Venereal warts are skin abnormalities characterized by pink/gray swellings near the anal region and sometimes extending to the genital area.. The most common symptoms of venereal warts a
Trang 1(also known as: condylomata acuminata)
What are venereal warts?
Venereal warts are skin abnormalities characterized by pink/gray swellings near the anal region and sometimes extending to the genital area They are often described
as having a cauliflower-like appearance.
How do venereal warts occur?
They are caused by a viral infection from the human papilloma virus This infection
is sexually transmitted and is highly contagious.
What are the symptoms of venereal warts?
The most common symptoms of venereal warts are a sense of fullness around the anal or genital region, itching, pain, bleeding from the affected area, and rectal, vaginal, or penile discharge.
Are there any other conditions that cause the same
symptoms as venereal warts?
Pruritus ani and skin conditions involving the anal or genital area.
What factors increase the risk of developing venereal warts?
Sexual activity with individuals who have venereal warts or are infected with the virus that causes this condition predisposes to the development of venereal warts Persons who are sexually promiscuous, homosexual males with other sexually transmitted diseases, HIV-infected individuals, and victims of sexual abuse due to spread of the infection from the abuser to their victim.
Can venereal warts predispose to cancer?
Yes Venereal warts are a risk factor for the development of squamous cell carcinoma of the anorectal region and carcinoma of the cervix and of other portions
of the genital tract.
Venereal warts
Chapter 8.12
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Trang 2What tests are performed to diagnose venereal warts?
The diagnosis is usually made by a physical examination of the affected area Sometimes biopsies are obtained A proctoscopy or flexible sigmoidoscopy may be required to determine whether there are additional warts present in the anus or rectum that cannot be visualized externally.
What over-the-counter treatments or home remedies
can be used for venereal warts?
None.
What prescription medications are used for venereal
warts and how do they work?
Podofilox (Condylox) may be prescribed by your physician It is a topical destructive agent that you apply directly to the warts It works by stopping the cells
in the warts from multiplying Imiquimod (Aldara) is another topical destructive cream that is applied to the warts It appears to destroy the warts by causing secretion of chemicals called cytokines, which stimulate an inflammatory reaction that is used to fight off the infection Podophyllum is also a topical destructive agent, but it has to be applied by your physician It destroys the tissue containing the warts.
What nonsurgical procedures can be used to treat venereal warts?
Laser therapy is often successful Burning of the warts with electrocautery is also highly successful Your physician may also consider injecting the warts with medications that cause their destruction including chemotherapy drugs and Interferon Cryotherapy, which involves applying liquid nitrogen to the warts, is also used.
Is surgery ever used as a treatment for venereal warts?
Yes.
When is surgery used to treat venereal warts?
Surgery is used for large warts that cannot be successfully removed with other therapies Surgery may also be used for warts that keep coming back, and warts that are in the anal canal and rectum.
What surgical procedures are performed for the
treatment of venereal warts?
The warts and a portion of the surrounding normal skin are surgically removed This is usually performed in conjunction with burning of the affected area using electrocautery.
Chapter 8
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Trang 3What additional information should I know about venereal warts?
Since venereal warts are considered to be a risk factor for cancers of the anal and genital regions, periodic examinations of the affected areas are necessary Women with venereal warts should undergo frequent Pap smears and genital examinations.
Patient information
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Trang 4This is trial version
Trang 55-ASA 5-aminosalicylic acid
5-FU 5-fluorouracil
5-HIAA 5-hydroxyindole acetic acid
APC adenomatous polyposis coli
APR abdominoperineal resection
Cl chloride
CT computed tomography
DALM dysplasia-associated lesion or mass
DCC deleted in colon cancer
EAS external anal sphincter
EMG electromyography
FAP familial adenomatous polyposis
HCO3 bicarbonate
HPV human papillomavirus
HPZ high-pressure zone
HSV-2 herpes simplex virus 2
IAS internal anal sphincter
IV intravenous
IVBP intravenous piggyback
LGV lymphogranuloma venereum
MEN multiple endocrine neoplasia
Mg magnesium
MRI magnetic resonance imaging
NHANES National Health and Nutrition Examination Survey
NHIS National Health Interview Survey
PNTML pudendal nerve terminal motor latency
RAIR rectoanal inhibitory reflex
SRUS solitary rectal ulcer syndrome
TNM tumor, nodes, metastases
Abbreviations
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Trang 6Barnes L, Corman ML, editors Colon and Rectal Surgery 4th ed Philadelphia, PA:
Lippincott–Raven Publishers, 1998
Feldman M, Friedman LS, Sleisenger MH, editors Sleisenger & Fordtran’s Gastrointestinal
and Liver Disease 7th ed Philadelphia, PA: Saunders, 2002.
