0071643192.pdf

SYMPTOMS/EXAM

■ A mass is noted in the rectum following defecation or straining, or even
upon standing.
■ Other symptoms include bloody mucous discharge, fecal incontinence,
dull pain.

DIAGNOSIS

■ All adult patients should be referred for endoscopy to rule out tumor,
polyps, IBD, or rectal ulcer.

TREATMENT

■ Manual reduction in infants
■ Surgical intervention in adults unless prolapse is minimal; if there is vas-
cular compromise, emergent surgery

Anorectal Tumors

See Table 11.11.

SYMPTOMS/EXAM

■ Nonspecific symptoms: Pruritus, pain, bleeding with stool, sensation of a
lump
■ Progressive anorexia, weight loss, diarrhea, constipation, tenesmus
■ Detectable by careful visual and digital examination

DIAGNOSIS/TREATMENT

■ Any ulcer that fails to heal in 30 days or any discrete skin lesion that does
not improve should be biopsied.
■ Surgical consult

LIVER DISORDERS

Hepatitis

Viral hepatitis affects 200,000–700,000 Americans each year. Hepatitis B and
C can progress to chronic hepatitis, and hepatitis C is the number one reason
patients require liver transplantation in the United States.

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES

The anus is the third most

common site for melanoma

metastasis, after the eye and

the skin.

TABLE 11.11. Classification of Anorectal Tumors by Location

TYPE LOCATION CELLTYPE CANCERS OUTCOME

Analcanal Proximal to dentate Transition zone between Adenocarcinoma, High-grade malignant

line squamous cell and columnar melanoma, transitional potential;metastasize

epithelium of rectum cell carcinoma, Kaposi early; poor prognosis

sarcoma, villous adenoma

Analmargin Distal to dentate Squamous cell Bowen’s, squamous cell Lower grade malignant

line carcinoma, basal cell potential, slow to

carcinoma, Paget disease metastasize

Hepatitis C is the number one

reason patients require liver

transplantation in the United

States.