GI Goljan anorectal disorders GI Goljan

Question 1

Signs and Sx of anorectal disease

Answer 1

bleeding;
pain;
pruritis (pinworms);
anal fistula (CD)

Question 2

What could bleeding be a sign of in anorectal disease?

Answer 2

internal hemorrhoids (painless);
anorectal cancer;
infection;
fissure

Question 3

What could pain in anorectal disease be from?

Answer 3

anal fissure;
thrombosed external hemorrhoids (painful)

Question 4

Define internal hemorrhoids

Answer 4

dilated superior hemorrhoidal veins in mucosa and submucosa => located above pectinate line (superior plexus)

Question 5

causes of internal and external hemorrhoids

Answer 5

straining at stool (MC);
pregnancy;
obesity;
anal intercourse;
portal HTN

Question 6

Clinical findings of internal hemorrhoids

Answer 6

often prolapse out of rectum;
commonly pass brigh red blood w/ stool (painless and blood coats stool);
anal pruritis and soiling of underwear

Question 7

Tx for internal and external hemorrhoids

Answer 7

high fiber diet, avoid prolonged sitting or stooling; warm baths;

topical hydrocortisone; stool softeners

Question 8

Surgical Tx for internal and external hemorrhoids

Answer 8

rubber band ligation (best overall), scleroTx, infrared photocoag;

Hemorrhoidectomy (most effective but most pain)

Question 9

Define external hemorrhoids

Answer 9

dilated inferior hemorrhoidal veins w/ painful thrombosis (below pectinate line so inferior plexus)

Question 10

Define rectal prolapse

Answer 10

intussusception of rectum through anus due to weak rectal support mechanisms

Question 11

causes of rectal prolapse in children < 2yr

Answer 11

whooping cough;
trichuriasis;
common sign of CF

Question 12

common cause of rectal prolapse in elderly

Answer 12

straining at stool

Question 13

define pilonidal sinus and abscess

Answer 13

excess hair in gluteal fold becomes traumatically burred into sinus => painful sacrococcygeal mass w/ purulent discharge

Question 14

Tx for pilonidal sinus and abscess

Answer 14

I&D;
if chronic disease=> marsupialization w/ wide excision and would left open

Question 15

Epidemiology of pruritis ani

Answer 15

males > females;
1-5% of population

Question 16

causes of pruritis ani

Answer 16

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

Question 17

Epidemiology of anorectal fistulas

Answer 17

all ages w/ assoc of constipation;
if young then more in infants;
boys > girls

Question 18

Etiology of anorectal fistulas

Answer 18

nonspecfic cryptoglandular infection (MC);
IBD (CD > UC);
trauma (episiotomy, prostatectomy, anal intercourse);
malignancy (anal CA, Tx for anal CA)

Question 19

Tx for anorectal fistulas

Answer 19

surgery

Question 20

Epidemiology of anal fissures

Answer 20

> 10% of anal complaints

Question 21

pathophys of anal fissures

Answer 21

firm bowel movements => once formed, perpetuated by BM;
assoc and perpetuated by spasm of internal sphincter

Question 22

Clinical findings of anal fissure

Answer 22

posterior (90%) fissure and/or ulcer bw anal verge and dentate line;
Anal tag at anal verge marks location;
prominent proximal papilla

Question 23

Tx for anal fissures

Answer 23

nitroglycerin ointment;
Botox of anal sphincter;
surgery

Question 24

If the anal fissure is not posterior bw the anal verge and dentate line, what should be considered?

Answer 24

crohn’s disease

Question 25

Types of anal CA

Answer 25

basaloid (epidermoid or cloacogenic) CA;

squamous cell carcinoma

Question 26

where and who is MC to have basaloid CA?

Answer 26

female dominant;
located in transitional zone above dentate line

Question 27

Tx for anal CA

Answer 27

surgery

Question 28

where is squamous cell carcinoma located?

Answer 28

anal canal

Question 29

What is the cause of anal squamous cell CA?

Answer 29

anal intercourse; HPV 16 and 18 associations