Anal and rectal diseases explained - part 10 pptx

(also known as: condylomata acuminata) What are venereal warts? Venereal warts are skin abnormalities characterized by pink/gray swellings near the anal region and sometimes extending to the genital area. They are often described as having a cauliflower-like appearance. How do venereal warts occur? They are caused by a viral infection from the human papilloma virus. This infection is sexually transmitted and is highly contagious. What are the symptoms of venereal warts? The most common symptoms of venereal warts are a sense of fullness around the anal or genital region, itching, pain, bleeding from the affected area, and rectal, vaginal, or penile discharge. Are there any other conditions that cause the same symptoms as venereal warts? Pruritus ani and skin conditions involving the anal or genital area. What factors increase the risk of developing venereal warts? Sexual activity with individuals who have venereal warts or are infected with the virus that causes this condition predisposes to the development of venereal warts. Persons who are sexually promiscuous, homosexual males with other sexually transmitted diseases, HIV-infected individuals, and victims of sexual abuse due to spread of the infection from the abuser to their victim. Can venereal warts predispose to cancer? Yes. Venereal warts are a risk factor for the development of squamous cell carcinoma of the anorectal region and carcinoma of the cervix and of other portions of the genital tract. 199 Venereal warts Chapter 8.12 This is trial version www.adultpdf.com What tests are performed to diagnose venereal warts? The diagnosis is usually made by a physical examination of the affected area. Sometimes biopsies are obtained. A proctoscopy or flexible sigmoidoscopy may be required to determine whether there are additional warts present in the anus or rectum that cannot be visualized externally. What over-the-counter treatments or home remedies can be used for venereal warts? None. What prescription medications are used for venereal warts and how do they work? Podofilox (Condylox) may be prescribed by your physician. It is a topical destructive agent that you apply directly to the warts. It works by stopping the cells in the warts from multiplying. Imiquimod (Aldara) is another topical destructive cream that is applied to the warts. It appears to destroy the warts by causing secretion of chemicals called cytokines, which stimulate an inflammatory reaction that is used to fight off the infection. Podophyllum is also a topical destructive agent, but it has to be applied by your physician. It destroys the tissue containing the warts. What nonsurgical procedures can be used to treat venereal warts? Laser therapy is often successful. Burning of the warts with electrocautery is also highly successful. Your physician may also consider injecting the warts with medications that cause their destruction including chemotherapy drugs and Interferon. Cryotherapy, which involves applying liquid nitrogen to the warts, is also used. Is surgery ever used as a treatment for venereal warts? Yes. When is surgery used to treat venereal warts? Surgery is used for large warts that cannot be successfully removed with other therapies. Surgery may also be used for warts that keep coming back, and warts that are in the anal canal and rectum. What surgical procedures are performed for the treatment of venereal warts? The warts and a portion of the surrounding normal skin are surgically removed. This is usually performed in conjunction with burning of the affected area using electrocautery. Chapter 8 200 This is trial version www.adultpdf.com What additional information should I know about venereal warts? Since venereal warts are considered to be a risk factor for cancers of the anal and genital regions, periodic examinations of the affected areas are necessary. Women with