Yamada T, editor Textbook of Gastroenterology 2nd ed Philadelphia, PA: Lippincott
Williams & Wilkins, 1995
Gordon PH, Nivatvongs S, editors Principles and Practice of Surgery for the Colon, Rectum
and Anus 2nd ed New York, NY: Marcel Dekker, 1999.
Gorbach SL, Bartlett JG, Blacklow NR, editors Infectious Diseases 2nd ed Philadelphia,
PA: Saunders, 1997
Review articles
Wald A Anorectal and pelvic pain in women: diagnostic considerations and treatment
J Clin Gastroenterol 2001;33(4):283–8.
Nelson R Anorectal abscess fistula: what do we know? Surg Clin North Am.
2002;82(6):1139–51
Bartram C Dynamic evaluation of the anorectum Radiol Clin North Am.
2003;41(2):425–41
Bharucha AE Fecal incontinence Gastroenterology 2003;124(6):1672–85.
Gopal DV Diseases of the rectum and anus: a clinical approach to common disorders
Clin Cornerstone 2002;4(4):34–48.
Utzig MJ, Kroesen AJ, Buhr HJ Concepts in pathogenesis and treatment of chronic anal
fissure – a review of the literature Am J Gastroenterol 2003;98(5):968–74.
Hong JJ, Park W, Ehrenpreis ED Review article: current therapeutic options for radiation
proctopathy Aliment Pharmacol Ther 2001;15(9):1253–62.
Maria G, Sganga G, Civello IM, Brisinda G Botulinum neurotoxin and other treatments
for fissure-in-ano and pelvic floor disorders B J Surg 2002;89(8):950–61.
Olsen AL, Rao SS Clinical neurophysiology and electrodiagnostic testing of the pelvic
floor Gastroenterol Clin North Am 2001;30(1):33–54,v–vi.
Moore HG, Guillem JG Anal neoplasms Surg Clin North Am 2002;82(6):1233–51.
Moore HG, Guillem JG Multimodality management of locally advanced rectal cancer
Am Surg 2003;69(7):612–9.
Schmitt SL, Wexner SD Treatment of anorectal manifestations of AIDS Int J STD AIDS.
1994;5(1):8–10
Further reading
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Trang 7abdominoperineal resection (APR) 129
Aldara (imiquimod) 200
anal adenocarcinoma 115
anal and rectal anatomy 1–8
anal canal 3
innervation 4
external anal sphincter 4
internal anal sphincter 4
rectum 4
musculature 4–5
external anal sphincter 4
internal anal sphincter 4
rectum 3–4
vascular supply 6–8
anal, arterial and venous 6
rectal, arterial and venous 6–8
anal carcinoma 111–113
clinical pearls 113
diagnosis 112
epidemiology 111
pathophysiology 112
patients at risk 112
symptoms 112
treatment 113
tumor subtypes 111
anal fissure 49–52, 173–174
clinical pearls 52
definition of 49
diagnosis 50
epidemiology 49
pathophysiology 49
patient information 173–174
patients at risk 49
symptoms 50
treatment 50–52
medical 50–52
surgical 52
anal stenosis 53–54
clinical pearls 54
Index
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Trang 8diagnosis 53
epidemiology 53
benign causes 53
malignant causes 53
pathophysiology 53
symptoms 53
treatment 54
medical 54
surgical 54
Analpram 174, 190
anesthetic agents, local 50, 72
benzocaine 50
lidocaine 50, 174
pramoxine 50
anorectal abscess 55–57
clinical pearls 57
definition 55
diagnosis 56
epidemiology 55
pathophysiology 55
patients at risk 55
symptoms 55
treatment 57
anorectal disease, HIV-associated 145–146
anorectal manometry 15–18, 22
anorectal ultrasound 31, 66, 175
anoscopy and proctoscopy 19–20
antibiotics 76, 140, 142, 148
Augmentin 76
azithromycin 140
doxycycline 140, 142
erythromycin 76, 140
penicillin 76, 148
tetracycline 76, 140, 148
trimethoprim–sulfamethoxazole 140
