Anorectal disorders: Difference between revisions

Latest revision as of 15:56, 23 April 2025

Background

Anatomy of the anus and rectum.

Anatomy of the anus.

The interior of the anal cami and lower part of the rectum, showing the anal columns and the anal valves between their lower ends (columns in image numerous than typical).

Coronal section of rectum and the anal canal.

Clinical Features

Visual Diagnosis

Differential Diagnosis

Anorectal Disorders

Anal fissure
Anal fistula
Anal malignancy
Anal tags
Anorectal abscess
Coccydynia
Colorectal malignancy
Condyloma acuminata
Constipation
Crohn's disease
Cryptitis
GC/Chlamydia
Fecal impaction
Hemorrhoids
- Internal hemorrhoid
- External hemorrhoid
Levator ani syndrome
Pedunculated polyp
Pilonidal cyst
Proctalgia fugax
Proctitis
Pruritus ani
- Enterobius (pinworms)
Rectal foreign body
Rectal prolapse
Syphilitic fissure

Non-GI Look-a-Likes

Prostatitis

Evaluation

Algorithmic Diagnostic Approach

Pain
- Bleeding
  - External hemorrhoid
  - Prolapsed internal hemorrhoid
  - Anal Fissure
    - Off midline = cancer, HIV, TB, Crohn's
- No bleeding
  - Swelling
    - Anorectal abscess
      - Perirectal
      - Ischiorectal
      - Intersphincteric
      - Supralevator
    - Pilonidal cyst
    - Anal fistula
    - Hidradenitis suppurativa
  - No swelling
    - Proctalgia fugax
No pain
- Bleeding
  - Cancer
  - Internal hemorrhoid
- Swelling
  - Itch: Condyloma acuminata
  - No itch: Rectal prolapse
- Itching
  - Discharge: Proctitis
  - No discharge: Pruritus Ani

Management

Disposition

External Links

References

Authors:

@@ Line 1: / Line 1: @@
-==Anal Tags==
+==Background==
-*Minor projections of skin at anal verge
+[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]]
-*Sometimes represent residuals of prior hemorrhoids
+[[File:Human anus-en.png|thumb|Anatomy of the anus.]]
-*Usually asymptomatic
+[[File:Gray1080.png|thumb|The interior of the anal cami and lower part of the rectum, showing the anal columns and the anal valves between their lower ends (columns in image numerous than typical).]]
-**Inflammation may cause itching and pain
+[[File:Gray1078.png|thumb|Coronal section of rectum and the anal canal.]]
-*Skin tags covering anal crypts, fistulas, and fissures are "sentinel tags"
-**Surgical referral for excision and/or biopsy is warranted
-*Inflammatory bowel disease may be associated with skin tag formation
-==[[Hemorrhoids]]==
+==Clinical Features==
+==Visual Diagnosis==
+<gallery mode="packed">
+File:PMC2653786 ijmsv06p0077g13.png|[[Anal tags]]
+File:DSCB4096(anal worms or just toilet paper remainders@).jpg|[[Enterobius]] (pinworms)
+File:M 44 anus 22.jpg|[[External hemorrhoid]]
+File:Anal fissure 2.jpg|[[Anal fissure]]
+File:SOA-Condylomata-acuminata-around-anus.jpg|[[Anal warts]]
+File:Perianalabscess.jpg|[[Perianal abscess]]
+File:Hemrrhoids 05.jpg|[[Internal hemorrhoid]] with prolapse
+File:Pilonidal abscess.jpg|[[Pilonidal cyst]]
+File:Full thickness rectal prolapse & mucosal prolapse..jpg|[[Rectal prolapse]]
+</gallery>
-==Cryptitis==
+==Differential Diagnosis==
+{{Anorectal DDX}}
+==Evaluation==
+===Algorithmic Diagnostic Approach===
+*Pain
+**Bleeding
+***External [[hemorrhoid]]
+***Prolapsed internal [[hemorrhoid]]
+***[[Anal Fissure]]
+****Off midline = cancer, [[HIV]], [[TB]], [[Crohn's]]
+**No bleeding
+***Swelling
+****[[Anorectal abscess]]
+*****Perirectal
+*****Ischiorectal
+*****Intersphincteric
+*****Supralevator
+****[[Pilonidal cyst]]
+****[[Anal fistula]]
+****Hidradenitis suppurativa
+***No swelling
+****[[Proctalgia fugax]]
+*No pain
+**Bleeding
+***Cancer
+***Internal [[hemorrhoid]]
+**Swelling
+***Itch: [[Condyloma acuminata]]
+***No itch: [[Rectal prolapse]]
+**Itching
+***Discharge: [[Proctitis]]
+***No discharge: [[Pruritus Ani]]
+==Management==
+==Disposition==
+==See Also==
+*[[Diagnoses by Body Part (Main)]]
+==External Links==
+==References==
+==References==
+<references/>
-==Diagnosis==
-===Pain and Bleeding===
-#external hemorrhoids
-##swelling
-##looks like skin if not thrombosed
-##12,7,9 o'clock
-#anal fissure
-##no swelling
-##off midline = CA, HIV, TB, Crohn's
-#prolapsed internal
-===Pain, No Bleeding===
-#swelling
-##abscess
-###perirectal
-###ischiorectal
-###intersphincteric
-###supralevator
-##pilonidal (drain off midline)
-##fistula (2/2 chronic abscess; don't probe)
-##hidradenitis suppurativa
-#no swelling
-##proctalgia fugax
-###episodic pain (women, pts < 45yo)
-##incontinence
-###urgency
-===Bleeding, No Pain===
-#CA
-#internal hemorrhoids
-===Painless Swelling===
-#itch --> condyloma acuminata (warts 2/2 HPV)
-#no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)
-===Itching===
-#discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)
-#no discharge --> pruritis ani (pinworms)
-==External Hemorroid Excision==
-<48 hrs
-All pts presenting with anorectal complaints should be considered for HIV testing
-==Source==
-Donaldson; adapted from Coates
 [[Category:GI]]
+[[Category:Symptoms]]