venereal warts should undergo frequent Pap smears and genital examinations. Patient information 201 This is trial version www.adultpdf.com 202 This is trial version www.adultpdf.com 5-ASA 5-aminosalicylic acid 5-FU 5-fluorouracil 5-HIAA 5-hydroxyindole acetic acid APC adenomatous polyposis coli APR abdominoperineal resection Cl chloride CT computed tomography DALM dysplasia-associated lesion or mass DCC deleted in colon cancer EAS external anal sphincter EMG electromyography FAP familial adenomatous polyposis HCO 3 bicarbonate HPV human papillomavirus HPZ high-pressure zone HSV-2 herpes simplex virus 2 IAS internal anal sphincter IV intravenous IVBP intravenous piggyback K potassium LGV lymphogranuloma venereum MEN multiple endocrine neoplasia Mg magnesium MRI magnetic resonance imaging Na sodium NHANES National Health and Nutrition Examination Survey NHIS National Health Interview Survey PNTML pudendal nerve terminal motor latency RAIR rectoanal inhibitory reflex SRUS solitary rectal ulcer syndrome TNM tumor, nodes, metastases 203 Abbreviations This is trial version www.adultpdf.com Textbooks Barnes L, Corman ML, editors. Colon and Rectal Surgery. 4th ed. Philadelphia, PA: Lippincott–Raven Publishers, 1998. Feldman M, Friedman LS, Sleisenger MH, editors. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease . 7th ed. Philadelphia, PA: Saunders, 2002. Yamada T, editor. Textbook of Gastroenterology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins, 1995. Gordon PH, Nivatvongs S, editors. Principles and Practice of Surgery for the Colon, Rectum and Anus . 2nd ed. New York, NY: Marcel Dekker, 1999. Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious Diseases. 2nd ed. Philadelphia, PA: Saunders, 1997. Review articles Wald A. Anorectal and pelvic pain in women: diagnostic considerations and treatment. J Clin Gastroenterol. 2001;33(4):283–8. Nelson R. Anorectal abscess fistula: what do we know? Surg Clin North Am. 2002;82(6):1139–51. Bartram C. Dynamic evaluation of the anorectum. Radiol Clin North Am. 2003;41(2):425–41. Bharucha AE. Fecal incontinence. Gastroenterology. 2003;124(6):1672–85. Gopal DV. Diseases of the rectum and anus: a clinical approach to common disorders. Clin Cornerstone. 2002;4(4):34–48. Utzig MJ, Kroesen AJ, Buhr HJ. Concepts in pathogenesis and treatment of chronic anal fissure – a review of the literature. Am J Gastroenterol. 2003;98(5):968–74. Hong JJ, Park W, Ehrenpreis ED. Review article: current therapeutic options for radiation proctopathy. Aliment Pharmacol Ther. 2001;15(9):1253–62. Maria G, Sganga G, Civello IM, Brisinda G. Botulinum neurotoxin and other treatments for fissure-in-ano and pelvic floor disorders. B J Surg. 2002;89(8):950–61. Olsen AL, Rao SS. Clinical neurophysiology and electrodiagnostic testing of the pelvic floor. Gastroenterol Clin North Am. 2001;30(1):33–54,v–vi. Moore HG, Guillem JG. Anal neoplasms. Surg Clin North Am. 2002;82(6):1233–51. Moore HG, Guillem JG. Multimodality management of locally advanced rectal cancer. Am Surg. 2003;69(7):612–9. Schmitt SL, Wexner SD. Treatment of anorectal manifestations of AIDS. Int J STD AIDS. 1994;5(1):8–10. 204 Further reading This is trial version www.adultpdf.com abdominoperineal resection (APR) 129 Aldara (imiquimod) 200 anal adenocarcinoma 115 anal and rectal anatomy 1–8 anal canal 3 innervation 4 external anal sphincter 4 internal anal sphincter 4 rectum 4 musculature 4–5 external anal sphincter 4 internal anal sphincter 4 rectum 3–4 vascular supply 6–8 anal, arterial and venous 6 rectal, arterial and venous 6–8 anal carcinoma 111–113 clinical pearls 113 diagnosis 112 epidemiology 111 pathophysiology 112 patients at risk 112 symptoms 112 treatment 113 tumor subtypes 111 anal fissure 49–52, 173–174 clinical pearls 52 definition of 49 diagnosis 50 epidemiology 49 pathophysiology 49 patient information 173–174 patients at risk 49 symptoms 50 treatment 50–52 