rectum

Question 1

.definition of

anorectal abscess

fistula

Answer 1

anorectal abscess: result of an infection of anal duct or glands

fistula: chronic complication of an abscess, it an open tract between 2 epithelium lined areas and most commonly associated with deeper anorectal abscesses

Question 2

.sx of anorectal abscess

and fistula

Answer 2

painful swelling at anus and painful pooping/sitting, coughing

fistual may cause anal drainage and pain

fever uncommon

Question 3

.examination of deeper anorectal abscesses

Answer 3

palpated on digital rectal exam or seen on imaging studies

Question 4

sx of severe tearing when pooping, with hematochezia and bright red blood

Answer 4

anal fissure. do a sitz bath

Question 5

.stage I internal hemorrhoid

Answer 5

confined to anal canal and may bleed when pooping

Question 6

.stage II internal hemorrhoid

Answer 6

protrude from anal opening but reduce spontaneously

bleeding and mucoid discharge may occur

Question 7

.stage III internal hemorrhoid

Answer 7

require manual reduction after bowel movements.

pts may have pain and discomfort

Question 8

.stage IV internal hemorrhoids

Answer 8

chronically protruding and risk strangulation, irreducible

Question 9

.tx for stage I and II internal hemorrhoids

Answer 9

high fiber diet and increased fluids, do bulk laxatives, sitz baths, topical rectal corticosteroids prn(lido)

Question 10

pilonidal cysts

gender

common in who

rare in who

Answer 10

4 x more likely to occur in males

more common in hirsute and obese people

rare in pts older than 40 years old

Question 11

what is a pilonidal cyst

Answer 11

abscess in the sacrococcygeal cleft associated with subsequent sinus tract development

Question 12

painful and fluctuant area at the sacrococcygeal cleft

Answer 12

pilonidal cyst

Question 13

tx of pilonidal cyst

Answer 13

surgical drainage then antibx

follicle removal may be required with unroofing of sinus tracts

Question 14

complications are urinary tract obstruction, UTI, perf of colon, stercoral ulcer, fecaliths

Answer 14

fecal impaction

Question 15

a proximal fecal impaction

Answer 15

think neoplasm

Question 16

anorectal fistula presentation

Answer 16

anal discharge and pain when the tract becomes occluded

tract should not be explored on exam because this may open new tracts

Question 17

.anorectal abscess and fistula tx

Answer 17

abscess: surgical I&D, followed by WASH- warm water cleansing, analgesics, stool softeners, and high fiber diet (WASH)

fistula must be surgically treated

Question 18

.anal fissure

definition

location

sx/PE/blood color

tx

Answer 18

painful linear tear/crack in the distal anal canal

most commonly on posterior midline

severe tearing pain on defecation

hematochezia, bright red blood on TP

80% resolve spontaneously

warm water sitz baths, analgesics, high fiber diet, increased water intake, stool softeners, laxatives, mineral oil

Question 19

.dx of hemorrhoids

Answer 19

anoscopy for internal

Question 20

.stage IV hemorrhoid and those unresponsive to conservative treatment

Answer 20

injection, rubber band ligation, sclerotherapy

Question 21

headache, general sense of illness

acute confusional states

Answer 21

fecal impaction

Question 22

fecaliths can cause what

Answer 22

appendicitis

Question 23

abdominal pain, rectal discomfort, anorexia, N/V common but nonspecific

Answer 23

think fecal impaction

Question 24

incontinence of small of amounts of water and semiformed stool may occur

Answer 24

this is as leakage passes by a large fecal impaction

** do not take anti-diarrhea medication

Question 25

avoid what in a large fecal impaction

Answer 25

diarrhea medications

Question 26

how to dx a proximal fecal impaction

Answer 26

sigmoidoscopy or barium enema

Question 27

.fecal impaction tx

Answer 27

breaking up impaction digitally followed by a warm water enema(with mineral oil),
do polyeythlene glycol after

proximal impaction: sigmoidoscopic water irrigation and suction

Question 28

cause of anal cancer

common in who

sx

tx

Answer 28

HPV

common in women with HPV and people with HIV infection

particularly men that have sex with men

asymptomatic

tx is surgery

Question 29

.which hemorrhoid tends to bleed and usually painless

Answer 29

internal

Question 30

.rubber band ligation is for what

Answer 30

hemorrhoids if failed conservative tx

Question 31

.which hemorrhoid is painful and doesn’t usually bleed

Answer 31

external

Question 32

.internal hemorrhoids s/s

Answer 32

intermittent rectal bleeding, painless bright red blood per rectum.