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GIGU & Men’s Health > Large Intestine And Anorectal Conditions > Flashcards

Large Intestine And Anorectal Conditions Flashcards

1
Q

Large Intestine: Common Symptoms

A

-Abdominal pain, discomfort, cramping
-Constipation
-Diarrhea
-Distension
-Incontinence
-Bleeding
-Gas

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2
Q

Large Intestine: Exam

A

Focused intestinal exam

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3
Q

Large Intestine: Common Diagnostic Tools

A

-Colonoscopy: Entire colon
-Sigmoidoscopy: Left side of colon
-Biopsy: Cancer
-Stool/Fecal Occult Blood Test (FOBT)
-Fecal immunochemical Test (FIT)*

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4
Q

Constipation: Definition

A

– Infrequent passing of stool
– Difficulty passing of stool
– Feeling of incomplete evacuation or impaction

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5
Q

Constipation in the elderly is common & often due to:

A

–Low fiber diets
-Lack of exercise
-Coexisting medical conditions
-Use of constipating drugs

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6
Q

Constipation: Complications

A

– hemorrhoids, anal fissure, prolapse
– Other: fecal impaction, syncope

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7
Q

Causes of Constipation: Acute

A

• Obstruction
• Ileus
• Fecal impaction
• Drugs-examples: NSAIDs, antihistamines, antidepressants, high blood pressure, antispasmodics

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8
Q

Causes of Constipation: Chronic (Functional)

A

– IBS
– Pelvic floor syndrome
– Slow transit constipation

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9
Q

Causes of Constipation: Chronic (Pathological)

A

– Diabetes mellitus
– Hypothyroidism
– Pregnancy
– CNS disorders: Parkinsons, stroke, MS, spinal cord lesions
– Tumors
– Peripheral nervous system disorders
– Low fiber diet
– Chronic laxative abuse
– Medication

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10
Q

Constipation: Functional Disorders

A

-Slow-transit constipation
-Irritable bowel syndrome
-Pelvic floor dysfunction

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11
Q

Constipation: Metabolic Disorders

A

-Diabetes mellitus
-Hypothyroidism
-Hypocalcemia
-Hypercalcemia

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12
Q

Causes of Constipation: CNS disorders

A

-Parkinson disease
-Multiple sclerosis
-Stroke
-Spinal cord lesions

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13
Q

Causes of Constipation: Dietary Factors

A

-Low-fiber diet
-Sugar-restricted Diet
-Chronic laxative abuse

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14
Q

Constipation: Red Flags

A

– Distended, tympanic abdomen (suggests mechanical obstruction)
– Vomiting
– Blood in stool
– Weight loss
– Recent onset of severe constipation or worsening in elderly

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15
Q

Constipation: Treatment

A

Lifestyle, diet
-Increase dietary fiber
-Increase water intake
-Exercise
-Treat underlying conditions

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16
Q

Fecal Impaction

A

Hard, dry stool mass becomes stuck in colon/ rectum, often due to long term constipation

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17
Q

Tenesmus

A

Cramping rectal feeling that gives sense of needing to have a bowel movement even if already had movement

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18
Q

Diarrhea is defined as:

A

-Stool weight > 200 g/ day
(Normal: 100 to 200 g/ day)

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19
Q

Diarrhea: Complications from fluid loss

A

Dehydration, electrolyte loss (sodium, potassium,
magnesium, chloride)

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20
Q

Causes of Diarrhea: Acute

A

• Infection: viral, bacterial, parasitic
• Food poisoning
• Drugs-examples: Laxatives, Magnesium-containing antacids, Antibiotics
• Dietary factors*

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21
Q

Causes of Diarrhea: Chronic (Functional)

A

IBS

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22
Q

Causes of Diarrhea: Chronic (Pathological)

A

– Colitis related conditions
– Malabsorption related conditions
– Hyperthyroidism: possible
– Diabetes mellitus
– Tumors
– Surgery
– Dietary factors* see slide

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23
Q

Dietary Factors that may worsen diarrhea

A

• Caffeine: coffee, tea, cola, OTC headache remedies (caffeine can stimulate bowel movements)
• Fructose: apple or pear juice, grapes, honey, dates, nuts, figs, prunes, soft drinks
• Sorbitol/mannitol: sugar free foods, mints
• Lactose: milk, ice cream, frozen yogurt, soft cheeses

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24
Q

Diarrhea: Red Flags

A

– Distended, tympanic abdomen (suggests mechanical obstruction)
– Vomiting
– Blood or pus in stool
– Weight loss
– Chronic diarrhea
– Signs of dehydration

