s pentad - hypotension/shock + AMS
dx cholangitis
US first
then ERCP (diagnostic and therapeutic)
labs for cholangitis
leukocytosis
increased alk phos
increased GGT
increased bilirubin > 2
ALT and AST can be elevated too
labs for choledocholithiasis
same for cholangitis
dx choledocholithiasis
US first
then ERCP (diagnostic and therapeutic)
will pts w choledocholithiasis be jaundiced
yes
what gallbladder diseases will need abx
cholecystitis (including acalculous)
cholangitis
what is an anal fissure
linear tear/crack in the anal mucosa distal to the dentate line; MC posterior midline
what other disease is anal fissure closely associated with
Crohn
sx anal fissure
painful defection; pain may last for minutes to hours; better before next BM
“passing glass” “passing a knife”
hematochezia
dx anal fissure
clinical
anoscopy for hematochezia
tx anal fissure
fiber, warm sitz bath
topical nifedipine, nitroglycerin, hydrocortisone, or diltiazem
botox injection - risk of fecal incontinence
lateral internal sphincterotomy - risk of fecal incontinence
acute vs chronic anal fissure
acute < 8 weeks
chronic > 8 weeks
anorectal/perianal abscesses arise from
anal crypt glands
MC organism involved in anorectal/perianal abscess
staph aureus
where are anorectal/perianal abscesses MC located
posterior rectal wall
sx anorectal/perianal abscess
severe, constant rectal pain worse with sitting, defecating, coughing
fluctuant = abscess
tx anorectal/perianal abscess
I & D then abx (augmentin or Cef + Metro)
what is an anal fistula
abnormal communication btwn anus and perirectal skin
what is anal fistula MC due to
drainage from abscess
Parks classifications for anal fistula
type 1 - Intersphincteric
type 2 - Transphincteric
type 3 - suprasphincteric
type 4 - extrasphincteric
which parks classification for anal fistula is MC
type 1
describe type 1 anal fistula
Intersphincteric - only through internal sphincter; due to perianal abscess
describe type 2 anal fistula
Transsphincteric - through internal and external sphincter; from ischiorectal abscess
describe type 3 anal fistula
Suprasphincteric - through internal sphincter and the extends superiorly btwn sphincters; from supralevator abscess
describe type 4 anal fistula
Extrasphincteric - begins at rectum (not the anus, unlike the other three types) and extends down through the levator ani muscle
what type of anal fistula is not included in the parks classification
superficial fistula; this is submucosal and does not involve sphincters
tx anal fistula
fistulotomy – open it and get rid of fistula by secondary intention
partial sphincterectomy - more likely to cause fecal incontinence
what are hemorrhoids
engorgement of venous plexus
what type of cells are internal hemorrhoids covered by
columnar cells
what type of cells are external hemorrhoids covered by
squamous cells
where do internal hemorrhoids originate from
superior hemorrhoid vein
where do external hemorrhoids originate from
inferior hemorrhoid vein
internal and external hemorrhoids in relation to dentate line
internal - proximal to (above)
external - distal to (below)
difference in sx internal vs external hemorrhoids
internal - bleed, no pain
external - pain, no bleed
if there is bleeding from the rectum, what test do you have to do
anoscopy
tx hemorrhoids
fiber supplementation, fuids
topical hydrocortisone or topical lidocaine
internal - rubber band ligation, sclerotherapy, etc
external - hemorrhoidectomy
grading for internal hemorrhoids
grade 1 - no protrusion
grade 2 - protrusion but spontaneously reduce
grade 3 - protrusion but manually reduce
grade 4 - protrusion and no reduction; risk strangulation
