rectum Flashcards
.definition of
anorectal abscess
fistula
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
.sx of anorectal abscess
and fistula
painful swelling at anus and painful pooping/sitting, coughing
fistual may cause anal drainage and pain
fever uncommon
.examination of deeper anorectal abscesses
palpated on digital rectal exam or seen on imaging studies
sx of severe tearing when pooping, with hematochezia and bright red blood
anal fissure. do a sitz bath
.stage I internal hemorrhoid
confined to anal canal and may bleed when pooping
.stage II internal hemorrhoid
protrude from anal opening but reduce spontaneously
bleeding and mucoid discharge may occur
.stage III internal hemorrhoid
require manual reduction after bowel movements.
pts may have pain and discomfort
.stage IV internal hemorrhoids
chronically protruding and risk strangulation, irreducible
.tx for stage I and II internal hemorrhoids
high fiber diet and increased fluids, do bulk laxatives, sitz baths, topical rectal corticosteroids prn(lido)
pilonidal cysts
gender
common in who
rare in who
4 x more likely to occur in males
more common in hirsute and obese people
rare in pts older than 40 years old
what is a pilonidal cyst
abscess in the sacrococcygeal cleft associated with subsequent sinus tract development
painful and fluctuant area at the sacrococcygeal cleft
pilonidal cyst
tx of pilonidal cyst
surgical drainage then antibx
follicle removal may be required with unroofing of sinus tracts
complications are urinary tract obstruction, UTI, perf of colon, stercoral ulcer, fecaliths
fecal impaction
a proximal fecal impaction
think neoplasm
anorectal fistula presentation
anal discharge and pain when the tract becomes occluded
tract should not be explored on exam because this may open new tracts
.anorectal abscess and fistula tx
abscess: surgical I&D, followed by WASH- warm water cleansing, analgesics, stool softeners, and high fiber diet (WASH)
fistula must be surgically treated
.anal fissure
definition
location
sx/PE/blood color
tx
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
.dx of hemorrhoids
anoscopy for internal
.stage IV hemorrhoid and those unresponsive to conservative treatment
injection, rubber band ligation, sclerotherapy
headache, general sense of illness
acute confusional states
fecal impaction
fecaliths can cause what
appendicitis
abdominal pain, rectal discomfort, anorexia, N/V common but nonspecific
think fecal impaction
incontinence of small of amounts of water and semiformed stool may occur
this is as leakage passes by a large fecal impaction
** do not take anti-diarrhea medication
avoid what in a large fecal impaction
diarrhea medications
how to dx a proximal fecal impaction
sigmoidoscopy or barium enema
.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
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
.which hemorrhoid tends to bleed and usually painless
internal
.rubber band ligation is for what
hemorrhoids if failed conservative tx
.which hemorrhoid is painful and doesn’t usually bleed
external
.internal hemorrhoids s/s
intermittent rectal bleeding, painless bright red blood per rectum.
