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Anorectal Conditions - Coggle Diagram
Anorectal Conditions
Anorectum
Common symptoms
pain, rectal bleeding, change in bowel habits, haemorrhoids, anal, discharge, perianal itching, swelling, tenderness, ulceration
Prevalence of STD is increasing- syphilis, gonorrhea, herpes, chlamydia, candidiasis
Disorders are general
Anorectal Abscess
May occur in and around rectum
Symptoms
Superficial-redness, swelling, tenderness
Deeper-toxic symptoms, lower abdominal
pain, fever
Many abscesses result in fistulas
People with enteritis or immunosuppressive conditions are susceptible
Management
Sitz baths, analgesics, incision & drainage,
dressing (packing)
Obstruction of anal gland, resulting in infection
Anal Fistula
Develop from trauma, fissures, regional
enteritis
Symptoms
Leakage of pus/stool, passage, of flatus /faces from vagina/bladder, systemic infection
Result from infection
A tiny, tubular, fibrous tract that extends
into anal canal from anus opening
Management
Fistulectomy, enemas, dressing
(packing)
Anal Fissure
Cause by trauma of passing large, hard stools/ tightening of anal canal, childbirth, overuse of laxatives
Symptoms
Painful defecation, burning & bleeding, bright-red stool
Management
Dietary modification, fiber supplements, stool softeners, increase water intake, sitz bath, emollient suppositories
A longitudinal tear / ulceration in
the anal canal lining
Surgery
Lateral internal sphincterotomy with excision of
fissure
Haemorrhoids
Cause
Shearing of mucosa during defecation
Increased pressure in hemorrhoidal
tissue d/t pregnancy
Types
Internal hemorrhoid
External hemorrhoid
Very common condition, 50% people >50
yrs old
Symptoms
Itching, pain, bright-red
bleeding
Internal hemorrhoid
Not painful until
it bleed /prolapse
External hemorrhoid
Severe pain,
edema & inflammation-ischemianecrosis
Dilated portions of vein in anal canal
Management (Non-Surgical)
High fiber diet
Increase fluid intake
Avoid excessive straining
Hydrophilic bulk-forming agents
(Metamucil)
Good hygiene
Warm compress, sitz bath, analgesic
ointments, suppositories, bed rest
Infrared photocoagulation, bipolar
diathermy, laser therapy, inj. sclerosing agents (prevent colapse)
Surgical Treatment
Rubber band ligation
Cryosurgical hemorrhoidectomy
Haemorrhoidectomy
For advanced thrombosed vein
Remove all tissue involved
Rectal sphincter is dilated
Hemorrhoid is removed by
clamp & cautery
Small tube inserted
Gelform gauze is applied
Sexually Transmitted Anorectal Diseases
Proctolitis
Involves rectum & lowest portion of descending colon
Symptoms
Similar as proctitis, watery stool/bloody
diarrhea, cramps, pain & bloating
Enteritis
Watery stool, bloody diarrhea, abdominal pain, weight
loss
Pathogens
E.histolytical, Giardia lamblia, Shigella,
Campylobacter
Involves descending colon
Proctitis
Associated with anal-receptive intercourse
Symptoms
Mucopurulent discharge,
bleeding, pain, diarrhea
Involves rectum
Pathogens
Neisseria gonorrhoeae, Chlamydia, herpes simplex virus, Treponema pallidum
Diagnostic & Treatment
Sigmoidoscopy
Rectal swab & culture
Antibiotics
Doxycycline, Zovirax,
Penicillin G, Erythromycin, Ciprofloxacin
Antiamebic therapy
Flagyl
Pilonical Sinus/Cyst
Results from local trauma
Inflammation-abscess
Found in intergluteal cleft on posterior
surface of lower sacrum
Antibiotic, I&D for abscess; further incision to remove cyst, dressing (packing)
‘Nest of hair’
Nursing Management
Assessment
Diet history
Exercise & activity levels
Elimination patterns & laxative use
Occupation (prolong sitting/standing)
Medical history
Inspection of stool: blood/mucus
Health history: pruritus, burning, anorectal pain
Perianal area- haemorrhoid, fissures, irritation,
purulent drainage
Rectal Examination
Thrombosed haemorrhoid
Prolapsed haemorrhoid
Rectal fissure
Nursing Diagnoses
Anxiety related to impending surgery & embarrassment
Acute pain related to irritation, pressure & sensitivity in anorectal
area after surgery
Constipation related to pain during elimination
Urinary retention related to postoperative reflex spasm & fear of
pain
Risk of infection
Nursing Goals
Adequate elimination patterns
Reduction of anxiety
Pain relief
Promotion of urinary elimination
Managing therapeutic regimen
Early detection and prevention of complications
(hemorrhage, infection)
Nursing Interventions
Relieving constipation
2L water intake
High-fiber foods
Laxatives
Regular bowel habit
Relaxation exercise
Analgesics
Reducing anxiety
Privacy
Remove soiled dressing
Identify psychosocial needs-individualize care plan
Room deodorizers
Relieving pain
1st 24hrs Post-Op
Floating pad/air bag under buttocks
Ice/analgesic ointments
Warm compress
Sitz bath
Comfortable position
24hrs Post-Op
Topical anesthetics
Wet dressing with petrolatum (petroleum jelly)
Prone position
Promoting urinary elimination
Use voluntary method
CBD
Control pain
Monitor urinary output
Increase fluid intake
Monitoring & managing complications
Assess dressing
Apply direct pressure
Assess tube/drain
Notify Dr
Avoid moist heat
Assess for systemic indicators of excessive bleeding
Perform sitz bath
Promote self-care
Avoid rubbing
Sitz bath
Perianal care
Test water temperature
Regular bowel movement
& good bowel habit
Avoid straining
High-fiber diet
Water intake
Moderate exercise
Laxatives
Avoid prolong sitting/standing