Internal anal spincter

mucous membrane like the rest of the gastrointestinal tract

epithelium is considered cutaneous

_______ the dentate line in sensitive. ______ the line is NOT ***

Arterial Supply: Above Dentate Line

Arterial Supply: Below Dentate Line

Venous Drainage: Above Dentate Line

Venous Drainage: Below Dentate Line

secrete mucous

empty gland secretions into canal

hemorrhoid most common complaint ***

Internal Hemorrhoid

External Hemorrhoid

Thrombosed External Hemorrhoid management

Second or Third-Degree Internal Hemorrhoid

Fourth Degree Hemorrhoid

Thrombosed or Gangerous fourth degree hemorrhoid

Internal Hemorrhoids

External Hemorrhoids

Protrudes into the anal canal but does not prolapse, painless w sense of fullness [internal hemorrhoids]

Prolapses but reduces spontaneously, occurs during defecation [internal hemorrhoids]

Prolapses and requires manual reduction, occurs spontaneously and requires manual reduction [internal hemorrhoids]

Irreducible prolapse [internal hemorrhoids]

Most common cause of intensely painful rectal bleeding of sudden onset ***

Superficial tear in anoderm

Anal fissures typically occur at __________, but ________ fissures are more common in women

Anal fissures may become chronic and develop fissure triad ***

Connection between two epithelium lined surfaces

Fistula in ano develops in 50-67% percent of patients with

Produce painful swelling at the anal verge, most common

Deep to external sphincter and inferior to levator ani

•May appear to be a mass in the rectum, may be confused with internal hemorrhoid

Outside of sphincter muscles

Perianal and buttock pain

•23% are obese or suffer DM

•Concurrent disorders such as Crohn’s, PID, diverticulitis

Emergent surgical treatment is indicated

Arise in the midline of the sacrococcygeal area in the natal cleft

•Theory that bacteria enter sterile hair follicle and produce inflammation and edema

•Contents result in hair follicle rupture and abscess formation

Solid immobile bulk of human feces that can develop in the rectum

•Often a complication of chronic constipation and chronic laxative use

•Most common in elderly

are out pockets of the colonic mucosa and submucosa through weaknesses of muscle layers in the colon wall

the condition of having diverticula in the colon that are not inflamed.

when the diverticula become inflamed

involves the entire GI tract

involves just the large bowel

Surgery can be curative ***

sx: RLQ pain, diarrhea, fatigue. Gradual onset.

sx: abdominal pain, hematochezia. Sudden onset.

Most common extraintenstinal manifestation of Crohn's disease

Most common extraintenstinal manifestation of Ulcerative Colitis

more comorbidity w UC than crohns

Bloody diarrhea is usually the primary symptom.

is characterized by colonic diameter ≥6 cm or cecal diameter >9 cm and the presence of systemic toxicity

Patients may have other somatic or psychosocial complaints (fatigue, myalgia, anxiety, depression, dyspepsia)

ACG Grading used for classification

+/- bleeding per rectum and fewer than 4 BMs per day

Bleeding per rectum with more than 4 BMs per day

Bleeding per rectum, more than 6 BMs per day, and a systemic illness or elevated ESR

greater than 10 BMs per day, continuous bleeding, systemic illness

•Able to tolerate oral alimentation

•Without manifestations of dehydration, toxicity (high fevers, rigors, prostration), abdominal tenderness, painful mass, obstruction, or >10% weight loss

•Ambulatory

•Fail to respond to treatment for mild-moderate disease, or

•Have more prominent symptoms of fever, significant weight loss, abdominal pain or tenderness, intermittent nausea or vomiting (without obstructive findings), or significant anemia

•Have persisting symptoms despite the introduction of steroids on an outpatient basis, or

•Present with high fever, persistent vomiting, evidence of intestinal obstruction, rebound tenderness, cachexia, or evidence of an abscess

•Asymptomatic or without inflammatory sequelae

•Includes those who responded to acute medical intervention or who underwent surgical resection without gross evidence of residual disease

•Without need for glucocorticosteroid therapy ***

the key to diagnosis of ulcerative colitis ***

gold standard dx for celiac disease ***

_______ can be an early manifestation of Crohn's Disease

should be considered in infants and children w persistent sx despite dietary lactose restriction

Autoimmune disease that effects the small intestine

characterized by an intestinal brush border lactase enzyme activity that is lower than that of normal infants.

characterized by a failure of the small bowel to absorb a sizable fraction of ingested lactose.

clinical syndrome in which lactose ingestion causes symptoms (eg, abdominal pain, bloating, flatulence, diarrhea) due to lactose malabsorption

_____ are the acute manifestation of infection, ______ are the chronic sequalae of these

Goodsall's Rule: If the external opening of a fistula lies _____ to a line drawn from 9 o’clock to 3 o’clock then it tracks around the anus laterally and opens into the midline posteriorly

Goodsall's Rule: If the external opening of a fistula lies _____ to a line drawn from 9 o’clock to 3 o’clock then it opens directly into the anal canal