Cardinal Signs and Symptoms

Sharp pain associated with scant, bright red rectal bleeding is the hallmark of anal fissure disease. The pain occurs during and after passage of stool like passing a piece of glass. Pain may radiate into the rectum or buttocks and sometimes seems out of proportion to what would be expected given the small size of the lesion. If pain is severe enough, patients may have difficulty with urinary hesitancy, retention, or frequency. Anticipation of pain with bowel movements may discour- Fig. 2. The...

References

Gastrointestinal hemorrhage. In Levine BA, Copeland EM III, Howard RJ, et al., eds. Current Practice of Surgery. Churchill Livingstone, New York, 1993 1-19. 2. Johnson SJ, Jones PF, Kyle J, Needham CD. Epidemiology and course of gastrointestinal haemorrhage in North East Scotland. BMJ 1973 3 655-660. 3. Talbot-Stern JK. Gastrointestinal bleeding. Emerg Med Clin North Am 1996 14 173-184. 4. Lieberman D. Gastrointestional bleeding initial management. Gastroenterol Clin...

Solitary Rectal Ulcer

Solitary rectal ulcer syndrome is a chronic benign disorder related to abnormal defecation. It is probably caused by mucosal trauma from straining, but direct digital trauma in an attempt to aid evacuation and possibly a primary neuromuscular pathology may also play a small role. Solitary rectal ulcer is stongly associated with internal intussusception of the rectal mucosa or overt rectal prolapse (90,91). Prolapsing of rectal mucosa combined with high transmural pressures during defecation may...

Acute Lower Gastrointestinal Hemorrhage

Lower GI hemorrhage accounts for 10 of all acute GI bleeding, with 70 occurring in patients older than 65 years (18). Although the origin of bleeding depends largely on the age of the patient and the rate of hemorrhage, the two most common causes of massive lower gastrointestinal hemorrhage are diverticular disease (Fig. 4) and angiodysplasias (Fig. 5) (Table 2) (9). Less common etiologies include ischemic colitis, neoplasms, Meckel's diverticulum, inflammatory bowel disease, postpolypectomy...

Clinical Presentation

In infectious diarrhea, symptoms will depend on the pathogenic properties of the organism involved. In IBD, the extent and severity of disease are the important factors. It is the chronicity of the patient's symptoms that will best help to distinguish infectious from idiopathic inflammation, as many features of the patient's history may be common to both conditions. The setting in which the diarrhea develops is helpful in making a diagnosis. The history should include recent types of food eaten...

Gastric Antral Vascular Ectasia

GAVE is an increasingly recognized cause of occult bleeding. This condition is most common in elderly women. Patients generally experience occult bleeding and have IDA that fails to respond to oral iron therapy. Although the cause is unknown, it is seen at higher frequency with autoimmune or connective tissue disorders and atrophic gastritis, hypergastrinemia, cirrhosis, or portal hypertension. The typical endoscopic Causes within reach of an upper endoscope Erosions within hiatal hernias...

Anorectal Varices

Anorectal varices are a result of portal hypertension and represent enlarged portal-systemic collaterals. They develop as a result of hepatofugal portal venous flow through the inferior mesenteric vein to the superior hemorrhoidal veins. An important distinction is that anorectal varices are not related to hemorrhoids, which are vascular cushions of ectatic venular-arteriolar connections of the hemorrhoidal plexus, and have no direct connection to the portal system. The prevalence of anorectal...

Safer Antiinflammatories The COX2Specific Inhibitors

The ulcer risk associated with Celecoxib has been evaluated by endoscopy in patients with osteoarthritis and rheumatoid arthritis in studies lasting 3-6 months. In a 3-month study of patients with osteo-and rheumatoid arthritis, celecoxib 200 mg bid caused fewer endo-scopic ulcers than naproxen 500 bid and ibuprofen 800 tid. There was no difference in the incidence of endoscopic ulcers compared with diclofenac 75 mg bid (22). A recent report compared the incidence of endoscopic ulcers in...

Treatment

The management of external hemorrhoids in most cases is conservative. Mildly symptomatic hemorrhoids and thrombosed external hemorrhoids can be managed with warm sitz baths two to three times per day. If patients are able, bed rest may help minimize swelling and aggravation of thrombosed external hemorrhoids. Agents that allow the passage of soft stools, such as psyllium seed preparations, synthetic mucilloids, and the sodium or calcium salts of dioctyl sulfosuccinate can decrease irritation of...