Gi: Test 2: 14. Adelman : Basic Proctology I & Ii

Front 1

why is it important to do a digital rectal exam on a newborn?

Back 1

to make sure that the rectum and anus are joined... they are deliniated by the pectinate line

Front 2

What is the pectinate line?

Back 2

divides the endoderm from ectoderm in the anus

below: painful
above: painless

Front 3

describe the 2 sphincters of the anus

Back 3

internal: no control

external: control

Front 4

what is used to define the location of anal abscesses?

Back 4

levator ani

(either above or below)

Front 5

what is the main drain for the large intestine?

Back 5

portal system

Front 6

Bleeding with no other symptoms should always be thought of as WHAT? until proven otherwise?

Back 6

CANCER

Front 7

most common cause of rectal bleeding:?

Back 7

hemorrhoids

Front 8

what are hemorrhoids?

Back 8

mass of distended veins enclosed in a sac of redundant rectal mucosa

Front 9

external hemorrhoids are a complication of what?

Back 9

INTERNAL hemorrhoids...

you wouldn't have external without the internal

Front 10

describe the progressive nature of hemorrhoids

Back 10

hemorrhoidal veins enlarge
stretch mucosa
more space for venous dilation
veins enlarge (repeat, repeat)

Front 11

What causes hemorrhoids?

Back 11

Diet-->alcohol, beer, coffee, soda (things that irritate the veins, and increase blood supply)

Pregnancy

straining-> pushes blood downwards because there are no valves in portal system

Portal HTN

TUMORS

Front 12

big difference in portal system

Back 12

no valves, need musculature to push the blood up

Front 13

if a pt has portal HTN can you remove hemorrhoids?

Back 13

NOPE

they will bleed out

Front 14

what is the major blood supply to external hemorrhoids?

Back 14

inferior rectal a.

Front 15

Stages of Hemorrhoids? (6)

Back 15

• I: Primary Hemorrhoids –small, no distention, rare bleeding
• II: Protruding, Retractile –occasional blood Protrude with Bm retracts inside after
movement.
• III: Protruding, Reducible Protrudes with Bm- can push hemorrhoids back in and they stay until next BM
• IV: Reducible, Re-protruding Protrude out all of the time can push back inside, but they fall back out
• V: Non-reducible—can not push into rectal canal
• VI: Strangulated –Protruding, congested, edematous This is an emergency—Must operate or will strangulate and get necrosis!

Front 16

number one tx for hemorrhoids?

Back 16

CHANGE DIET

less beer/alcohol (BOO), coffee, soda, milk, fried foods

Front 17

how does pregnancy cause hemorrhoids?

***TEST

Back 17

mechanical obstruction by fetus

pushes against the superior rectal vein

pushes the blood down and doesn't allow it to get back up

Pools in the bum (2nd or 3rd trimester)

Front 18

pain all the time vs pain when pooping..consider fissure/abscess

Back 18

fissure: pain when pooping

abscess: pain all the time

Front 19

most common place for an anal fissure?

2nd?

Back 19

1st: posterior midline

2nd: anterior midline

Front 20

if a pt has a LATERAL anal fissure, what should you be thinking? (3)

Back 20

Crohn's or UC (IBD)

Trauma

note: you need to think foul play if seen in a kid

Front 21

What causes anal fissures? 5

Back 21

Hard bowel movement

Anal stenosis (narrowing of internal sphincter post tear)

Hemorrhoids

Diet

Trauma

Front 22

pt presents with PAIN, bleeding, and some burning and itching in the anus. Likely going on?

Back 22

FISSURES

Front 23

dude has some bleeding, pain, and now feels a bump/mass around the anal opening.. differential diagnosis?

Back 23

Abscess
External Thrombus
Cancer

Front 24

abscess outside, around the butt is what kind of abscess

Back 24

infra-levator

Front 25

what is an external thrombi? cause? complication of?

**

Back 25

mechanical obstruction resulting from a forceful effort to expel a constipated stool

complication of: internal hemorrhoids

• Clot forms within distended segment of superior hemorrhoidal vein
• Three layers of the blood vessel.—the Inner and middle layers rupture only the outer layer remains intact

Front 26

dude was really straining to pass a bowel movement, they have pain and a bump...what do they have?

***TEST

Back 26

external thrombi

Front 27

pt has pain, no bleeding, feel lump or mass, it is very hot and tender...what do they have??

**TEST

Back 27

ABSCESS

Front 28

how do you treat a perianal abscess

**TEST

Back 28

INCISION AND DRAINAGE

Front 29

pt has a sort of hard lump or ulcer in perianal area, may have pain, may have bleeding...what should you be thinking?

Back 29

squamous cell carcinoma

Front 30

• Greater than 60% of peri-anal tumors are

Back 30

squamous cell

Front 31

pt presents with pain, bleeding, pruritis/odor, and a lump in the groin. What do they likely have?

Back 31

squamous cell tumor

can also have:
• Ulcerating, hard, tender mass
• Rolled, everted edges with central ulceration
• Inguinal lymphadenopathy

Front 32

what are the edges like in a squamous cell tumor?

**TEST

Back 32

• Rolled, everted edges with central ulceration

Front 33

pt has a irregular ulcer in the peri anal skin with hard raised edges or a hard bluish nodule..what do they likely have?

Back 33

Basal cell tumors

prognosis is good, you just cut them out

Front 34

you see multiple small purple bumps with swelling, irritation, discharge, and blood. What are they? cause? can become?

Back 34

Condyloma

cause: HPV

can turn into squamous cell carcinoma

Front 35

what do you make sure to do whenever you have a condyloma

Back 35

BIOPSY

Front 36

Mrs. Jones come in with son, she says her boy has been itching his butt a lot especially at night..what does he have

Back 36

Puritis Ani (SYMPTOM--not a disease)

Front 37

Primary causes of puritis ani?

Back 37

worms (Enterobius)
fissures
condyloma
worms
contact dermatitis

diet is #1 secondary

Front 38

• Burning, itching, drainage, fecal soiling, soreness/pain are S.S of what?

Back 38

puritis ani

Front 39

if a kid has an itchy butt, what likely caused? how do you diagnose?

Back 39

Pin Worm (Enterobius)

Tape test (scotch tape on butthole to see if worm eggs are there)

Front 40

pt comes in with gas, abdominal cramps, and diarrhea...no organic cause, does not keep them up at night

Back 40

irritable bowel syndrome

Front 41

if someone has diarrhea, and you ask them if it keeps them up at night, and it does, what is the cause (organic/functional)

Back 41

ORGANIC

Front 42

• F:M – 2:1
• Abdominal cramping
• Bowel distension
• Constipation or Diarrhea

Back 42

Irritable Bowel

Front 43

just read the following for IBS

Back 43

Physiological Mechanisms of irritatble bowel
• Increased motility
• Nonsystematic contraction
• Increased sensitivity to pain, produced by stretch receptors in bowel wall
• Stress

Front 44

guy comes to ER, loads of pain, can sit or lay on right side, having trouble moving bowels. 102 temp, WBC high, right buttock hot, red, indurated, hard and very tender...what do they have?

***TEST

Back 44

Abscess

Ischo-rectal abscess (spelling)

Front 45

pts with supralevator, pelvi-rectal abscess will have problems with what?

Back 45

urination

Front 46

TEST QUESTION:

WHAT MUST YOU DO TO AN ABSCESS?

****

Back 46

INCISE AND DRAIN