medical 50–52 surgical 52 anal stenosis 53–54 clinical pearls 54 definition 53 205 Index This is trial version www.adultpdf.com diagnosis 53 epidemiology 53 benign causes 53 malignant causes 53 pathophysiology 53 symptoms 53 treatment 54 medical 54 surgical 54 Analpram 174, 190 anesthetic agents, local 50, 72 benzocaine 50 lidocaine 50, 174 pramoxine 50 anorectal abscess 55–57 clinical pearls 57 definition 55 diagnosis 56 epidemiology 55 pathophysiology 55 patients at risk 55 symptoms 55 treatment 57 anorectal disease, HIV-associated 145–146 anorectal manometry 15–18, 22 anorectal ultrasound 31, 66, 175 anoscopy and proctoscopy 19–20 antibiotics 76, 140, 142, 148 Augmentin 76 azithromycin 140 doxycycline 140, 142 erythromycin 76, 140 penicillin 76, 148 tetracycline 76, 140, 148 trimethoprim–sulfamethoxazole 140 anticholinergic drugs 66, 157 atropine 66 clindium 66 dicyclomine 66 hyoscyamine 66 antidiarrheal agents 66, 95 codeine 66 diphenoxylate 66 loperamide 66 Anusol 178 Asacol (5-ASA containing agent) 192 Index 206 This is trial version www.adultpdf.com aspirin (5-ASA) containing agents, 107, 165, 192, 198 atropine 66 azathioprine 82, 107, 186, 198 Azulfidine (5-ASA containing agent) 192 Balneol (lubricating agent) 91, 190 barium enema 21–23, 31, 35, 60 basal cell carcinoma of the perianal region 115–116 Bentyl (dicyclomine) 176 benzocaine 50 biofeedback therapy 18, 25–26, 190 Botox, botulinum toxin 25, 52, 63, 78, 174, 196 Bowen’s disease 116 calcium channel blockers 50 calcium polycarbophyl 72, 174 diltiazem 50 nifedipine 50 Carafate (sucralfate) 192 carcinoid tumors, rectal 133 chlamydia and lymphogranuloma venereum 139–140 clinical pearls 140 diagnostic testing 140 epidemiology 139 incubation time 139 organism 139 pathophysiology 140 patients at risk 139 transmission 139 treatment 140 Chlamydia trachomatis 139 cholestyramine 66 Citrucel (methylcellulose) 72, 174, 178, 182, 196 clindamycin 76 clindium 66 codeine 66 Colace (stool softener) 196 colonoscopy 27–30 condylomata acuminate (venereal warts) 149–151, 199–201 Condylox (podofilox) 200 constipation 59–63 clinical pearls 63 definition 59 diagnosis 60–62 epidemiology 59 pathophysiology 59–60 Index 207 This is trial version www.adultpdf.com patients at risk 59 symptoms 60 treatment 63 corticosteroids 96, 107, 165, 192 defecation, the normal process 9–11 diarrhea 155–157 clinical pearls 157 diagnostic testing 156 epidemiology 155 pathophysiology 155 patients at risk 155 symptoms 156 treatment 157 dicyclomine 66, 176 diltiazem 50 Dipentum (5-ASA containing agent) 192 diphenoxylate 66 dynamic proctography 31–34 electromyography (EMG), anorectal 22, 25, 31, 35–36, 66, 175 epinephrine 27 fecal impaction 159–160 clinical pearls 160 definition 159 diagnostic testing 160 epidemiology 159 pathophysiology 160 patients at risk 159 symptoms 159 treatment 160 fecal incontinence 65–67, 175–176 clinical pearls 66 definition 65 diagnosis 66 epidemiology 65 pathophysiology 65 patient information 175–176 patients at risk 65 symptoms 65 treatment 66 fecal osmotic gap 44 FiberCon (calcium polycarbophyl) 72, 174, 175, 178, 182, 196 fiber supplements calcium polycarbophyl (FiberCon) 72, 174, 175, 178, 182, 196 Index 208 This is trial version www.adultpdf.com [...]... 125–127 transanal resection 129–130 transanal ultrasound 45–46 Treponema pallidum 147 Tronolane 174 Tucks (lubricating agent) 91, 190 ulcerative proctitis 105 108 , 197–198 clinical pearls 108 definition 105 diagnosis 106 107 epidemiology 105 pathophysiology 105 106 patient information 197–198 symptoms 106 treatment 107 108 vascular supply, of the anus and rectum 6–8 anal, arterial and venous 6 rectal, arterial... rectoanal inhibitory reflex (RAIR) 15, 17 rectovaginal fistula 101 102 clinical pearls 102 diagnosis 102 epidemiology 101 pathophysiology 101 patients at risk 101 symptoms 101 treatment 102 Remicade (infliximab) 82, 186 S pouch 161 Secca System 