Hemorrhoids, Fistulas and Fissures
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| What are hemorrhoids? | varicosities (dilated veins) that may occur inside or outside the anal sphincter
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| What is a fistula? | an abnormal opening on the cutaneous surface near the anus (i.e. from sphincter to skin, or from sphincter to bladder, urethra, vagina ect)
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| What is an anal fissure? | a linear ulceration or laceration of the skin of the anus
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| What is a Fistulotomy? | opening of the fistula tract, incising the fistula with a partial anus division
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| What is a Fistulectomy? | removal of the fistula tract
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| What causes hemorrhoids? | Repeated increased pressure and obstructed blood flow causes permanent dilation to occur (Such as straining at stool with increased intraabdominal and hemorrhoidal venous pressures)
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| What are external hemorrhoids? | Small, reddish-blue lumps at edge of anus outside of anal sphincter.
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| What is the risk of external and internal hemorrhoids? | *Bleeding *Hemorrhoid may become thrombosed (blood in hemorrhoid becomes clotted and infected)
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| List four predisposing factors for hemorrhoids: | *Pregnancy *Chronic constipation *Straining during bowel movements *Diarrhea *Prolonged sitting and standing *Portal hypertension (cirrhosis) *Congestive Heart Failure
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| What are non-invasived Tx of hemorrhoids? | *Bulk Stool softeners *Topical creams and hydrocortisone for pruritis and inflammation *Analgesic ointments *Sitz baths
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| What is hemorrhoidal rubber-band litigation? | the application of tight bands around the hemorrhoid cutting off the blood supply, resulting in necrosis
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| What is hemorrhoidal sclerotherapy? | inserting a sclerosing agent directly into the hemorrhoid
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| Who are anal fistulas common in? | PTs with Crohns disease
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| What do Anal Fissures usually result from? | trauma caused by hard stool that overstretches the anal lining and is aggravated by defecation
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| What can a PT do to reduce pain from Firtulas and Fissures? | *Low bulk diet and encourage high residue *Tucks pads or ice packs to reduce inflammation and pain
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| What color will ischemic tissue from hemorrhoids be? | dark red to black (necrotic)
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| What is the pain management of bowel movements for PTs with hemorrhoids/fissures/fistulas? | Give analgesic before first bowel movement and sitz bath after for pain relief
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