EMQs in Clinical Medicine.pdf - Peshawar Medical College

Anorectal conditions – answers 179
I
There may be signs of urinary tract infection, i.e. frequency and dysuria.
Chlamydia sp. and other sources of sexually transmitted infection are
more common in younger men whereas bacteria such as Escherichia coli
are more common in older men.
65 Anorectal conditions
Answers: E A F K B
E
A
F
K
A 28-year-old man with Crohn’s disease complains of watery discharge
from a puckered area 2 cm from the anal canal.
Fistulae are a well-recognized complication of Crohn’s disease. A full
rectal examination is important to detect other causes of fistula in ano,
e.g. rectal carcinoma.
A 32-year-old woman who has recently given birth complains of
excruciating pain on defecation, which persists for hours afterwards.
Examination reveals a defect posterior to the anal canal.
This condition is very painful and frequently means that a rectal examination
is not possible. The patient is often constipated because defecation
is so painful. This results in a vicious cycle as the stools become
harder, resulting in defecation becoming more difficult and painful.
A 30-year-old builder complains of a pain and discharge from an area
in the midline of the natal cleft about 4 cm above the anus. This
problem has been remitting and recurring for 2 years.
Pilinoidal sinuses always occur in the midline of the natal cleft. They are
more common in men than in women.
A 27-year-old pregnant woman presents with constipation and
bright-red blood coating her stools. On examination in the lithotomy
position, two bluish tender spongy masses are found protruding from
the anus. These do not reduce spontaneously and require digital
reduction.
Spongy vascular tissue surrounds and helps close the anal canal.
However, if these cushions enlarge they can prolapse and bleed to form
haemorrhoids/piles.
First-degree haemorrhoids remain in the rectum.
Second-degree haemorrhoids prolapse through the rectum on defecation
but spontaneously reduce.
Third-degree haemorrhoids can be reduced only with digital reduction.
Fourth-degree haemorrhoids remain prolapsed.
Constipation resulting in prolonged straining is a common cause and so
a high-fibre diet may be a useful preventive measure.