GI: Anorectal Disease Flashcards
pt. p/w:
Bright Red Bleeding with BM
Pruritus
Prolapse, sense of perianal fullness
hemorrhoids
Which hemorrhoid type is painful?
external
Which hemorrhoid Grade?
bulge in anal canal
no prolapse
Grade I
Which hemorrhoid Grade?
prolapse reduces spontaneously
Grade II
Which hemorrhoid Grade?
prolapse requires manual reduction
Grade III
Which hemorrhoid Grade?
chronic prolapse
Grade IV
1st line tx for hemorrhoids
Fluid & Fiber
+/- Short Course CS creams/suppositories
Procedure for external hemorrhoid…
excision
procedure for internal hemorrhoid
rubber band ligation
2 indications for hemorrhoidectomy
Grade IV internal
symptomatic Grade III
Patient presents w.
Intense itching & Burning
Circumferential erythema
pruritis ani
Tx for pruritis ani…
witch hazel
zinc oxide
pt. p/w:
Passing glass, sitting on a knife
Bright red blood on TP
anal fissue
MC location for anal fissure
posterior midline
2 topicals for anal fissure
lidocaine
nifedipine/nitro
What condition?
a/w perianal crohn disease
progress to fistula
perianal abscess
pt. p/w
Localized anal/rectal pain
Erythematous, palpable fluctuant mass
Surrounding Edema
perianal abscess
in addition to DRE, what must be done in PE for perianal abscess?
palpate for inguinal LAD
imaging for perianal abscess…
CT/MRI pelvis
What condition?
Chronic manifestation of abscess
a/w CD
perianal fistula
pt. p/w:
Abscess Drainage
Palpable cord
perianal fistula
imaging if complex/recurrent perianal fistula
MRI pelvis
imaging if IBD concern w. perianal fistula
colonoscopy
Dx imaging for anal condyloma
anoscopy
causative agent of anal condyloma
HPV
Tx options for anal condyloma
podofilox, imiquimod
in office trichloroacetic acid
Cell type for anal cancer?
squamous cells
Inguinal LAD should be concerning for…
anal CA
patient p/w…what should be on DDx?
Bleed, Anorectal pain Sensation of mass Warts Skin irritation Friable ulcerations External lesions
anal CA
anal CA dx…
Scope + Bx
Pt. complains of…
constipation/fecal incontinence
Incomplete evacuation
Seepage
Mass protruding thru anus
rectal prolapse
On PE, you notice…
Protrusion when straining
rectal prolapse
on DRE you notice
Mucosa of rectal wall feels floppy, loose
rectal prolapse
2 tests in addition to clinical presentation for rectal prolapse…
defecography, anorectal manometry
Tx for rectal prolapse
surgery
Patient p/w…
Need to apply pressure on vagina to defecate Pelvic pressure Constipation Fecal incontinence Sexual dysfunction
rectocele