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25
Q

Diarrhea: Acute Watery

A

-Likely to be infection person)
-Considerations: travel, tainted food, known outbreak

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26
Q

Diarrhea: Acute Bloody

A

Diverticular bleeding
Ischemic colitis
If recurrent: consider IBD

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27
Q

Diarrhea: Large volume (over 1 liter/day)

A

-Endocrine
-If oil droplets (w/ weight loss): malabsorption

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28
Q

Diarrhea: After Eating Certain Foods

A

Food intolerance

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29
Q

Diarrhea: Voluminous, watery or fatty

A

Consider small bowel disease

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30
Q

Diarrhea: Frequent, small volume, possible blood, mucus

A

Consider large bowel

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31
Q

Diarrhea: Treatment (Lifestyle, Diet, Supplement)

A

• Rehydration (may need IV if severe): Ice chips, ginger ale, fruit juices,…
• Electrolyte support: Gatorade, etc
• Diet: eat as tolerated (bananas, rice, apple sauce) Avoid fried, greasy foods
• Probiotics (foods, supplements)
• Fiber? (Depending on root cause)

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32
Q

Diarrhea: Treatment (Other)

A

• Refer to MD: may need antidiarrheals
• Identify and treat underlying conditions
– May include medication
• Acupuncture

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33
Q

Bowel Incontinence

A

Involuntary defecation

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34
Q

Bowel Incontinence: Possible Causes

A

-Fecal impaction, nerve damage, congenital, diabetes, dementia, trauma to rectum/anus, inflammatory process

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35
Q

GI Bleeding: Melena

A

– Older black tarry colored stool
– Represents upper GI bleed

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36
Q

GI Bleeding: Hematochezia

A

– Brighter blood
– Represents lower GI bleed

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37
Q

GI Bleeding: Hematochezia

A

– Brighter blood
– Represents lower GI bleed

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38
Q

Hematochezia: Causes

A

Tumor, polyps, IBD, hemorrhoids, anal fissure

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39
Q

GI Bleeding: Importance of Amount

A

– Bleeding from anal fissure/ hemorrhoid: spots on toilet paper
– UC: blood in toilet, in stool

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40
Q

Elderly: Minor vs. Major Bleeding

A

– Minor bleeding: hemorrhoids & colorectal cancer
– Major bleeding: diverticular disease (diverticulosis)

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41
Q

Large Intestine: Acute Issues

A

• Ileus (temporary arrest of peristalsis)
• Hernia
• Volvulus (twisting of intestines)
• Intussusception (intestines telescope)
• Perforation & peritonitis
• Obstruction

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42
Q

Large Intestine: Generic Symptoms

A

• Acute onset
• Severe pain
• May be signs of shock
• Requires immediate medical attention

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43
Q

Intestinal Obstruction: Structural/Mechanical Causes

A

– Surgical adhesions or scar tissue (MC-60-75%)
– Hernias
– Tumors
– Volvulus
– Intussusception
– Diverticulitis
– Fecal impaction

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44
Q

Symptoms related to the Large intestine

A

• Milder sx that develop gradually
• Pain in lower abdomen
• Increasing constipation w/ abdominal distention
• Colicky spams last longer
• Vomiting less prominent

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45
Q

Pathological Disease

A

-Physiological change to tissue or organ
-Gross abnormalities seen by endoscope or tissue biopsy (Blood, pus, scars, ulcers)

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46
Q

Functional Disease

A

-Physiological function with no known organic basis
-Absence of evidence of underlying organic cause
-Diagnosis primaryily based on subjective findings

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47
Q

Irritable Bowel Syndrome (IBS)

A

• Chronic functional disorder
• Recurrent abdominal pain with altered bowel habits

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48
Q

Irritable Bowel Syndrome (IBS): Epidemiology

A

– Tends to begin adolescence / 20’s
– More females

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49
Q

IBS: Causes

A

-Unclear
– Possible combination of psychological / physical factors

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50
Q

IBS: Diagnosing

A

-Clinical
– Rule out other differences
– Fulfills Rome Criteria

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51
Q

IBS: Rome IV Criteria

A

• Recurrent abdominal pain
– At least 1 day/ week in last 3 months
• Associated with 2 or more of the following:
– Related to defecation
– Associated with change in frequency of stool
– Associated with change in form of stool
• Onset of sx: at least 6 months before diagnosis

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52
Q

IBS: Red Flags

A

– Fever, weight loss, bleeding
– Changes in odor

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53
Q

IBS may develop into anorectal issues including:

A

Anal fissure, Hemorrhoids, Abscess

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54
Q

IBS: Co-morbidities

A

– Fibromyalgia
– Endometriosis
– Interstitial cystitis

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55
Q

IBS: Diagnostic Procedures

A

• Tests are to only rule out other DDx or to screen for organic causes

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56
Q

IBS: Medical/Psychological Treatment

A

• Support and understanding
• Education about disorder
• Counseling / therapy
• Stress management

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57
Q

IBS: Lifestyle, Diet, Supplements

A

• Exercise regularly at sx
• Water to remain hydrated
• Avoid food triggers*
• Fiber
• Probiotics, peppermint
• Acupuncture, massage

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58
Q

Colitis

A

Inflammation of the Colon

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59
Q

Inflammatory Bowel Disease

A

• Chronic inflammation of GI tract
– Relapsing diarrhea & abdominal pain

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60
Q

Inflammatory Bowel Disease: Subtypes

A

– Crohn’s disease
– Ulcerative Colitis

61
Q

Inflammatory Bowel Disease: Epidemiology

A

– Usually begins before 30
– Affects both sexes equally
– Familial tendency, especially with Crohn’s

62
Q

Crohn Disease: Description

A

– Chronic inflammatory disease
– Typically affects distal ileum & right sided colon
– But can occur in any part of GI
– Never the rectum

63
Q

Crohn’s Disease: Symptoms

A

-Chronic diarrhea-episodic*
-Chronic abdominal pain
-Fever
-Anorexia
-Weight loss
-Symptoms related to malabsorption & nutritional deficiencies (peripheral neurology, fatigue)*

64
Q

Crohn’s Disease: Other extra intestinal manifestations

A

-Inflammation: Eye, mouth/skin, joints, liver/bile
-Headaches
-Depression

65
Q

Crohn Disease: Exams

A

• Hyperactive bowel sounds possible (diarrhea)
• Tender abdomen: Guarding, rebound
• Palpable mass or fullness may be present
• Perianal disease possible

66
Q

Crohn Disease: Diagnostic Procedures

A

-Endo/colonoscopy: Can identify skip lesions
-Labs: Malabsorption (CBC, iron, ferritin, B12, folate)

67
Q

Crohn’s Disease: Lifestyle

A

-Address emotional factors
-Acupuncture
-Stop smoking

68
Q

Ulcertative Colitis: Descrption

A

-Chronic inflammation and ulcerations with intermittent bloody diarrhea

69
Q

Ulcerative Colitis affects ____ and contains no ______ or _____

A

Left sided colon; No fistulas or abcesses

70
Q

Skip lesions are possible with:

A

Crohn’s disease

71
Q

Ulcertative Colitis: Symptoms

A

-Bloody diarrhea*
-Lower abdominal pain & cramps*
-Sense of urgency to defecate
-Fever
-Nausea
-Anorexia
-Weight Loss

72
Q
  • may be described as 10-20 liquid, bloody stools & variable abdominal pain
A

Ulcerative colitis

73
Q

Ulcerative Colitis: Systemic Symptoms

A

-Fatigue
-Dehydration
-Anemias
-Joint Pain
-Rashes

74
Q

Ulcerative Colitis: Exam

A

-Increased bowel sounds (diarrhea)
-Abdominal tenderness
-Distention

75
Q

Ulcerative colitis may have findings related to other systemic sx including:

A

-Tenting of skin (dehydration)
-Anemias, rashes etc.

76
Q

Ulcerative Colitis: Diagnostic procedures

A

-Sigmoidoscopy with biopsy (will see uniform inflammation)

77
Q

Ulcerative Colitis: Prognosis

A

-Recurrent episodes “flair ups”
-Normal life expectancy

78
Q

Crohn’s vs. Ulcerative Colitis: Location

A

-Crohn’s: 80% involve small bowel & right sided colon
-Ulcerative Colitis: In large intestine only

79
Q

*Crohn’s vs. Ulcerative Colitis: Skip Lesions

A

-Crohn’s: Yes
-UC: No

80
Q

*Crohn’s vs. Ulcerative Colitis: Skip Lesions

A

-Crohn’s: Yes
-UC: No

81
Q

*Crohn’s vs. UC: Bleeding

A

-Crohn’s: Rare
-UC: Present

82
Q

Crohn’s vs. UC: Fistulas

A

Crohn’s: Fistulas, mass, abcess common
-UC: No

83
Q

Crohn’s vs. UC: Perianal lesions

A

Crohn’s: Significant
UC: Not significant

84
Q

Microscopic colitis: 2 forms

A

-Collagenous (connective tissue)
-Lymphocytic (lymphocytes)

85
Q

Microscopic Colitis: Epidemiology

A

– More common in women over 40
– Peak incidence: 60’s and 70’

86
Q

Microscopic Colitis: Associations

A

– may have other autoimmune diseases: thyroiditis, celiac, etc
– Bacterial or virus may also play a role
– Medications

87
Q

Microscopic Colitis: Risk Factors

A

– Smoking
– Medications: pain relievers, PPI, antidepressants/antianxiety

88
Q

Microscopic Colitis: Complications/Prognosis

A

– About 15% have persistent symptoms
– Diarrhea may reoccur intermittently over years
– Most resolve within 3 years
– Does not appear to increase risk for colon cancer
– Possible nutritional deficiencies?

