This is a video on anorectal disorders.
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ADDITIONAL TAGS:
Anorectal disorders
Fecal incontinence
Hemorrhoids
Anal fistula
Anal fissure
Pilonidal cyst
Rectal
prolapse
Anal cancer
Perianal abscess
By Waterced - [ Ссылка ], CC BY-SA 4.0, [ Ссылка ]
Fecal incontinence
Def: recurrent uncontrolled passage of fecal material ( 10 mL) for 1 month in people 3 years old
Dx: Clinical, history. Consider flexible sigmoidoscopy or anoscopy. Definitive test is manometry
Tx: medical (fiber or other bulking agents), biofeedback (muscle strengthening, control exercises), injections (dextranomer/hyaluronic acid), or surgery
Hemorrhoids
Dilation of the submucosal layer (purple or blue bulge) within the anorectum
Risk factors: constipation, old age, straining, prolonged sitting (increased venous hypertension)
Sx: bleeding (BRBPR=internal), itching, burning/pain (external), asymptomatic (40%)
Dx: usually clinical. Best test is anoscopy
Tx: dietary changes (hydration, fiber, stool softeners, reduced fat/alcohol); regular exercise; sitz bath; topical steroids + anesthetics → internal hemorrhoid ligation → surgery (hemorrhoidectomy)
By WikipedianProlific and Mikael Häggström - File:Hemorrhoid.png by WikipedianProlific, CC BY-SA 3.0, [ Ссылка ]
Fecal incontinence
Pathophys: occlusion of anal crypt gland → bacterial overgrowth → formation of abscess (collection of pus) near the anus.
Risk factors: Crohn’s, diabetes, steroids
Sx: discomfort when wiping → severe pain +/- systemic signs (fever). Red, tender, fluctuant mass on the skin.
Tx: I&D. Systemic abx decrease recurrent and fistula formation (given to high risk patients with diabetes, systemic illness [fever, cellulitis])
By McortNGHH - Own work, CC BY-SA 4.0, [ Ссылка ]
Perianal
abscess
Anorectal fistula (fistula in ano)
Abnormal communication between epitheliaized surface of anal anal and external peranal skin. Caused by chronic inflammation (perianal abscess, IBD, cancer, radiation, infxn)
Sx: discharge (pus, serous fluid, fecal matter, +/-blood, +/- foul smelling); skin maceration; itching
If infected → pain, swelling, fever
Dx: clinical. +/- imaging: fistulogram, MRI, endosonography.
Tx: manage inflammation. Surgery (fistulotoma) helps, but they can recur (from residual fistula tracts).
By McortNGHH - Own work, CC BY-SA 4.0, [ Ссылка ]
Anal fissure
Mucosal tear. Can be caused by: tight sphincter + large caliber stool; prolonged diarrhea; anal sex; IBD; malignancy
Sx: pain with defection; BRBPR. Tear visible on exam, usually on posterior midline anus, +/- skin tag at distal end
Tx: sitz bath, topical lidocaine, nitroglycerin paste, botulism to relax sphincter, fiber. Surgically release tension (lateral internal sphincterotomy)
Infected follicle on the lower back (butt crack) creates a cyst. Occurs with hairy back/butt and prolonged sitting (often makes 15-30 years old, obese, sedentary, deep gluteal clefts).
Sx: pain (worse with bending down), fluctuant mass 4-5 cm above the anus in intergluteal region. +/- drainage (mucoid, pus, blood).
Dx: clinical
Tx: drain and resect; also excise sinus tracts.
By Jonathanlund - Own work, CC BY-SA 4.0, [ Ссылка ]
Risk: age 40; multiparous women; prior pelvic surgery; constipation, straining; stroke, dementia
Sx: straining, fecal incontinence, abd pain/discomfort. Digital maneuver required to pass stool.
Exam: Mass protruding through anus, increases in size with Valsalva. concentric rings = full-thickness prolapse
Dx: clinical
Tx for small prolapse: medical (fiber, hydration); biofeedback (pelvic floor strengthening)
Tx for large prolapse: surgery (rectopexy)
A. full thickness external rectal prolapse.
Circumferential arrangement of folds
B. mucosal prolapse. Radial folds
By [ Ссылка ], Public Domain, [ Ссылка ]
Anal cancer
Cancer that arises in the anus; usually squamous cell carcinoma
Risk: HPV, smoking, HIV/AIDs, receptive anal sex
Sx: Pain, pressure in the anus; change in bowel habits; bleeding, itching, discharge
Dx: anal pap for high risk patients; biopsy
Tx: Nigro protocol (5-fluorouracil and mitomycin and medical radiation); resection if necessary
By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, [ Ссылка ]
