Term
| Cushions of tissue and dilated or enlarged veins in the lower portion of the rectum or anus. |
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Definition
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Term
| What are the 2 types of hemorrhoids? |
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Definition
| Internal (both inside and above anus) and external (under the skin and around the anus) |
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Term
| Describe 1st and 2nd degree internal hemorrhoids. |
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Definition
| 1st - bleeding but no prolapse. 2nd - prolapse outside anal canal upon defecation but retract spontaneously. |
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Term
| Can 3rd or 4th degree internal hemorrhoids be manually reduced? |
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Definition
| 3rd. 4th has strangulation. |
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Term
| The major drainage of the hemorrhoidal plexus is through the ____________ which drains into the inferior mesenteric vein and portal system. |
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Definition
| Superior hemorrhoidal vein |
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Term
| What precipitating factors lead to the dev. of hemorrhoids? |
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Definition
| Inc. intra-abdominal pressure impairing venous return (pregnancy, ascites, exercise, straining, tumors) or systemic or portal venous HTN (CHF or cirrhosis) |
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Term
| What is the most significant sx of hemorrhoids? |
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Definition
| rectal bleeding (bright red blood) |
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Term
| Are internal hemorrhoids typically painful? |
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Definition
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Term
| What are conservative tx measures for hemorrhoids? |
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Definition
| High fiber diet and inc. fluid intake, Anusol HC suppositories |
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Term
| What medical txs are available for stage I, II, and III hemorrhoids w/ recurrent bleeding despite conservative measures? |
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Definition
| Rubber band ligation, sclerotherapy, or infra-red photocoagulation |
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Term
| When are surgical hemorrhoidectomies performed? |
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Definition
| Chronic severe bleeding d/t stage III or IV or acute thrombosed stage IV |
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Term
| A condition characterized by acute onset of an intensely painful and violet perianal nodule covered w/ skin. |
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Definition
| Thrombosed external hemorrhoid |
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Term
| Describe the clinical presentation in a pt w/ fecal impaction. |
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Definition
| Constipation or fecal incontinence, acute abd pain, or chronic LBO |
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Term
| What types of pts are prone to fecal impaction? |
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Definition
| Spinal cord injury, bed-bound, CVA, narcotic meds, complication of anorectal procedures |
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Term
| What is the tx for fecal impaction? |
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Definition
| 1-2 fleet enemas followed 1 hr later by mineral oil enema, manual disimpaction usu. required |
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Term
| A collection of pus in one of the anatomic spaces of the anal region resulting from blockage of the anal glands. |
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Definition
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Term
| What is the most common location of anorectal abscesses? |
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Definition
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Term
| Anorectal abscesses are usually polymicrobial but >90% will include what? |
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Definition
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Term
| Pt w/ these types of anorectal abscesses usu. present w/ fever and pain but no obvious abnormality on exam. |
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Definition
| Intersphincteric or supralevator abscess |
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Term
| An _______ abscess usu. presents as a lg. tender fluctuant mass of the buttock. |
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Definition
|
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Term
| What is the tx for anorectal abscess? |
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Definition
| Surgically draining the infected cavity |
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Term
| A complication of anorectal abscess that is an abnormal passage b/t perianal skin and the interior of the anal canal or rectum. |
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Definition
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Term
| 90% of fistula-in-ano cases are of what origin? |
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Definition
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Term
| A guide to finding the internal opening of a fistula based on the external opening. |
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Definition
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Term
| What is the conservative tx for fistula-in-ano? |
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Definition
| fibrin adhesive injection |
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Term
| What is the surgical tx for uncomplicated fistulas? |
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Definition
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Term
| A longitudinal cut in the anoderm causing a painful linear ulcer at the margin of the anus. |
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Definition
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Term
| 90% of anal fissures occur in the _______ and 10% occur in the ________. |
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Definition
| Posterior midline. Anterior midline. |
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Term
| What diseases may cause lateral anal fissures? (6) |
|
Definition
| 1)Crohn's 2)TB 3)Syphilis 4)Anal CA 5)Leukemia 6)HIV |
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Term
| What is the typical c/o in pts w/ anal fissures? |
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Definition
| Severe pain, c/o passing "razor blades" |
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Term
| What classic triad of s/sx on PE is considered diagnostic for anal fissures? |
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Definition
| Tender, skin tag distal to fissure, hypertrophied anal papilla |
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Term
| What dietary modification is rec. for anal fissure? |
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Definition
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Term
| What meds are used to tx anal fissure? |
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Definition
| Sitz baths, stool softeners, Anusol HC or Canasa (mesalamine), nitroglycerin cream 0.2%, CCB |
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Term
| what is the standard tx for chronic anal fissure? Post-partum tx? |
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Definition
| Lateral anal sphincterectomy. Advancement flap. |
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Term
| Are pilonidal cysts more common in men or women? What age does infection MC occur? |
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Definition
| Men 4:1. Puberty and 30yo. |
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Term
| Pilonidal cysts are AKA what? |
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Definition
| Jeep Rider's dz (repeated trauma to the gluteal region) |
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Term
| Name 3 predisposing factors to pilonidal cysts. |
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Definition
| Obesity, body hair in the area, sedentary lifestyle |
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Term
| What are the sx of pilonidal cysts? |
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Definition
| Asymptomatic unless infected - can cause abscess - fistula |
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Term
| How can the first episode of pilonodal cysts be treated? |
|
Definition
| Cephalexin (Keflex) or Amoxicillin-clavulanate (Augmentin) |
|
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Term
| what is the only way to cure pilonodal cysts? |
|
Definition
| Surgery (open-technique*, closed marsupialization, Z-plasty) |
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Term
| What is the MC STD of the anus and rectum? |
|
Definition
| Condylomata Acuminata (anal or perianal warts) |
|
|
Term
| What is the etiologic agent for anal warts? |
|
Definition
| HPV - 6 and 11 most common |
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Term
| What subtypes of HPV are associated w/ squamous cell CA? |
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Definition
|
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Term
| What are the sx of anal warts? |
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Definition
| Pruritis. Rarely bleed or painful. |
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Term
| What med that is cytotoxic to condylomas can be used to tx HPV? What can they not be used for? |
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Definition
| Podophyllin. Anal canal lesions. |
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Term
| Who are the majority of pts that present w/ anal CA? |
|
Definition
| Women in 7th decade present w/ bright red stools and pain |
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Term
| What type of CA makes up the majority of all primary CA of the anus? |
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Definition
|
|
Term
| What is used to dx and tx anal CA? |
|
Definition
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