proctology Flashcards
the rectum and anal canal start at level ___ and is ___cm in length
S3; 12-15cm
the midpoint of the anal canal has an undulating demarcation known as
dentate line
the dentate line is __cm from the anal verge
2
the dentate line takes a ___ appearance
pleated
T/F: the anal canal consists of epithelium of different types at different levels
true
there are 6-14 folds within the dentate line known as
columns of morgagni
between the columns of morgagni at the lower end there is a small pocket known as
crypts
___ are of surgical significance as foreign material may lodge in them, obstructing the ducts of the anal gland and result in abscesses
crypts
what are 5 muscles of the rectum
internal sphincter, conjoined longitudinal muscle, external sphincter, and levator ani, puborectalis
___ muscle is at the anorectal ring, this muscle coats the rectum and is joined by fibers from the levator ani and puborectalis muscles. It descends between the internal and external anal sphincters. Function is to affix the anal canal and evert the anus during defecation
conjoined longitudinal muscle
Lowest portion of the external sphincter is below and lateral to the internal sphincter. There is a palpable groove at this level and is referred to as the
intersphincteric groove.
____ is a broad thin muscle that forms the greater part of the floor of the pelvic cavity and is innervated by S4
levator ani
___ is the standard position when discussing anorectal disease and treatment
left lateral sims
____is a small tear in the thin, moist tissue (mucosa) that lines the anus.
anal fissure
___ are Areas of hypertrophied cutaneous tissue located adjacent to the anus, MC posterolateral quadrants of the anus
skin tags
___ is an unpleasant cutaneous sensation (various degrees of itching). Men MC 4:1. Perianal skin becomes thin, friable, tender, blistered, ulcerated, and weeping. In later stages, the skin is raw, red, and oozing or pale and thickened (lichenified)
pruritus ani
T/F pruritus ani can be caused by antibiotics/ overuse of topical steroids
true
T/F pruritus ani can be caused by diet
true: coffee, chocolate, tomatoes, spicy food, citrus
There are areas in the anal canal that are highly vascular masses of thick submucosa with smooth muscle and elastic connective tissue (cushions). ____are a sliding downward of this part of the anal canal lining.
Hemorrhoids
T/F hemorroids are still a problem even if no symptoms
false
what are 4 types of hemorroids
internal, external, mixed or strangulated
75% of frank bleeding from bowel is due to what condition
internal hemorrhoids
what does 1st degree internal hemorrhoids look like
no protrusion but bulge into lumen of rectal canal
2nd degree internal hemorrhoids do what
protrude at stool & reduce spontaneously
3rd degree internal hemorrhoids protrude at stool like 2nd degree, but…
must be manually reduced
4th degree hemorrhoids also protrude at stool, but..
can not be reduced
treatment of hemorrhoids include
diet, education, stool softener, suppositories, hot sitz baths.. can also use rubber band ligation
___ is a painful linear ulcer situated in the anal canal and extends below the dentate line to the margin of the anus. Very common
Symptoms: pain for 30min-hours after defecation, frank bleeding, constipation, dysuria
Affects men and women with most located mid-line posterior
fissure in ano
a lateral fissure can be indicative of ___
severe systemic disease
___ can mimic any condition- often confused with cancer and crohns
Schistosomiasis
___ is a sexually transmitted disease of the anorectum that is due to papilloma virus. Cauliflower like masses that are often soft, friable, and bleed easily. 1-6mo incubation period and transmittable. Bleeding and pruritus ani may be only symptoms. Definitive dx made by dark field exam that will demonstrate spirochetes. Treatments include: podophyllin, surgical excision, electro desiccation, cryotherapy, and US.
Condylomata acuminata
T/F: any chronic unhealed ulcer should be considered as potentially squamous cell carcinoma
true
____ is an abnormal communication between the anal canal and perianal skin
fistula in ano
90% of fistula in ano originate in ___ with greatest conc of this area located in posterior aspect of anal canal
crypts of morgagni
___ is an acute manifestation while the fistula is a chronic situation. Will have acute pain and swelling. Pain increased with sitting, movement, defecation, coughing, sneezing. Usually history includes diarrhea. Symptoms also include malaise and pyrexia
abscess
MC benign condition of the large bowl is..