anticholinergic drugs 66, 157
atropine 66
clindium 66
dicyclomine 66
hyoscyamine 66
antidiarrheal agents 66, 95
codeine 66
diphenoxylate 66
loperamide 66
Anusol 178
Asacol (5-ASA containing agent) 192
Index
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Trang 9aspirin (5-ASA) containing agents, 107, 165, 192, 198
atropine 66
azathioprine 82, 107, 186, 198
Azulfidine (5-ASA containing agent) 192
Balneol (lubricating agent) 91, 190
barium enema 21–23, 31, 35, 60
basal cell carcinoma of the perianal region 115–116
Bentyl (dicyclomine) 176
benzocaine 50
biofeedback therapy 18, 25–26, 190
Botox, botulinum toxin 25, 52, 63, 78, 174, 196
Bowen’s disease 116
calcium channel blockers 50
calcium polycarbophyl 72, 174
diltiazem 50
nifedipine 50
Carafate (sucralfate) 192
carcinoid tumors, rectal 133
chlamydia and lymphogranuloma venereum 139–140
clinical pearls 140
diagnostic testing 140
epidemiology 139
incubation time 139
organism 139
pathophysiology 140
patients at risk 139
transmission 139
treatment 140
Chlamydia trachomatis 139
cholestyramine 66
Citrucel (methylcellulose) 72, 174, 178, 182, 196
clindamycin 76
clindium 66
codeine 66
Colace (stool softener) 196
colonoscopy 27–30
condylomata acuminate (venereal warts) 149–151, 199–201
Condylox (podofilox) 200
constipation 59–63
clinical pearls 63
definition 59
diagnosis 60–62
epidemiology 59
pathophysiology 59–60
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Trang 10patients at risk 59
symptoms 60
treatment 63
corticosteroids 96, 107, 165, 192
defecation, the normal process 9–11
diarrhea 155–157
clinical pearls 157
diagnostic testing 156
epidemiology 155
pathophysiology 155
patients at risk 155
symptoms 156
treatment 157
dicyclomine 66, 176
diltiazem 50
Dipentum (5-ASA containing agent) 192
diphenoxylate 66
dynamic proctography 31–34
electromyography (EMG), anorectal 22, 25, 31, 35–36, 66, 175
epinephrine 27
fecal impaction 159–160
clinical pearls 160
definition 159
diagnostic testing 160
epidemiology 159
pathophysiology 160
patients at risk 159
symptoms 159
treatment 160
fecal incontinence 65–67, 175–176
clinical pearls 66
definition 65
diagnosis 66
epidemiology 65
pathophysiology 65
patient information 175–176
patients at risk 65
symptoms 65
treatment 66
fecal osmotic gap 44
FiberCon (calcium polycarbophyl) 72, 174, 175, 178, 182, 196
fiber supplements
calcium polycarbophyl (FiberCon) 72, 174, 175, 178, 182, 196
Index
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Trang 11methylcellulose (Citrucel) 72, 174, 178, 182, 196
psyllium (Metamucil, Konsyl) 50, 72, 174, 196
Flagyl (metronidazole) 186
Fleet’s enema 25, 28
flexible sigmoidoscopy 20, 35, 37–40, 60, 140
5-fluoruracil (5-FU), side effects 131
Foley catheter 170
gonorrhea 141–142
clinical pearls 142
diagnostic testing 141
incubation time 141
organism 141
pathophysiology 141
patients at risk 141
symptoms 141
transmission 141
treatment 142
Goodsall’s rule 84
Hemoccult fecal blood test 37
hemorrhoids 69–74, 177–178
anatomy 69
clinical pearls 74
complications 70–71
definition 69
diagnosis 71
epidemiology 69
pathophysiology 70
patient information 177–178
symptoms 71
treatment 72–73
herpes simplex 143–144
clinical pearls 144
diagnostic testing 144
epidemiology 143
incubation time 143
organism 143
pathophysiology 143
patients at risk 143
symptoms 143
transmission 143
treatment 144
