[5] Anal Fissure Flashcards

1
Q

What is an anal fissue?

A

A tear in the mucosal lining of the anal canal

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2
Q

What is an anal fissure most commonly due to?

A

Trauma from defecation of hard stool

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3
Q

What can anal fissures be classified as?

A

Acute or chronic

Primary or secondary

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4
Q

What is considered to be an acute anal fissure?

A

Present for <6 weeks

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5
Q

What is considered to be a chronic anal fissure?

A

Present for >6 weeks

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6
Q

What is a primary anal fissure?

A

One occurring with no underlying disease

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7
Q

What is a secondary anal fissure?

A

One occurring due to an underlying disease, e.g. Inflammatory bowel disease

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8
Q

What are anal fissures usually caused by?

A

Inflammation or trauma to the anal canal

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9
Q

What are the major risk factors for anal fissures?

A

Constipation
Dehydration
Inflammatory bowel disease
Chronic diarrhoea

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10
Q

What are the symptoms of anal fissures?

A

Post-defecation pain
Bleeding
Itching

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11
Q

Describe the pain in anal fissures?

A

Intense pain post-defecation, which can last several hours

Pain can be far out of proportion to the size of the fissure

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12
Q

Describe the blood in anal fissures

A

Commonly bright red blood on wiping

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13
Q

What may be found on examination with anal fissures?

A

Fissures can be visible and/or palpable on DRE

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14
Q

What may be required for diagnosis of anal fissures?

A

Examination under anaesthesia

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15
Q

Why may examination under anaesthesia be required for the diagnosis of anal fissures?

A

Because often patients will refuse a DRE due to the intense pain

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16
Q

Where might anal fissures present?

A

Posterior midline or anterior midline

17
Q

What % of anal fissures present in the posterior midline?

A

90%

18
Q

When are anterior anal fissures more likely?

A

In females, or if an underlying cause is present

19
Q

How can fissures within the anal canal usually be identified?

A

With proctoscopy

20
Q

What are multiple fissures and anteriorly located fissures more likely to be due to?

A

An underlying cause

21
Q

What do multiple fissures and anteriorly located fissures require?

A

Further investigations (if no known cause is apparent)

22
Q

What does the medical management of an anal fissure involve?

A

Reducing risk factors and providing adequate analgesia
Stool softening
Creams

23
Q

How can stool softening be achieved in anal fissures?

A

Measures such as increasing fibre in the diet and fluid intake

24
Q

What medication can be trialled if there is no change in stool following initial conservative management?

A

Stool softening laxatives

25
Q

Give two examples of stool softening laxatives

A

Movicol

Lactulose

26
Q

What creams can be used in anal fissures?

A

GTN cream or diltiazem cream

27
Q

How do GTN or diltiazem creams work?

A

They increase the blood supply to the region and relax the internal anal sphincter, putting less pressure on the fissure, promoting healing and reducing pain

28
Q

What is surgical treatment reserved for in anal fissure?

A

Chronic fissures, where medical management has failed to resolve the symptoms

29
Q

What surgical technique is used to treat anal fissures?

A

A lateral sphincterotomy

30
Q

What is the recurrence of anal fissures after surgery?

A

Between 1-5%

31
Q

Where do the majority of cases of recurrence of anal fissures after surgery occur?

A

In those with an underlying predisposition to the condition