rectum Flashcards

1
Q

.definition of

anorectal abscess

fistula

A

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

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2
Q

.sx of anorectal abscess

and fistula

A

painful swelling at anus and painful pooping/sitting, coughing

fistual may cause anal drainage and pain

fever uncommon

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3
Q

.examination of deeper anorectal abscesses

A

palpated on digital rectal exam or seen on imaging studies

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4
Q

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

A

anal fissure. do a sitz bath

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5
Q

.stage I internal hemorrhoid

A

confined to anal canal and may bleed when pooping

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6
Q

.stage II internal hemorrhoid

A

protrude from anal opening but reduce spontaneously

bleeding and mucoid discharge may occur

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7
Q

.stage III internal hemorrhoid

A

require manual reduction after bowel movements.

pts may have pain and discomfort

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8
Q

.stage IV internal hemorrhoids

A

chronically protruding and risk strangulation, irreducible

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9
Q

.tx for stage I and II internal hemorrhoids

A

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

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10
Q

pilonidal cysts

gender

common in who

rare in who

A

4 x more likely to occur in males

more common in hirsute and obese people

rare in pts older than 40 years old

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11
Q

what is a pilonidal cyst

A

abscess in the sacrococcygeal cleft associated with subsequent sinus tract development

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12
Q

painful and fluctuant area at the sacrococcygeal cleft

A

pilonidal cyst

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13
Q

tx of pilonidal cyst

A

surgical drainage then antibx

follicle removal may be required with unroofing of sinus tracts

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14
Q

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

A

fecal impaction

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15
Q

a proximal fecal impaction

A

think neoplasm

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16
Q

anorectal fistula presentation

A

anal discharge and pain when the tract becomes occluded

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

17
Q

.anorectal abscess and fistula tx

A

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

fistula must be surgically treated

18
Q

.anal fissure

definition

location

sx/PE/blood color

tx

A

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

19
Q

.dx of hemorrhoids

A

anoscopy for internal

20
Q

.stage IV hemorrhoid and those unresponsive to conservative treatment

A

injection, rubber band ligation, sclerotherapy

21
Q

headache, general sense of illness

acute confusional states

A

fecal impaction

22
Q

fecaliths can cause what

A

appendicitis

23
Q

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

A

think fecal impaction

24
Q

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

A

this is as leakage passes by a large fecal impaction

** do not take anti-diarrhea medication

25
avoid what in a large fecal impaction
diarrhea medications
26
how to dx a proximal fecal impaction
sigmoidoscopy or barium enema
27
.fecal impaction tx
breaking up impaction digitally followed by a warm water enema(with mineral oil), do polyeythlene glycol after proximal impaction: sigmoidoscopic water irrigation and suction
28
cause of anal cancer common in who sx tx
HPV common in women with HPV and people with HIV infection particularly men that have sex with men asymptomatic tx is surgery
29
.which hemorrhoid tends to bleed and usually painless
internal
30
.rubber band ligation is for what
hemorrhoids if failed conservative tx
31
.which hemorrhoid is painful and doesn't usually bleed
external
32
.internal hemorrhoids s/s
intermittent rectal bleeding, painless bright red blood per rectum.