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Anorectal Disease. Anal Fissure
ANAL FISSURE
14. What is the most common location for idiopathic anal fissure?
Show answer
90% are posterior, and 10% are anterior.
15. What are the most common symptoms of anal fissure?
Show answer
Tearing anal pain and bleeding with bowel movements.
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Anorectal Disease
55 ANORECTAL DISEASE
Eric L. Sarin M.D., John B. Moore M.D.
1. What aspect of the initial patient encounter is most important in the diagnosis of anorectal disease?
Show answer
Clinical history, including duration of complaints, exacerbating or alleviating issues, precipitating events, dietary and bowel habits, and current or previous treatments. This may not sound glamorous, but you will never encounter a more grateful patient than one whose rectal problem you have solved.
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intramuscular and intersphincteric anal glands which are the site of anorectal abscesses and fistulas in ano,Queries 4
Anorectal Disease. Hemorrhoids
HEMORRHOIDS
21. What are hemorrhoidal tissues, and what are their normal functions?
Show answer
Hemorrhoids are cushions of vascular tissue that contribute to anal continence and protect the sphincter mechanism during defecation. Hemorrhoids are not veins, but sinusoids. Bleeding originates from presinusoidal arterioles, thus explaining the bright red arterial color.
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Anorectal Disease. Anorectal Abscess & Fistula In Ano
ANORECTAL ABSCESS AND FISTULA IN ANO
5. What is the most common cause of anorectal abscess?
Show answer
Ninety percent result from cryptoglandular infection.
6. What are the four potential anorectal spaces used to classify anorectal abscesses?
Show answer
1. Perianal (area of the anal verge)
2. Ischiorectal (area lateral to the external sphincter muscles, extending from the levator ani muscles to the perineum)
3. Intersphincteric (area between the internal and external sphincter muscles, continuous inferiorly with the perianal space and superiorly with the rectal wall)
4. Supralevator (area superior to the levator ani muscles, inferior to the peritoneum, and lateral to the rectal wall)
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, anorectal disease, purpose of a seton for a fistula in ano,Top Search
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euro-ion in dextrose 5% water, mss,Inflammatory Bowel Disease. Controversies
CONTROVERSIES
17. Should all patients with enteroenteral fistulas secondary to Crohn’s disease have surgery when the fistula is discovered?
Show answer
For: Such patients ultimately do poorly, develop further intraperitoneal septic complications, and almost always require surgery.
Against: Many of these patients do well without operative treatment until they develop symptoms. It is fine to wait for symptoms.
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Anorectal Disease. Pilonidal Sinus Disease
PILONIDAL SINUS DISEASE
29. What is the most common clinical presentation of a pilonidal sinus?
Show answer
Pain and swelling in the sacrococcygeal region, which typically are associated with a (sometimes several) chronic draining sinus tract.
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pilonidal sinus and anorectal pain,Imperforate Anus
84 IMPERFORATE ANUS
Frederick M. Karrer M.D., Denis D. Bensard M.D.
1. What is imperforate anus?
Show answer
It is a congenital defect in which the opening of the anus is absent or misplaced, usually fistulizing anteriorly to the perineum or genitourinary (GU) tract. Anorectal malformations range from slight anterior malpositioning of the anus to complex cloacal deformities. Children with anorectal malformations commonly have other congenital anomalies, such as the VACTERL association.
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Colorectal Carcinoma
54 COLORECTAL CARCINOMA
Kathleen Liscum M.D.
1. What are the top three causes of cancer deaths in the United States?
Show answer
Lung, breast or prostate, and colon cancer.
2. List a few of the presenting symptoms of patients with colorectal cancer.
Show answer
Intermittent rectal bleeding, vague abdominal pain, fatigue secondary to anemia, change in bowel habits, constipation, tenesmus, and perineal pain.
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Inflammatory Bowel Disease
50 INFLAMMATORY BOWEL DISEASE
Anthony J. LaPorta M.D., Gilbert Hermann M.D.
1. What two clinical entities encompass the diagnosis of inflammatory bowel disease?
Show answer
Crohn’s disease and ulcerative colitis (acute or chronic).
2. Although the two diseases often overlap, they usually can be distinguished by clinical criteria. What are the major clinical differences?
Show answer
Rectal bleeding is unusual in Crohn’s disease but common in chronic ulcerative colitis. An abdominal mass and anal complications (fissure, fistula) are more common in Crohn’s disease.
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Trauma To The Colon & Rectum. Rectal Trauma
RECTAL TRAUMA
9. How do rectal injuries occur?
Show answer
Similar to colon injuries, most rectal injuries result from penetrating trauma. Blunt pelvic fractures should be assessed with a strong suspicion for rectal (and urethral) injury.
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98 URODYNAMICS AND VOIDING DYSFUNCTION
Firouz Daneshgari M.D.
1. What is urodynamics?
Show answer
Urodynamic studies assess the functional aspects of the storage and emptying ability of the lower urinary tract (LUT). The principles of urodynamic studies originated from hydrodynamics. The components of urodynamic studies are cystometrogram, leak point pressures, urethral profile pressures, pressure-flow studies, uroflowmetry, and electromyography. These studies have evolved into videourodynamics with the addition of fluoroscopy (i.e., video).
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83 INTESTINAL OBSTRUCTION OF NEONATES AND INFANTS
Richard J. Hendrickson M.D., Denis D. Bensard M.D.
1. What signs or symptoms suggest intestinal obstruction in the neonate?
Show answer
Signs and symptoms vary according to the level of obstruction. Proximal intestinal obstruction leads to the early onset of bilious emesis, generally with minimal abdominal distention. In contrast, neonates with distal intestinal obstruction present after the first day of life with bilious vomiting and pronounced abdominal distention. Bilious emesis should always be interrogated further in infants and children.
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j pediatr surg 37:909-911,
Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