89
Q

Microscopic Colitis: Symptoms

A

-Chronic watery non-bloody diarrhea
-Lasting from weeks to years (may have remission)

90
Q

Microscopic Colitis: Other Common Symptoms

A

– Abdominal pain & bloating
– Mild weight loss
– Nausea, weakness
– Possible fecal incontinence

91
Q

Microscopic Colitis: Exam

A

-Distention
-Increased bowel sounds
-May have tenderness
-If severe, may have signs of dehydration, malabsorption, weight loss

92
Q

Microscopic Colitis: Diagnostic Procedures

A

Endoscopy & Biopsy

93
Q

Microscopic Colitis: Lifestyle Treatment

A

• Low-fat, low-fiber diet.
• Discontinue dairy products, gluten or both.
• Avoid caffeine and sugar.

94
Q

Diverticulosis: Description

A

Mucusal herniations commonly in the distal colon

95
Q

Diverticulosis: Cause

A

• Cause: unsure
– May be result of increased bowel pressure
– Attributed to low fiber diet

-Typically asymptomatic

96
Q

Diverticulosis: Epidemiology

A

-Common after age 40

97
Q

Diverticulosis: Significant risk factor

A

Constipation

98
Q

Diverticulosis: Other risk factors

A

– Increasing age over 40
– De-conditioning & lack of exercise
– Smoking
– Obesity
– Family history

99
Q

Diverticulosis, if symptomatic will result in:

A

-LLQ pain, especially after a meal (spasm)
-Irregular bowel movement: Constipation or diarrhea
-May have bloating, gas, vomiting
-Some relief with bowel movement

100
Q

Diverticulosis: Exam

A

-Some distention and tenderness in LLQ possible (not as severe as diverticulitis)

101
Q

Diverticulosis: Diagnostic procedures

A

Scoping

102
Q

Diverticulosis: Lifestyle

A

-If asymptomatic, treat constipation
-High fiber diet (20-35g daily)

103
Q

Diverticulitis: Description

A

• Develops from diverticulosis.
-herniated mucosa has now become infected & inflamed

104
Q

Diverticulitis: Complications

A

-Abscess
-Perforation
-Peritonitis
-Bowel obstruction
-Fistulas

105
Q

Diverticulitis: Risk Factors

A

– Elderly
– Medications that might increase risk of infection

106
Q

Diverticulitis: Symptoms

A

-Acute onset of severe pain in LLQ
-Fever
-Chills as severity increases
-Constipation or diarrhea

107
Q

Diverticulitis: Exam

A

-Distended abdomen
-Tymapinic with percussion
-Palpation: muscle rigidity and guarding
-Rebound tenderness
-Palpable mass

108
Q

Diverticulitis: Diagnostic Procedures

A

-CT initially
-Colonoscopy with resolution

109
Q

Diverticulosis vs. Diverticulitis: Herniations

A

Diverticulosis: Herniations in colon
-Diverticulitis: Herniations now infect3ed

110
Q

Diverticulosis vs. Diverticulitis: Symptoms

A

Diverticulosis: Asymptomatic mostly
Diverticulitis: LLQ pain, Fever

111
Q

Colorectal Polyps: Description

A

• Fleshy growth in lining of colon or rectum

112
Q

Colorectal polyps can lead to:

A

Colorectal cancer

113
Q

Colorectal polyps is typically:

A

Asymptomatic

114
Q

Colorectal Cancer: Diagnostic Screening

A

– Digital rectal exam & fecal occult blood test
– Sigmoidoscopy, colonoscopy, barium enema

115
Q

Colorectal Cancer: Treatment

A

– Surgical through colonoscopy or sigmoidoscopy

116
Q

Colorectal Cancer: Predisposing factors

A

– Older age, African American
– Personal history of colon polyps
– History of IBD, DM
– Family history
– Certain types of diets: low fiber, high protein, fat, refined carb diet
– Other: obesity, lack of physical activity, smoking, heavy alcohol use

117
Q

Colorectal Cancer: Symptoms

A

– Persistent change in stool: consistency, diarrhea, constipation
– Blood: rectal bleeding or in stool
• For rectal cancer, bleeding with defecation
– Fatigue, weakness, severe anemia
– Unexplained weight loss

118
Q

When would you screen for colorectal cancer?

