GI Goljan anorectal disorders GI Goljan Flashcards
Signs and Sx of anorectal disease
bleeding;
pain;
pruritis (pinworms);
anal fistula (CD)
What could bleeding be a sign of in anorectal disease?
internal hemorrhoids (painless);
anorectal cancer;
infection;
fissure
What could pain in anorectal disease be from?
anal fissure;
thrombosed external hemorrhoids (painful)
Define internal hemorrhoids
dilated superior hemorrhoidal veins in mucosa and submucosa => located above pectinate line (superior plexus)
causes of internal and external hemorrhoids
straining at stool (MC);
pregnancy;
obesity;
anal intercourse;
portal HTN
Clinical findings of internal hemorrhoids
often prolapse out of rectum;
commonly pass brigh red blood w/ stool (painless and blood coats stool);
anal pruritis and soiling of underwear
Tx for internal and external hemorrhoids
high fiber diet, avoid prolonged sitting or stooling; warm baths;
topical hydrocortisone; stool softeners
Surgical Tx for internal and external hemorrhoids
rubber band ligation (best overall), scleroTx, infrared photocoag;
Hemorrhoidectomy (most effective but most pain)
Define external hemorrhoids
dilated inferior hemorrhoidal veins w/ painful thrombosis (below pectinate line so inferior plexus)
Define rectal prolapse
intussusception of rectum through anus due to weak rectal support mechanisms
causes of rectal prolapse in children < 2yr
whooping cough;
trichuriasis;
common sign of CF
common cause of rectal prolapse in elderly
straining at stool
define pilonidal sinus and abscess
excess hair in gluteal fold becomes traumatically burred into sinus => painful sacrococcygeal mass w/ purulent discharge
Tx for pilonidal sinus and abscess
I&D;
if chronic disease=> marsupialization w/ wide excision and would left open
Epidemiology of pruritis ani
males > females;
1-5% of population
causes of pruritis ani
anorectal disease (internal hemorrhoids, fissures, anal incontinence, diarrhea, cancer);
infections (pinworm, Candida, venereal disease);
local irritants (soap, underwear, obesity, coffee, beer, acidic foods)
dermatologic disease (psoriasis, atopic dermatitis);
diabetes mellitus
Epidemiology of anorectal fistulas
all ages w/ assoc of constipation;
if young then more in infants;
boys > girls
Etiology of anorectal fistulas
nonspecfic cryptoglandular infection (MC);
IBD (CD > UC);
trauma (episiotomy, prostatectomy, anal intercourse);
malignancy (anal CA, Tx for anal CA)
Tx for anorectal fistulas
surgery
Epidemiology of anal fissures
> 10% of anal complaints
pathophys of anal fissures
firm bowel movements => once formed, perpetuated by BM;
assoc and perpetuated by spasm of internal sphincter
Clinical findings of anal fissure
posterior (90%) fissure and/or ulcer bw anal verge and dentate line;
Anal tag at anal verge marks location;
prominent proximal papilla
Tx for anal fissures
nitroglycerin ointment;
Botox of anal sphincter;
surgery
If the anal fissure is not posterior bw the anal verge and dentate line, what should be considered?
crohn’s disease
