Anorectal Disease

SUGGESTED READINGS ANORECTAL DISEASE

Current Surgical Diagnosis and Treatment, 12th Edition, Ch. 31.

OBJECTIVES ANORECTAL DISEASE

1. State the etiological factors in the development of hemorrhoidal disease, including the roles of heredity, diet, pregnancy, and occupation.
2. Describe the symptoms and physical findings of patients with internal hemorrhoids.
3. Outline the principles of management of patients with symptomatic external hemorrhoids and symptomatic internal hemorrhoids.
4. Describe the various types of perianal infections, including perianal, perirectal, ischiorectal, and pelvirectal infection.
5. Outline the symptoms, physical findings of patients with perianal infections.
6. Describe the symptoms and physical findings of patients with fissure-in-ano and outline the principles of management.

CASE HISTORIES ANORECTAL DISEASE

1. A 69-year-old male with a history of a perianal abscess 7 years ago, now presents with mild perirectal pain and purulent discharge. Examination reveals an external opening in the left anterior perianal region. What is your management plan for this case?

2. A 43-year-old male presents with severe right-sided perirectal pain. Examination reveals a temperature of 101. There is tender, fluctuant mass in the right perianal area with overlying erythema. What is your management plan for this case?

3. A 52-year-old male with a long history of constipation and hemorrhoids presents with bright red blood per rectum. He notes the blood on the tissue paper after bowel movements. As well, he notes hemorrhoidal prolapse during bowel movements requiring manual reduction. What is your management plan for this case?

4. A 39-year-old female presents with severe perianal itching. The itching is noted to be worse at night, often awaking her from sleep. She describes her personal hygiene as scrupulous. Examination reveals marked erythema and excoriation of the perianal area. Work-up including barium enema and sigmoidoscopy fails to reveal any other colorectal pathology. What is your management plan for this case?

5. A 49-year-old male with a 2 day history of pain and bright red rectal bleeding with bowel movements, following an episode of constipation. Pain was acute in onset and is always with bowel movements and lasts for 40 minutes. What is your management plan for this case?

6. A 70-year-old man has an ulcerated lesion in the perianal area. Biopsy reveals squamous cell carcinoma. Describe the treatment options. Discuss the significance of palpable groin lymph nodes.

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