Rectal disorders: hemorrhoids and fissures PP Week 4 Flashcards

1
Q

rectum

A

lower 10- 15cm of the large intestine

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2
Q

anatomical anal canal

A

outlet of the digestive system, tube that is 3.8 cm long running from perianal skin of the buttock to the mucosal lining of the rectum

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3
Q

internal sphincter

A

subconsciously controlled so you don’t shit yourself

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4
Q

external sphincter

A

action is voluntary, it is highly innervated (vagal nerve)

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5
Q

both sphincters

A

are highly vascular

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6
Q

where the anal canal meets the rectum there is a ring of folds

A

called the the dentate line; it separates the anal canal and the rectum and dilineates where the nerve fibers end (below is innervated/ extremely sensitive to pain, above is not)

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7
Q

within the dentate lines are

A

anal crypts which are small tube like depressions opening into the anal canal

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8
Q

veins from rectum and anus drain into

A

the portal vein, which leads to the liver, and then to the general circulation

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9
Q

the lymph vessels of the rectum drain into

A

lymph nodes in the lower abdomen

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10
Q

the lymph of the anus drain into

A

the lymph nodes in the groin

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11
Q

rectal exam

A

inspect the skin around the anus for any abnormality, with a gloved finger- probe rectum clockwise for documentation

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12
Q

an anoscope or protoscope

A

3- 10 inch rigid viewing tubes- if you palpated something on the DRE that was abnormal, use this to visualize

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13
Q

sigmoidoscope

A

longer, more flexible, can observe as much as 2 or more feet of the large intestine- would use if pt was having dark red stools

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14
Q

stop if

A

area in or around anus proves to be painful- use some type of anesthetic before continuing. ex anal ca

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15
Q

sometimes give what before a sidmoidoscopy to rid lower bowel of stool

A

cleansing enema

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16
Q

what may be obtained during sigmoidoscopy?

A

stool samples for microscopic examination and cultures

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17
Q

hemorrhoids

A

dilated, twisted (aka varicose) veins located in the wall of the rectum and anus

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18
Q

when do hemorrhoids occur

A

when veins in the rectum or anus enlarge; they may eventually bleed, may also develop a blood clot

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19
Q

internal hemorrhoids

A

above the boundary between the rectum and the anus (anorectal junction)

20
Q

eternal hemorrhoids

A

below the anorectal junction

21
Q

both internal and external hemorrhoids may

A

remain in the anus or protrude outside the anus

22
Q

hemorrhoidal bleeding

A

bleeding is actually arterial

23
Q

hemorrhoidal tissue is thought to contribute

A

to anal incontinence and functions as a compressible lining that provides complete closure of the anus

24
Q

external hemorrhoids located

A

distal to dentate line

25
internal hemorrhoids located
proximal to dentate line
26
mixed hemorrhoids are located
both proximal and distal to dentate line
27
internal hemorrhoid classification**
graded according to the degree to which they prolapse from the anal canal grade 1- viusualized on anoscopy and may buldge into the lumen but do not prolapse below dentate line grade 2- prolapse out of the canal with defecation or with straining but reduce spontaneously grade 3- prolapse out of the canal with defecation or straining, and will require manual reduction grade 4- are irreducible and may strangulate
28
most common cause of hemorrhoids
constipation
29
other causes of hemorrhoids
preggo, intreased intra- abdominal pressure (portal HTN, hep c, liver ca), hereditary, aging (d/t thinning of supportive tissue), prolonged straining
30
internal hemorrhoid-
portal venous system (heptasplenomegaly, hep c), not thrombosed
31
external hemorrhoid
systemic venous system; can become thrombosed with resultant bluish mass called external hemorrhoid
32
generalized sx of hemorrhoids
bleeding on stool or in toilet, mucosal protrusion, discharge, soiled underwear (d/t internal), sensation of incomplete evacuation, PAINLESS UNLESS THROMBOSED, bleeding from external is darker, thrombosed blood
33
sx of internal hemorrhoids
pain not a usual feature until thrombosus, infection or erosion of the overlying mucosal surface. Most pts c/o BRBPR with a feeling of vague anal discomfort which is increased when hemorrhoid enlarges or prolapses
34
prolapse internal hemorrhoid sx
edema and sphincteric spasm
35
prolapsed chronic internal hemorrhoid
constant soiling, very little pain
36
sx of external hemorrhoids
usually very painful because they lie under the skin, tender blue swelling at the anal verge d/t thrombosis of a vein in the external plexus (need not be associated with enlargement of internal veins). Spasm often occurs since the thrombus usually lies at the level of the sphinteric muscles
37
dx of internal or external hemorrhoids
is clinical; inspection, DRE, direct vision through anoscope and proctoscope
38
what position for DRE
prone, jack- knife position or lateral Sim's position
39
location of hemorrhoids should be described according to their anatomic position
using a clockwise pattern
40
**since hemorrhoids are very common,
they must not be regarded as the cause of rectal bleeding or chronic hypochromic anemia until a through investigation has been made of the more proximal GI tract
41
chronic anemia in the presence of a large but not bleeding hemorrhoid should provoke
a search for a polyp, cancer, or ulcer
42
treatment for hemorrhoids
includes medical as well as surgical modalities- medical: stool bulking agents i.e. psyllium or methylcellulose, sitz bath (probably most effective topical treatment for relief of symptoms) most hemorrhoids respond to conservative therapies such as these
43
treatment for internal hemorrhoids
if remain permanently prolapsed, best tx is surgery. Milder degrees of prolapse or enlargement with pruritis ani or intermittent bleeding can be successfully handled by banding or injection of sclerosing solutions
44
treatment for external hemorrhoids
if acutely thrombosed, treated with incision, extraction of the clot and compression of the incised area following clot removal. No surgical procedure if there is acute inflammation of the anus, ulcerative proctitis, or UC
45
what should be done before a pt is subjected to a hemorrhoidectomy
proctoscopy and barium enema
46
surgical therapy
rubber band ligation, infared photocoagulation (laser), sclerotherapy or hemorrhoidectomy (only for symptomatic combined internal and external)