polyps
T/F neoplastic polyps are found with carcinoma
true
MC complaint area of IBS
lower GI
MC lesion that exists between the anus and isch tub
abscess
complication of keesay method
bleeding
what is keesay method treatment for
internal hemorroid
3 common tests for GI
spect, colonoscopy, manual inspection
another name for the dentate line
pectinate line
what does the pectinate line divide
the upper 2/3 from the lower 1/3 rectum
HPV treatment options
electrosurgery / excision, freezing, topicals
what is the purpose of the prostate
makes fluid that combined with sperm cells from the testicles makes semen
what are s/s of pinworm
pinworm MC in kids (5-10yo) and easily spread. S/S= itching pain rash and presence in stool
what is tenesmus
recurrent inclination to evacuate bowels, pain/cramping- feeling urge even after defication
what causes tenesmus
inflammatory bowel disease MC: Chrons and UC
what can you palpate on DRE
prostate, uterus, ovaries, and sometimes the bladder
if the prostate feels boggy, soft, non-tender, might have
BPH
if prostate is painful with palpation could be
prostatis
if prostate feels rock hard what is a likely dx
cancer
what is the median sulcus
on prostate and separates the 2 lateral lobes
another name for the median sulcus is
longitudinal groove
what does the prostate encircle
the urethra
where is the prostate location in relation to the bladder
just inferior
diabetes can cause what condition/complication with relation to the anus
puritis ani -> bleeding and anal fissures -> abcess??
patients require transrectal US guided biopsy if have one of these 3 scenarios (relation to PSA lvls and DRE findings)
- PSA 4-10ng/ml with abnormal DRE
- PSA >10ng/ml- regardless DRE
- palp nodule on DRE regardless of PSA
normal feel of a prostate with DRE
rubbery and walnut sized
DRE of prostatitis is pain but could also feel how
soft and boggy
what is prostatitis
inflammation of the prostate (25% GU concerns from young-mid age men)
is prostatitis symptomatic? *
acute- yes; chronic can be asymptomatic…. MC LBP
what is a risk factor for prostatitis (another health condition)
diabetes
T/F: bacterial prostatitis has SUDDEN onset
yes
what causes bacterial prostatitis and most UTIs
escherichia coli
____ has S/S like prostatitis, can be due to msl spasm and like nerve entrapment
prostadynia
what is another name for chronic pelvic pain syndrome (CPPS)
prostadynia
what is BPH
benign prostate hyperplasia
T/F BPH can lead to prostate cancer
no; its benign… but they can co-exist (does not increase risk)
where does BPH happen
in transitional zone
do patients with BPH have symptoms
20% do
what are some symptoms of BPH
can block lower urinary tract, interrupt stream, cause hesitation, and urgency
what can cause an increased PSA besides cancer?
BPH, recent DRE (for 2 days!), and prostatitis
what does PSA stand for
prostate specific antigen
a PSA of 0-4 is considered…
normal*
PSA level 4-10 is considered
slightly increased; 10-20 moderately
what PSA level is considered severe increase
20-35
T/F PSA varies with age
yes; it increases- so there will be different norms per age gp *
what is finasteride
a treatment used for BPH
another name for finasteride
PROSCAR
what is the difference between finasteride and alpha blocker that can also be used to treat BPH
finasteride will decrease size of prostate as well as help with symptoms. alpha blocker has no effect on size
what are 3 surgery options available for BPH
TURP (core out), laser, prostatectomy
what are some risk factors for developing prostate cancer
over 50yo; african american, family hx, smoking, diet/weight, and vasectomy might
what is a supplemental option that can treat BPH without affecting PSA levels
saw palmetto
____ causes prostate to feel like “pebble”
cancer
T/F: prostate cancer can cause urinary obstruction
false
why doesn’t prostate cancer affect urinary tract like BPH?
cancer usually is peripheral, not central
what are some S/S of prostate cancer
blood in urine/semen, pain in back, hips, and thighs
what percent of prostate cancer is asymptomatic
47%
why is prostate cancer so serious
can met to bone
what is bisphosphonates (fosamax) used to treat
helps increase bone density and slows loss of bone density
what medication can be used to help decrease risk of fracture from met to bone
fosamax
T/F cyrosurgery is an option for prostate cancer
yes
MC type of prostate cancer
adenocarcinoma
____ is a score used to evaluate tissue samples from a tumor and determine how progressed the tumor is/malignant
Gleason score
T/F: gleason score of 1-5 is bad
false- it is low risk; over 10 is increased risk
finestride (used to treat BPH) can also be used to treat,,,
prostadynia
T/F: penile cancer and prostate cancer are related
no
another name for hemorroids
piles
what are hemorroids
swelling of veins in the lower part of the rectum
