Anorectal disorders: Difference between revisions

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==Diagnosis==
==Diagnosis==
===Pain and Bleeding===
===Pain and Bleeding===
 
#external hemorrhoids
 
##swelling
1)  external hemorrhoids
##looks like skin if not thrombosed
 
##12,7,9 o'clock
    -swelling
#anal fissure
 
##no swelling
    -looks like skin if not thrombosed
##off midline = CA, HIV, TB, Crohn's
 
#prolapsed internal
    -12,7,9 o'clock
 
2)  anal fissure
 
    -no swelling
 
    -off midline = CA, HIV, TB, Crohn's
 
3)  prolapsed internal
 


===Pain, No Bleeding===
===Pain, No Bleeding===
 
#swelling
 
##abscess
1) swelling
###perirectal
 
###ischiorectal
    a. abscess
###intersphincteric
 
###supralevator
          i. perirectal
##pilonidal (drain off midline)
 
##fistula (2/2 chronic abscess; don't probe)
          ii. ischiorectal
##hidradenitis suppurativa
 
#no swelling
          iii. intersphincteric
##proctalgia fugax
 
###episodic pain (women, pts < 45yo)
          iv. supralevator
##incontinence
 
###urgency
    b. pilonidal (drain off midline)
 
    c. fistula (2/2 chronic abscess; don't probe)
 
    d. hidradenitis suppurativa
 
2) no swelling
 
    a. proctalgia fugax
 
        -episodic pain (women, pts < 45yo)
 
    b. incontinence
 
        -urgency
 


===Bleeding, No Pain===
===Bleeding, No Pain===
 
#CA
 
#internal hemorrhoids
1) CA
 
2) internal hemorrhoids
 


===Painless Swelling===
===Painless Swelling===
 
#itch --> condyloma acuminata (warts 2/2 HPV)
 
#no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)
1) itch --> condyloma acuminata (warts 2/2 HPV)
 
2) no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)
 


===Itching===
===Itching===
 
#discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)
 
#no discharge --> pruritis ani (pinworms)
1) discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)
 
2) no discharge --> pruritis ani (pinworms)
 


==External Hemorroid Excision==
==External Hemorroid Excision==
<48 hrs
<48 hrs


All pts presenting with anorectal complaints should be considered for HIV testing
 
*All pts presenting with anorectal complaints should be considered for HIV testing
 
 
Anorectal Emergencies Algorithm.pdf
 


==Source==
==Source==
Donaldson; adapted from Coates
Donaldson; adapted from Coates


[[Category:GI]]
[[Category:GI]]

Revision as of 05:35, 14 March 2011

Diagnosis

Pain and Bleeding

  1. external hemorrhoids
    1. swelling
    2. looks like skin if not thrombosed
    3. 12,7,9 o'clock
  2. anal fissure
    1. no swelling
    2. off midline = CA, HIV, TB, Crohn's
  3. prolapsed internal

Pain, No Bleeding

  1. swelling
    1. abscess
      1. perirectal
      2. ischiorectal
      3. intersphincteric
      4. supralevator
    2. pilonidal (drain off midline)
    3. fistula (2/2 chronic abscess; don't probe)
    4. hidradenitis suppurativa
  2. no swelling
    1. proctalgia fugax
      1. episodic pain (women, pts < 45yo)
    2. incontinence
      1. urgency

Bleeding, No Pain

  1. CA
  2. internal hemorrhoids

Painless Swelling

  1. itch --> condyloma acuminata (warts 2/2 HPV)
  2. no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)

Itching

  1. discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)
  2. 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

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