PR EXAM

Question 1

What would make it almost impossible to perform

Answer 1

anal fissures extremely painful

ulcerative colitis too, could be painful due to inflammation as it commonly affects the left side, you may have ulcerations in the mucosia

Question 2

what marker is used to divide internal and external hemorrhoids

Answer 2

dentate line

Question 3

why are you asking them to cough

Answer 3

check for rectal prolapse

hemorids coming oot

good tone (ces)

Question 4

innervation of hemoroids

Answer 4

internal - visceral
external - somatic

Question 5

what may you find in UC

Answer 5

bloody finger
excess mucous

Question 6

what may you find in crones

Answer 6

skin tags
fistula
bloody finger

Question 7

normal prostate

Answer 7

walnut size
symmetrical
soft consistency (tip of the nose)

Question 8

what are you looking for when inside

Answer 8

hard stools for constipation
lumps/bumps
prostate

Question 9

HOW DOES ONE GET A ANAL FISTUAL

Answer 9

1. usually starts as an abscess and w hen that abscess pops and the pus does not drain properly it forms a tract
2. or if you have IBD esp chrones
3. rectal cancer
4. tb?

Question 10

symptoms of anal fistula

Answer 10

1.itchy
2. discharge - smell, blood, pus
Anal discomfort or pain, often exacerbated by sitting or defecation.
3. mucous
4. wet underwear from discharge
4. because an absess is usually a caus emay have systemic symptoms but may not have any signs of infection because the abscess could have drained fully?

5.What is the most important risk factor for anal fissure formation?

6. pain when defecating, sitting down

Question 11

definition of anal fistula

Answer 11

1. abnormal connection between anus and the skin (perianal )

Question 12

how would you diagnose an anal fistual

Answer 12

1. physical exam, look for the etxernal opening, redness, pus etc (you may not alwyas be able to see the external )
2. DRE - to find the internal opening
3. MRI pelvis - really good to visualize the tract is it deep? complex? ESP IN CHRONES !!!

Question 13

so to have a fistula do you need an absess

Answer 13

You don’t always have to have an anal abscess in order to develop an anal fistula, but most anal fistulas do originate from a previous or existing abscess.

Question 14

What is the most important risk factor for anal fissure formation?

Answer 14

CONSTIPATION
- HARD STOOL CAUSES TEARS

Question 15

what are some of the things you can do to treat fistula

Answer 15

fistulotomy - used mainly when it do not extend deeply into the sphincter muscles

seton string