Acute Ano-rectal Conditions

Posted by e-Medical PPT Friday, August 10, 2012
Diagnosis of anal conditions which present with rectal bleeding
Bleeding but no pain:
Carcinoma of the Colon,Carcinoma of Rectum,hemorrhoids,colitis
Bleeding + pain = fissure or carcinoma of anal canal
The most common causes of rectal bleeding in patients who visit primary care physicians are hemorrhoids, fissures and polyps.

Careful history focusing on the nature of the pain and its relationship to defaecation
The pattern of pain helps differentiate anal fissure from hemorrhoids and other conditions. (hemorrhoids and rectal cancer are usually not painful)
Anorectal pain that begins gradually and becomes excruciating over a few days with localized are of tenderness is more likely to be
abscess.
A nagging, aching discomfort made worse by defecation could be due to piles.
An occasional, severe, cramp-like pain deep in the anal canal, that often occur at night, lasting about half an hour
proctalgia fugax. Proctalgia fugax  pain is excruciating and may be accompanied by sweating, pallor and tachycardia. Patients experience urgency to defecate, yet pass no stool.
A knife-like pain when you have your bowels open, and which may last for 10–15 minutes afterwards. often described like 'passing glass'. In addition to the pain, some bright red blood on the toilet paper is noticed.Anal fissure.

Diagnosis of anal conditions which present with pain
Pain alone
 Fissure ( pain after defaction)
 Proctalgia fugax (pain spontaneously at night)
 Anorectal abscess
Pain with bleeding
 Fissure
Pain with a lump
 Perianal haematoma
 Anorectal abscess
Pain, lump and bleeding
 Prolapsed haemorrhoids/rectum
 Carcinoma of the anal canal

Anorectal examination
One of the most important examinations in a patient with abdominal disease.
Still its the least popular segment of the entire physical examination.
Should not be omitted from your examination, especially in middle-aged and older patient, why?
risks missing an asymptomatic carcinooma
Can be done in numerous positions:
 Left Lateral (Sims’) position. The usual position when the patient is in bed. Turn patient on to left side with pelvis vertical. Ask patients to draw knees up to chest with buttocks on the side of the couch
 The Knee-elbow position. Patient kneeling on couch, resting on elbows, of particular use when palpating the prostate and seminal
The Dorsal Position. This position with the patient lying on the back with right leg flexed is useful when the patient is in severe pain, and movement is contra-indicated. Enables assessment of rectovesical pouch in abdominal emergencies.
 Lithotomy. best position for examination but not always available.
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