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46 Cards in this Set

  • Front
  • Back
why is it important to do a digital rectal exam on a newborn?
to make sure that the rectum and anus are joined... they are deliniated by the pectinate line
What is the pectinate line?
divides the endoderm from ectoderm in the anus

below: painful
above: painless
describe the 2 sphincters of the anus
internal: no control

external: control
what is used to define the location of anal abscesses?
levator ani

(either above or below)
what is the main drain for the large intestine?
portal system
Bleeding with no other symptoms should always be thought of as WHAT? until proven otherwise?
most common cause of rectal bleeding:?
what are hemorrhoids?
mass of distended veins enclosed in a sac of redundant rectal mucosa
external hemorrhoids are a complication of what?
INTERNAL hemorrhoids...

you wouldn't have external without the internal
describe the progressive nature of hemorrhoids
hemorrhoidal veins enlarge
stretch mucosa
more space for venous dilation
veins enlarge (repeat, repeat)
What causes hemorrhoids?
Diet-->alcohol, beer, coffee, soda (things that irritate the veins, and increase blood supply)


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

Portal HTN

big difference in portal system
no valves, need musculature to push the blood up
if a pt has portal HTN can you remove hemorrhoids?

they will bleed out
what is the major blood supply to external hemorrhoids?
inferior rectal a.
Stages of Hemorrhoids? (6)
• I: Primary Hemorrhoids –small, no distention, rare bleeding
• II: Protruding, Retractile –occasional blood Protrude with Bm retracts inside after
• 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!
number one tx for hemorrhoids?

less beer/alcohol (BOO), coffee, soda, milk, fried foods
how does pregnancy cause hemorrhoids?

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

abscess: pain all the time
most common place for an anal fissure?

1st: posterior midline

2nd: anterior midline
if a pt has a LATERAL anal fissure, what should you be thinking? (3)
Crohn's or UC (IBD)


note: you need to think foul play if seen in a kid
What causes anal fissures? 5
Hard bowel movement

Anal stenosis (narrowing of internal sphincter post tear)



pt presents with PAIN, bleeding, and some burning and itching in the anus. Likely going on?
dude has some bleeding, pain, and now feels a bump/mass around the anal opening.. differential diagnosis?
External Thrombus
abscess outside, around the butt is what kind of abscess
what is an external thrombi? cause? complication of?

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

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

how do you treat a perianal abscess

pt has a sort of hard lump or ulcer in perianal area, may have pain, may have bleeding...what should you be thinking?
squamous cell carcinoma
• Greater than 60% of peri-anal tumors are
squamous cell
pt presents with pain, bleeding, pruritis/odor, and a lump in the groin. What do they likely have?
squamous cell tumor

can also have:
• Ulcerating, hard, tender mass
• Rolled, everted edges with central ulceration
• Inguinal lymphadenopathy
what are the edges like in a squamous cell tumor?

• Rolled, everted edges with central ulceration
pt has a irregular ulcer in the peri anal skin with hard raised edges or a hard bluish nodule..what do they likely have?
Basal cell tumors

prognosis is good, you just cut them out
you see multiple small purple bumps with swelling, irritation, discharge, and blood. What are they? cause? can become?

cause: HPV

can turn into squamous cell carcinoma
what do you make sure to do whenever you have a condyloma
Mrs. Jones come in with son, she says her boy has been itching his butt a lot especially at night..what does he have
Puritis Ani (SYMPTOM--not a disease)
Primary causes of puritis ani?
worms (Enterobius)
contact dermatitis

diet is #1 secondary
• Burning, itching, drainage, fecal soiling, soreness/pain are S.S of what?
puritis ani
if a kid has an itchy butt, what likely caused? how do you diagnose?
Pin Worm (Enterobius)

Tape test (scotch tape on butthole to see if worm eggs are there)
pt comes in with gas, abdominal cramps, and diarrhea...no organic cause, does not keep them up at night
irritable bowel syndrome
if someone has diarrhea, and you ask them if it keeps them up at night, and it does, what is the cause (organic/functional)
• F:M – 2:1
• Abdominal cramping
• Bowel distension
• Constipation or Diarrhea
Irritable Bowel
just read the following for IBS
Physiological Mechanisms of irritatble bowel
• Increased motility
• Nonsystematic contraction
• Increased sensitivity to pain, produced by stretch receptors in bowel wall
• Stress
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?


Ischo-rectal abscess (spelling)
pts with supralevator, pelvi-rectal abscess will have problems with what?