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31 Cards in this Set
- Front
- Back
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dentate line
-aka -definition |
- pectinate line
- divides the anorecum into two portions - junction b/w the columnar epithelium of the rectum and the anoderm |
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what is in the proximal portion of the dentate line
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- few sensory innervations, columnar epi, and columns of morgagni
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Columns of morgagni
- what do they become continuous with? |
- longitudinal folds in the proximal portion of the dentate line
- anal crypts |
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what usually originate in anal crypts?
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- perirectal abscesses
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what does the portion distal to dentate line have?
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many more sensory inervations and is lined w/ stratified squamous epithelium
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internal hemorrhoids
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- hemorrhoids that arise **above** the dentate line
- covered by insensitive rectal mucosa - usually **not painful** |
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how do internal hemorrhoids present?
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- discomfort, bleeding, prolapse
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external hemorrhoids
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- arise **below** the dentate line
- covered by anoderm - are often **painful** due to large amounts of sensory innervations in the area |
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how do external hemorrhoids present?
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severe pain, especially when thrombosis develops
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hemorrhoid grading:
I |
I - no prolapse
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hemorrhoid grading:
II |
II - occasional prolapse w/ spont reduction after defecation
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hemorrhoid grading:
III |
III - prolapse w/ straining, coughing; frequently required manual reduction
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hemorrhoid grading:
IV |
IV - chronically prolapsed; cannot be reduced
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treatment of non-serious hemorrhoids
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- most can be treated **conservatively** w/:
- stool softners - stool bulking agents - sitz baths - topical anesthetics |
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what is done if conservative treatment fails?
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recurring hemorrhoids tx'd w/ **rubber band ligation**
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what is rubber band ligation?
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hemorrhoid's base is tightly bound by a rubber band and the hemorrhoid undergoes necrosis and falls off
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what is done for serious prolapsing hemorrhoids (stages III & IV)
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surgery is necessary:
-**hemorrhoidectomy -**staple hemorrhoidectomy |
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which surgical technique is preferred?
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*hemorrhoidectomy
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staple hemorrhoidectomy
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- circular strip of mucosa is excised w/ a handheld device that is a mix b/w a mechanical scalpel & surgical stapler
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what are two types of rectal abscesses?**
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1. infralvevator (common)**
2. supralevator (rare, but worse)** |
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infralevator
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- common
- includes perianal, ischiorectal, and postanal abscesses |
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supralevator
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- rare, but worse
- include postrectal and pelvirecctal abscesses |
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what do rectal abscesses develop from?
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**infected anal crypts**
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where can rectal abscesses spread to?
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subQ, submucosal, and intramuscular perirectal regions of rectum
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MC symptoms of rectal abscesses
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pain, but if systemic signs, physician should suspect a supralevator abscess
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how are supralevator abscesses confirmed?
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by needel aspiration of pus under local anesthesia
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what is done for "pointing" (bulging) abscesses?
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inject local anesthesia, excise as wide as the fluctuant area, and then drain the abscess
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what else can produce recurrent abscesses?
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recurrent fistula obstruction
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what is a fissure-in-ano?
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painful, linear ulcer at the anal margin
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what are the cardinal signs of a fissure-in-ano?
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- hx of constipation, diarrhea, anxiety
- a/w crypt infxn, **enlarged papilla, sking tags**, narrow anal canals - recent anal sx, proctitis, basal cell carcinoma of anus |
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cardinal sings of fissure-in-ano pt 2
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- disproportionately intense pain that occurs @ defectation & persists for hrs
- **small amts of bright red blood unmixed w/ stool** - usually single - usually clear, punched out, not large/indolent |