hidradenitis suppurativa 75–76
clinical pearls 76
definition 75
Index
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Trang 12diagnosis 75
epidemiology 75
pathophysiology 75
patients at risk 75
symptoms 75
treatment 76
HIV-associated anorectal disease 145–146
diagnostic testing 146
epidemiology 145
organism 145
pathophysiology 146
patients at risk 145
symptoms 145
treatment/clinical pearls 146
human papilloma virus 149
hyoscyamine 66, 176
ileoanal pouch anastomosis 161–166
alternative procedures 162
clinical pearls 166
complications 164–165
general description 161–162
how the procedure is performed 162–163
results 164
imiquimod 200
immunomodulating agents 82, 107, 165, 186, 198
azathioprine 82, 107, 165, 198
6-mercaptopurine, 82, 107, 198
Imodium 175, 192
infliximab 82, 186
innervation, of the anus and rectum 4
external anal sphincter 4
internal anal sphincter 4
rectum 4
isotretinoin 76
J pouch 161
Kaopectate (kaolin and pectin) 192
Kegal exercises 26, 66, 88, 179–180
Konsyl (psyllium) 50, 72, 174, 175, 178, 182, 196
leiomyosarcoma 134
leucovorin, side effects 132
levamisole, side effects 132
Levbid (hyoscyamine) 176
Index
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Trang 13lidocaine 50, 174
Lidomantle 174, 178
Lomotil (atropine) 176
loperamide 175, 192
low anterior resection 129
lubricating agents 91
Balneol 91
Tucks 91
lymphoma, rectal 135
malignant melanoma 116–117
medical therapy for rectal cancer 131–132
current therapy for TNM stage II and III rectal cancer 131
5-fluoruracil (5-FU), side effects 131
leucovorin, side effects 132
levamisole, side effects 132
radiation therapy, side effects 132
6-mercaptopurine, 82, 107, 186, 198
Metamucil 50, 72, 174, 178, 182, 196
metastatic rectal tumors 135
methylcellulose 72, 174, 178, 182, 196
metronidazole 186
MiraLax (polyethylene glycol) 182
modified Dukes’ classification 125, 126
musculature, of the anus and rectum 4–5
external anal sphincter 4
internal anal sphincter 4
National Health and Nutrition Examination Survey (NHANES) 59
National Health Interview Study (NHIS) 59
Neisseria gonorrhoea 141
nifedipine 50
Nigro protocol 113
nitroglycerin 50, 88
nonrelaxing puborectalis syndrome 77–78, 181–183
clinical pearls 78
definition 77
diagnosis 78
epidemiology 77
pathophysiology 77
patient information 181–183
patients at risk 77
symptoms 77
treatment 78
NuLev (hyoscamine) 176
Index
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Trang 14Pentasa (5-ASA containing agent) 165
perianal Crohn’s disease 79–81, 185–187
clinical pearls 81
definition 79
diagnosis 80–81
epidemiology 79
pathophysiology 80
patient information 185–187
patients at risk 79
symptoms 80
treatment 81
perianal fistula 83–85
clinical pearls 85
definition 83
diagnosis 84
epidemiology 83
patients at risk 83
symptoms 83
treatment 85
perianal Paget’s disease 117
pilonidal sinuses 167–168
clinical pearls 168
diagnostic testing 168
epidemiology 167
pathophysiology 167
symptoms 167
treatment 168
podofilox 151, 200
podophyllum 150, 200
polyethylene glycol 182
pramoxine 50
prednisone 192
Preparation H 178
proctalgia fugax 87–88
clinical pearls 88
definition 87
diagnosis 87
epidemiology 87
patients at risk 87
symptoms 87
treatment 88
ProctoCream 178, 190
pruritus ani 89–91, 189–190
causes 90
clinical pearls 91
definition 89
Index
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