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Clin Med III > hernias, anal diseases > Flashcards

hernias, anal diseases Flashcards

1
Q

external hemorrhoids

A
  • distal to dentate line
  • covered by modified squamous epithelium
  • somatic pain receptors
  • painful, esp when thrombosed
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2
Q

internal hemorrhoids

A
  • proximal to dentate line
  • viscerally innervated
  • not sensitive to pain, touch, temp
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3
Q

how are external hemorrhoids classified?

A
  • no classification system
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4
Q

how are internal hemorrhoids classified?

A
  • graded I - IV
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5
Q

grade I internal hemorrhoid

A
  • seen on anoscopy
  • may bulge into lumen
  • does not prolapse below dentate line
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6
Q

grade II internal hemorrhoid

A
  • prolapse out of anal canal with BM or straining

- reduce spontaneously

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7
Q

grade III internal hemorrhoid

A
  • prolapse out of anal canal with BM and straining

- requires manual reduction

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8
Q

grade IV internal hemorrhoid

A
  • irreducible

- may strangulate

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9
Q

hemorrhoid risk factors

A
  • advanced age
  • diarrhea
  • pregnancy
  • pelvic tumors
  • prolonged sitting
  • straining, chronic constipation
  • anticoagulation
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10
Q

clinical manifestations of hemorrhoids

A
  • many asymptomatic
  • almost always painless bleeding assoc with BM
  • BRBPR
  • fecal incontinence
  • sensation of fullness in perianal area
  • irritation or itching
  • painful when thrombosed
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11
Q

diagnosis of hemorrhoids

A
  • good hx and PE
  • anoscopy
  • DRE
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12
Q

external hemorrhoid management

A
  • hydrocortisone rectal creams or suppositories
  • astringants or protectants
  • anesthetics
  • excision and clot evacuation if thrombosed < 72 hours
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13
Q

internal hemorrhoid management

A
  • rubber band ligation
  • sclerotherapy
  • hemorrhoidectomy
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14
Q

types of hemorrhoidectomies

A
  • conventional- high post of complications, low recurrence
  • hemorrhoidal artery ligation- low post op complications, high recurrence
  • stapled- mod post op complication and recurrence
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15
Q

pain management s/p hemorrhoid surgery

A
  • almost always have pain due to spasm of internal sphincter
  • PO NSAIDs
  • avoid opioids d/t constipation
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16
Q

who is most commonly effected by anal fissures?

A
  • infants

- middle aged people

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17
Q

primary causes of anal fissures

A
  • constipation
  • diarrhea
  • vaginal delivery
  • anal sex
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18
Q

secondary causes of anal fissures

A
  • crohn’s
  • granulomatous disease
  • malignancy
  • infectious diseases
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19
Q

sx of anal fissures

A
  • anal pain at rest
  • exacerbated by BM
  • anal bleeding
  • longitudinal tears
  • chronic fissures are less painful, have raised edges
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20
Q

acute vs chronic anal fissures timeline

A
  • acute < 8 weeks

- chronic > 8 weeks

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21
Q

management of anal fissures

A
  • fiber, stool softners, laxatives
  • sitz bath
  • topical analgesics and vasodilators
  • sphincterectomy
  • botox
  • fissurectomy
  • anal advancement flap
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22
Q

anal abscess

A
  • acute infection of anal crypt gland
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23
Q

anal fistula

A
  • chronic anal abscess

- abscess ruptures or is drained -> epithelialize track forms -> connects abscess to perirectal skin

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24
Q

ischiorectal anal abscess

A
  • penetrates through external anal spincter into ischiorectal space
  • seen on exam
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25
Q

intersphincteric anal abscess

A
  • between internal and external sphincters
  • usually dont cause skin changes
  • found on DRE
26
Q

supralevator anal abscess

A
  • may originate from pelvic or crypt gland infections
  • severe perianal pain, fever
  • sometimes urinary retention
  • no obvious external findings
  • usually need CT to dx
  • can cause sepsis
27
Q

clinical manifestation of anal abscesses

A
  • severe, constant pain
  • fever, malaise
  • purulent rectal drainage if ruptured
  • indurated, erythematous, tender, fluctuant
28
Q

