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Flashcards in Anorectal Disease Deck (121)
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1

Anorectal Disorders

Anal fissures
Anal fistulas
Hemorrhoids
Rectal prolapse
Pilonidal disease
Pruritus ani

2

Define Anal Fissures

Painful linear tear or crack in the distal anal canal

3

Etiology of Anal Fissures

Trauma to anal canal: defecation, straining, constipation

4

Clinical Presentation of Anal Fissures

Complaint of severe tearing pain during defecation
Mild associated hematochezia

5

PE for Anal Fissures

Visual inspection of the anus

6

Appearance of Acute Anal Fissures

Cracks in the epithelium

7

Appearance of Chronic Anal Fissures

Fibrosis & development of a skin tag

8

First-Line Treatment of Anal Fissures

Fiber supplements
Stool softeners
Sitz baths

9

Second-line Treatment of Anal Fissures

0.4% nitroglycerin ointment
Botulinum toxin (Botox)

10

SE of 0.4% Nitroglycerin Ointment

Headache
Dizziness

11

Last Option for the Treatment of Anal Fissures

Internal anal sphincterotomy

12

Location of Perianal Abscess

Anal glands at the base of the rectum become infected

13

Causes of Perianal Abscess

Anal fissure/fistulas
Hemorrhoids
Blocked anal glands

14

Risk Factors of Perianal Abscess

Colitis
IBD
DM2
Mean age: 40 y.o.
Women > Men

15

Clinical Presentation of Perianal Abscess

Constant pain
Swelling & redness around the anus
Discharge of pus around the anus
Painful bowel movements

16

Deeper Perianal Abscess Clinical Presentation

Same as "normal" perianal abscess
Fever
Chills
Malaise

17

Laboratory Studies for Perianal Abscess

Wound Cultures

18

Treatment of Perianal Abscess

I&D
Pacing & return in 24 hours
Sitz baths TID & post BM
Follow up for inspection for possible fistula formation

19

Etiology of Anal Fistula

Anorectal abscess
Crohn's
Radiation proctitis

20

Clinical Presentation of Anal Fistula

Hx of drained abscess
Anorectal pain
Purulent drainage & irritation from the skin

21

PE for Anal Fistula

Identification of external opening that drains pus, blood, or stool
DRE may express pus or stool from opening

22

Treatment of Anal Fistula

Fistulotomy
Complex fistulas: fibrin glue
fistula plug

23

Define Pruritus Ani

Perianal itching or discomfort

24

Causes of Pruritius Ani

Idiopathic
Hygiene related
Fistulas/fissures
Fecal incontinence
Parasites
Lichens sclerosis

25

PE of Pruritus Ani

Inspection may reveal anal excoriations & erythema
Hygiene issues
Thickened or leathery skin
Anoscopy

26

Treatment & Prevention for Pruritus Ani

Treat underlying cause
Avoid spicy & acidic foods
After BM, clean with wipes
Place gauze or cotton ball next to anal opening
Talcum powder
Use zinc oxide or hydrocortisone ointment

27

Define Rectal Prolapse

Painless protrusion of the rectum through the anus

28

Most Common Individuals that have Rectal Prolapse

Women >50
Infants
CF patients

29

Symptoms of Rectal Prolapse

Feeling a bulge or appearance of reddish-colored mass outside the anus
Pain in the anus or rectum
Leakage of blood or stool

30

Causes of Rectal Prolapse

Chronic constipation or diarrhea
Straining during BM
Weakness of anal sphincter
Damage to nerves
Pregnancy
Back surgery
Women >40