Surgical Disease of Anus Flashcards
What is the function of hemorrhoidal tisse?
Engorge w/ blood to cushion anal canal during defecation
How do you classifiy an internal hemorroid?
1st degree: Bleed
2nd degree: Bleed and Prolapse w/ Spontaneous reduction.
3rd degree: Bleed, prolapse and MANUAL reduction
4th degree: Bleed, prolapse, can’t be reduced
What are the symptoms of an internal hemorrhoid?
Bright red bleeding, PAINLESS unless strangulated, Sense of rectal fullness
What are the symptoms of an external hemorrhoid?
Sudden onset, Painful, Rarely bleed, Thrombose
How do you treat a hemorrhoid patient?
Diet change, increase in Fiber and Fluids
What is an anal Fissure? How do they form?
A split in the anoderm at the midline;
Forceful dilation of the anal canal during defecation exposes internal sphincter muscle. Muscle spasms in response to exposure and fails to relax w/ next dilation
What is the clinical presentation of an anal fissure?
Pain and bleeding w/ defecation. Blood on TISSUE, not in stool
What will you find during an anoscopy if you suspect anal fissure?
- Proximal hypertrophied anal papilla.
- Midline split of anoderm
- Sentinel pile at the anal verge
If you find an ulcer/fissure that is not in the midline what should you be suspicious of?
Malignancy
How do you treat anal fissures?
Stool softeners, Botulinum toxin, NO, Nifedipine
What is a Lateral internal anal sphincterotomy?
Used after other methods fail; Cut internal sphincter muscle
How is a Perianal Abscess diagnosed?
Palpable mass on rectal exam, Anal pain, Systemic sepsis
What is a fistula-in-ano?
Develops when an abscess is drained; Not a surgical emergency
Explain the Salmon-Goodsall Rule
If opening is on anterior wall of anus, the other side is straight forward through the anus.
If opening is on posterior wall of anus, the other side opens on the anterior side.
How is Pilondial Disease diagnosed?
Recurring abscess over the sacrococcygeal/perianal region.
Pain, purulent drainage, inspissated hair and induration
