gi 3.3 Flashcards by Morgan C

Internal hemorrhoids

tissue

Columnar epithelium

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nerve endings in internal or external hemorrhoids

external

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Internal hemorrhoids

Bleeding, protrusion, seepage/soilage, staining, pruritus

RARELY painful

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Internal hemorrhoids

grade classification

Grade 1- non prolapsing
Grade 2- reduce on own
Grade 3-reduce manually
Grade 4-irreducible

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Internal hemorrhoids

grade trmt

Grade 1- RBL or sclerotherapy
Grade 2-RBL
Grade 3- RBL or hemorrhoidectomy
Grade 4- hemorrhoidectomy

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Internal hemorrhoids

trmt

High fiber, fluids, fiber supplements, stool softener

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External hemorrhoids

tissue

Squamous epithelium

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External hemorrhoids

Protrusion, Soilage, Staining, pruritus

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External hemorrhoids

trmt

Symptomatic relief- sitz bath, stool softeners, pain meds
Excision
Thrombectomy

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most Anal fissures are anterior or posterior

posterior

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Anal fissures

location

Distal to dentate line

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Anal fissures

causes

Crohns, malignancy, TB, syphilis, CMV, HIV, trauma (large hard stool or diarrhea)
Hypertonic/stastic anal sphincter
Ischemia
Chronic: may be from sentinel skin tags, hypertrophic papilla, exposed IAS, hyperspastic IAS, anal stenosis, fistula

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Anal fissures

Pain, spasm, bleeding, soilage, difficult pooping

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Anal fissures

trmt

Symptomatic relief- sitz bath, stool softeners, pain meds
Topical NTG
Botox
Lateral internal sphincterotomy
Anoplasty
Fissurectomy
Anal stretch

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acute Anorectal suppuration

abscess

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chronic Anorectal suppuration

fistula

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Anal abscesses

types

Perianal, intersphincteric, ischiorectal (MC), supralevator

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Anal abscesses

Pain, swelling, drainage, bleeding, constipation, urinary difficulties

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Anal abscesses

trmt

Drain abscess

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Anal fistulae

types

Intersphincteric (MC), transsphincteric, suprasphincteric, extrasphincteric

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Anal fistulae

trmt

fistuloplasty/ectomy, anoplasty, fibrin glue

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Rectal prolapse

Incontinence, constipation, protrusion, bleeding, discharge, sensation of incomplete emptying, rectal pressure/tenesmus

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Rectal prolapse trmt

Repair abdomen

Perineal repair

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May only be able to see on toilet

Rectal prolapse

Fecal incontinence types

Pseudo Incontinence- soilage, frequency, urgency Overflow incontinence Diarrheal states Sphincter disruption- dt anorectal procedure, trauma to pelvic floor, or pseudo neuropathy

Fecal incontinence PE

Inspect DRE Endoscopy

Fecal incontinence trmt

Treat underlying condition Fix constipation Biofeedback therapy

Condyloma acuminata causes

Sexually transmitted | HPV

Condyloma acuminata risks

Homosexual males Doing anal Immunosuppression, HIV

Condyloma acuminata sx

Visible palpable warts, pruritus, soilage, bleeding, wetness, discomfort

Condyloma acuminata trmt

Stop Podophyllin, Bichloroacetic acid, trichloroacetic acid bc they can cause it Must treat partners as well or it wont go away

SCC BCC Pagets disease Bowen’s disease where are these anal neoplasms located

anal margin

where are these anal neoplasms located ``` Epidermoid carcinoma SCC TCC Cloacogenic carcinoma Basaloid carcinoma Adenocarcinoma Malignant melanoma Sarcoma ```

anal canal

Anal neoplasms sx

Bleeding, pain, mass, pruritus, discharge

Anal neoplasms trmt

Remove it Abdominal perineal resection Radiotherapy Chemo

Pruritus ani?

Anal itching and burning from excoriation, secretions, and irritant

Pruritus ani causes

Bad hygiene, cleaning too much, soilage, foods, obesity

Pruritus ani trmt

Change hygiene, change diet Psyllium- bulks up stools Treat cause Stop scratching

Hidradenitis suppurativa?

Infection of apocrine sweat glands

what does Hidradenitis suppurativa cause?

Causes abscesses and sinus tract formation

location of Hidradenitis suppurativa

Occurs in neck, axilla, groins, genitals, scalp

Hidradenitis suppurativa | risks

Obese, heavy sweaters, african american, irritatin, trauma

Hidradenitis suppurativa | trmt

Good hygiene incision and drain abscess cut it out

Pilonidal disease cause

Congenital- remnants in medullary canal, developmental dermal inclusions Acquired- rxn to imbedded hair, hair follicle infections

Pilonidal disease risks

Hirsutism Chronic trauma Deep intergluteal fold

Pilonidal disease sx

Acute: pilonidal abscess Chronic: pilonidal sinus

Pilonidal disease trmt

Excision, cystostomy, cleft closure

Refer any anorectal disorder to specialist if

anorectal disorder is unclear or pt does not respond to trmt

Primary sclerosing cholangitis (PSC)?

Chronic progressive inflammation, fibrosis, and stricturing of medium and large ducts in intra and extra hepatic biliary tree that leads to fatigue

Associated with UC

Primary sclerosing cholangitis (PSC)

“Beading of bile ducts”

Primary sclerosing cholangitis (PSC)

2 goals of trmt: | Primary sclerosing cholangitis (PSC)

Slow and reverse disease progression- many drugs don't succeed Manage disease and complications

Primary sclerosing cholangitis (PSC) | trmt

Ursodeoxycholic acid (UDCA) is best Endoscopic therapy to dilate or stent the stricture ATB if cholangitis Transplant

Primary biliary Cirrhosis?

Chronic progressive disease where T cells destroy small intrahepatic bile ducts

Primary biliary Cirrhosis | cause

Unknown

Primary biliary Cirrhosis | sx

Asymptomatic | Fatigue, pruritus (from hyperbilirubinemia), RUQ pain, arthropathy

Primary biliary Cirrhosis | pe

May be normal Hypopigmentation, excoriation (from itching), jaundice Late stage: ascites, clubbing, edema

Primary biliary Cirrhosis | labs

``` + antimitochondrial antibodies (AMA) Inc LFT esp. Alk phos Histology shows Asymmetric destruction of bile ducts Do liver biopsy, MRCP, ERCP Need all 3 to dx ```

Primary biliary Cirrhosis | trmt

No widely acceptable trmt Treat underlying sx: itching, bone disease, hyperlipidemia Ursodiol if caught early Cholestyrene resin reduces pruritus Liver transplant if they think you'll die within a year