66, 176 Sengstaken–Blakemore tube 170 sitz marker study 35, 61–62 solitary rectal ulcer syndrome 103 104 , 195–196 clinical pearls 104 definition 103 diagnosis 104 ... Chicago and has also served as a staff physician at Cleveland Clinic, Florida He is the author of more than 60 clinical research papers in the fields of gastroenterology and clinical pharmacology and has authored a number of chapters in gastroenterology, colorectal surgery, and critical care medicine textbooks Dr Ehrenpreis is married with three children, and lives in Skokie, Illinois Anal and rectal diseases. .. Illinois Anal and rectal diseases explained Perianal and rectal complaints are among the most common seen by primary care physicians, surgeons, and gastroenterologists However, the wide variety of disorders associated with these complaints are, in general, poorly understood Illustrated throughout with color images and exquisitely detailed line diagrams, Anal and Rectal Diseases Explained provides a practical... with color images and exquisitely detailed line diagrams, Anal and Rectal Diseases Explained provides a practical introduction to the presentation, diagnosis, and management of a broad range of anal and rectal diseases Anal and rectal diseases explained Eli D Ehrenpreis ... definition 103 diagnosis 104 epidemiology 103 pathophysiology 103 patient information 195–196 patients at risk 103 symptoms 103 treatment 104 staging of rectal cancer 125–127 modified Dukes’ classification 125, 126 TNM classification 125–127 sucralfate 96, 104 , 192, 196 surgery for rectal cancer 129–130 abdominoperineal resection 129 low anterior resection 129 transanal resection 129–130 syphilis 147–148... performed 162–163 results 164 imiquimod 200 immunomodulating agents 82, 107 , 165, 186, 198 azathioprine 82, 107 , 165, 198 6-mercaptopurine, 82, 107 , 198 Imodium 175, 192 infliximab 82, 186 innervation, of the anus and rectum 4 external anal sphincter 4 internal anal sphincter 4 rectum 4 isotretinoin 76 J pouch 161 Kaopectate (kaolin and pectin) 192 Kegal exercises 26, 66, 88, 179–180 Konsyl (psyllium)... (hyoscyamine) 176 210 This is trial version www.adultpdf.com Index lidocaine 50, 174 Lidomantle 174, 178 Lomotil (atropine) 176 loperamide 175, 192 low anterior resection 129 lubricating agents 91 Balneol 91 Tucks 91 lymphoma, rectal 135 malignant melanoma 116–117 medical therapy for rectal cancer 131–132 current therapy for TNM stage II and III rectal cancer 131 5-fluoruracil (5-FU), side effects... radiation therapy, side effects 132 6-mercaptopurine, 82, 107 , 186, 198 Metamucil 50, 72, 174, 178, 182, 196 metastatic rectal tumors 135 methylcellulose 72, 174, 178, 182, 196 metronidazole 186 MiraLax (polyethylene glycol) 182 modified Dukes’ classification 125, 126 musculature, of the anus and rectum 4–5 external anal sphincter 4 internal anal sphincter 4 National Health and Nutrition Examination Survey... should have a copy on their shelf!” Dr Sunanda Kane, Department of Medicine, Gastroenterology Division, University of Chicago ISBN 1-9 0134 6-6 7-6 This is trial version www.adultpdf.com 9 781901 346671 Eli D Ehrenpreis About the author Eli D Ehrenpreis, MD, is Assistant Professor of Medicine at Rush Presbyterian St Luke's Medical Center in Chicago, Illinois, and a practicing gastroenterologist at Adult . trial version www.adultpdf.com EXPLAINED SERIES Anal and rectal diseases explained Eli D Ehrenpreis Anal and rectal diseases explained Eli D Ehrenpreis Perianal and rectal complaints are among the. 105 diagnosis 106 107 epidemiology 105 pathophysiology 105 106 patient information 197–198 symptoms 106 treatment 107 108 vascular supply, of the anus and rectum 6–8 anal, arterial and venous 6 rectal, . 99 rectoanal inhibitory reflex (RAIR) 15, 17 rectovaginal fistula 101 102 clinical pearls 102 diagnosis 102 epidemiology 101 pathophysiology 101 patients at risk 101 symptoms 101 treatment 102 Remicade