Anal Diseases Flashcards
define perianal disease
thesis recurrent abscess formation, leading to pain and leakage
diagnosis of perianal disease
PR examination
management of perianal disease
surgical drainage
antibiotics
define haemorrhoids
enlarged vascular cushions in the lower rectum and anal canal
presentation of haemorrhoids
painless bleeding
itch
diagnosis of haemorrhoids
PR examination
proctoscopy
sigmoidoscopy
management of haemorrhoids
only if symptomatic
grade I- III= sclerosation or rubber banding
grade IV= haemorrhoidectomy
HALO/THD procedure (locates artery supplying haemorrhoid and ties it off)
define a rectal prolapse
rectum loses its normal attachments inside the body (can be partial or complete)
presentation of a rectal prolapse
protruding mass from the anus (particularly after defecation)
PR bleeding and mucus
diagnosis of rectal prolapse
PR shows poor anal tone
management of rectal prolapse
rectoplexy (reattachment of rectum)
Derlome’s procedure (mucosa and muscle removed)
anterior resection (removal of that part of rectum)
too frail for surgery = bulking agents and manual reduction education
define an anal fissure
this is a tear in the anal margin, due to a constipated stool
what does multiple fissures indicate?
Crohn’s
presentation of an anal fissure
acute pain following an episode of constipation (can b up to 1/2 hour after)
PR bleeding
management of an anal fissure
dietary advice
stool softener e.g. docusate
GTN cream and diltiazem to relax sphincters
sphincterotomy or botox injection
define an anal fistula
abnormal communication between two epithelial surfaces
presentation of an anal fistula
recurrent abscess, pain, itch, PR bleeding
diagnosis of an anal fistula
examination
proctoscopy
sigmoidoscopy
management of an anal fistula
insertion of seton (suture if high fistula) LIFT procedure (closure and removal of infected tissue)
classification of haemorrhoids
1st degree= no prolapse
2nd degree= prolapse when straining and return on relaxation
3rd degree= can be pushed back
4th degree= permanent prolapse
topical therapies for haemorrhoids
anusol and germoloid creams
score for major lower GI bleeds for discharge planning
Oakland score
what causes an anorectal abscess?
infection originating in cryptoglandular epithelium lining the anal canal that spreads to soft tissues with abscess formation
location of anorectal absccesses
ischiorectal
intersphincteric
supralevator
perianal
what to expect if extreme pain in haemorrhoids
blood supply strangulation
what is a perianal haematoma cause?
rupture of perianal subcutaneous blood vessel
presentation of perianal haematoma
blue/ black bulge at anal margin
classification for anal fistula
Park’s classification
what is Goodsall’s rule?
transverse line through the anus in lithotomy position. Fistula with opening anterior to this will follow a straight line to the anus. Fistulae with an opening posterior will follow a curved line
what is the pilonidal sinus?
hair containing sinus that can cause inflammation
management of pilonidal sinus
hygiene
shaving
surgery - incision and drainage, WLE and flap
RF for anal carcinoma
HPV
receptive anal intercourse
most common anal carcinoma
squamous cell
management of anal carcinoma
radiotherapy +/- chemotherapy