diagnosis of anal abscess

A
  • hx, PE
  • DRE
  • CT
  • transperitoneal or endorectal US
29
Q

management of anal abscess

A
  • drainage*
  • perianal and ischiorectal drained through skin
  • perirectal and intersphincteric drained in OR
  • supralevator drainage depends
  • +/- abx
30
Q

clinical presentation of anal fistula

A
  • non-healing anorectal abscess after drainage
  • intermitten rectal pain
  • malodorous perianal drainage
  • perianal skin excoriated and inflamed
  • external opening and palpable cord possible
31
Q

classification system for anal fistulas

A
  • park system
32
Q

park type 1 fistula

A
  • intersphincteric

- starts at dentate line and ends at anal verge

33
Q

park type 2 fistula

A
  • transphincteric

- tracks through external sphincter into ischiorectal fossa

34
Q

park type 3 fistula

A
  • supraspincteric

- originates in anal crypt and terminates in ischiorectal fossa

35
Q

parks type 4 fistula

A
  • extrasphincteric
  • high in anal canal
  • terminates in skin overlying buttock
36
Q

diagnosis of anal fistulas

A
  • hx and PE

- imaging for complex fistula- esp if assoc with crohn’s

37
Q

what is goodsall’s rule used for

A
  • determining how anal fistulas track
38
Q

goodsall’s rule for external openings posterior to line through ischial spines

A
  • tracks in curvilinear fashion
39
Q

goodsall’s rule for external openings anterior to line through ischial spines

A
  • tracks in radial fashion
40
Q

pilonidal disease

A
  • infection of skin and subq tissue in upper part of natal cleft
  • found just below sacrum
  • pores get damaged -> collect debris and hair -> become infected -> tract formation
41
Q

risk factors for pilonidal disease

A
  • overweight/ obesity
  • local trauma
  • sedentary lifestyle, prolonged sitting
  • deep natal cleft
  • family hx
42
Q

acute sx of pilonidal disease

A
  • mild- severe pain while sitting
  • drainage
  • fever, malaise
  • tender red mass
43
Q

chronic sx of pilonidal disease

A
  • recurrent persistent gluteal pain
  • drainage
  • tender red mass
  • usually reoccur 2-3 X a year
44
Q

treatment for pilonidal disease

A
  • I & D
  • local anesthesia
  • pack with gauze
  • possible recurrence
  • dont usually require abx
  • primary closures, off midline closures, z- plasty, v-y flap
45
Q

types of groin hernias

A
  • inguinal- more common

- femoral- assoc with more complications

46
Q

types of abdominal wall or ventral wall hernias

A
  • incisional

- umbilical

47
Q

risk factors for groin hernias

A
  • hx of hernia or prior repair
  • older age, male, caucasian
  • chronic cough or constipation
  • abdominal wall injury
  • smoking
  • family hx
48
Q

what causes congenital groin hernias?

A
  • failure of processus vaginalis to close
49
Q

direct groin hernia

A
  • protrude medial to inferior epigastric vessels in hesselbach’s triangle
50
Q

indirect groin hernia

A
  • protrude at internal inguinal ring
51
Q

femoral hernias

A
  • protrude through femoral ring
52
Q

clinical manifestation of groin hernias

A
  • bulge in groin
  • heaviness or dull discomfort usu at end of day or with standing
  • mod-severe pain with incarceration or strangulation
  • on R side 2/3 of time
53
Q

treatment for groin hernias

A
  • definitive treatment- surgical repair
  • uncomplicated- elective repair
  • complicated- emergent surgery
  • truss of pt is not surgical candidate
54
Q

hernia strangulation

A
  • ischemia and necrosis
55
Q

hernia incarceration

A
  • trapping of hernia contents
56
Q

spigelian and parastromal hernias

A
  • abdominal wall hernias

- occur off midline

57
Q

types of abdominal wall hernia’s

A
  • epigastric
  • umbilical
  • spigelian
  • parastromal
  • incisional
58
Q

mesh onlay

A
  • above fascia
59
Q

mesh inlay

A
  • between fascia
60
Q

mesh sublay

A
  • between rectus muscles and peritoneum
61
Q

mesh underlay

A
  • intraperitoneum

Clin Med III (26 decks)

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