A

-Age 50
-Earlier if family history

119
Q

Colorectal Cancer: Diagnosis

A

– Early diagnosis through routine exam & screen through fecal occult blood testing
– Colonoscopy

120
Q

Anal Fissures

A

• Painful tear or crack in lining of anal canal

121
Q

Anal Fissures: Cause

A

– Trauma after passage of large, hard stool
– Or from frequent loose stools

122
Q

Anal Fissues: Risk Factors

A

– Anything causing constipation: diet, medication

123
Q

Anal Fissues: Risk Factors

A

– Anything causing constipation: diet, medication

124
Q

Anal Fissure: Signs/Symptoms (Acute)

A

• Sharp, burning or tearing pain with or after bowel movement
• Bright red blood on toilet paper
• Pain may persist for minutes to hours
• Reoccurs with next movement

125
Q

Anal Fissure: Signs/Symptoms (Chronic)

A

Intermittent bleeding

126
Q

Anal Fissure exam is used to rule out

A

Thrombosed hemorrhoid

127
Q

Anorectal Abscess

A

• Localized pus in perirectal space

128
Q

Anorectal Abscess: Symptoms

A

– pain, perianal swelling, redness, tenderness

129
Q

Anorectal Abscess: Exam

A

• Exam: DRE (tender, swelling)
– DDx: hemorrhoid

130
Q

Anorectal Abscess: Exam

A

• Exam: DRE (tender, swelling)
– DDx: hemorrhoid

131
Q

Anorectal Fistula

A

• Tubelike opening that extend from anal canal to perianal skin

132
Q

Anorectal Fistula: Sign/Symptoms

A

– Discharge and possible pain

133
Q

Ano Proctitis

A

• Inflammation of the rectal tissue

134
Q

Ano Proctitis: Possible Causes

A

– Ulcerative colitis, Crohn’s, radiation, infections (including STD’s)

135
Q

Ano Proctitis

A

– Rectal bleed (bright red and persistent)
– Changes in bowel
–mucus, mild diarrhea
– Urgency (tenesmus)

136
Q

Pruritus Ani: Symptoms

A

• Itching of perianal skin

137
Q

Pruritis Ani: Causes

A

– Crohn’s, hemorrhoids, skin disorders, infections (candida,
pinworms), hygiene
– Foods & dietary supplements: vitamin C

138
Q

Hemorrhoids

A

• Dilated veins in lower rectum

139
Q

Hemorrhoids: Epidemiology

A

– Prevalence increases with age

140
Q

Hemorrhoids: Associations

A

– Straining and constipation
– Pregnancy, obesity, IBD, etc

141
Q

Hemorrhoids: External

A

-can be thrombosed, painful, purplish

142
Q

Hemorroids: Internal

A

-bleeding after defecation, possible mucus, less painful

143
Q

Hemorrhoids: Symptoms (External)

A

-Protrusion
-Rarely bleed
-May become thrombosed

144
Q

Hemorrhoids: Symptoms (Internal)

A

– Bleeding after movement
– Not as painful as external
– May have mucus discharge or sense of incomplete evacuation

145
Q

Hemorrhoids: Treatment

A

– Stool softeners
– Sitz bath
– Anesthetic ointment
– Witch hazel

146
Q

Levator Syndrome

A

• Episodic rectal pain caused by spasm of the levator ani muscle

147
Q

Levator Syndrome: Symptoms

A

• Pain:
– Spasm lasting <20 min (brief and intense or vague ache )
– May be high in the rectum or in pelvic floor muscles
– May refer to thigh and buttock
– Can waken patient from sleep
– Can occur in clusters: occur for period of time then disappear for weeks or months
• Worsens: with sitting, bowel movements or intercourse
• Improves: with walking or standing

148
Q

Levator Syndrome: Symptoms

A

• Pain:
– Spasm lasting <20 min (brief and intense or vague ache )
– May be high in the rectum or in pelvic floor muscles
– May refer to thigh and buttock
– Can waken patient from sleep
– Can occur in clusters: occur for period of time then disappear for weeks or months
• Worsens: with sitting, bowel movements or intercourse
• Improves: with walking or standing

149
Q

Levator Ani Syndrome: Exam/Diagnosis

A

-Exclude other rectal conditions
-Levator muscle: hypertonic, tender (may be only on left)
-May have tests for infections, IBD, etc.

GIGU & Men’s Health (7 decks)

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