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Gastroenterology > Anal Disorders > Flashcards

Anal Disorders Flashcards

1
Q

How long does an acute anal fissure last?

A

< 6 weeks

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2
Q

Where are the majority of anal fissures located?

A

Posterior midline

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3
Q

What are some causes of anal fissures?

A

Tearing from passage of hard stool
Anal trauma
Drugs
IBD
STIs
Dermatological conditions
Pregnancy/childbirth

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4
Q

What are the 2 main symptoms of anal fissures?

A

Localised pain (sharp, can be persistent, tearing sensation)
Bleeding (small amount, bright red, on wiping)

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5
Q

When would you consider referral for an anal fissure?

A

Atypical looking
Elderly
Severe symptoms
Diagnosis unclear

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6
Q

What pain relief can be given for anal fissures?

A

Simple analgesia
Warm bath
Lidocaine ointment (before defecation)

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7
Q

What are some management options for anal fissures? (Not medications)

A

Keep stools soft and easy to pass
Anal hygiene
Avoid straining
Avoid stool withholding
Manage underlying causes

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8
Q

What are the medical managements for anal fissures?

A

GTN 0.4% recital ointment applied BD for 6-8 weeks
Diltiazem 2% topical
Botox
Surgical management

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9
Q

What is the main side effect of GTN 0.4% rectal ointment?

A

Headache/dizziness

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10
Q

What are haemorrhoids?

A

Abnormal enlargement of mucosal fissions in the anal canal

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11
Q

What is the function of the mucosal cushions in the anal cavity?

A

Help maintain continence

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12
Q

What cells usually cover external piles?

A

Modified squamous epithelium

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13
Q

What cells often cover internal piles?

A

Columnar epithelium

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14
Q

What is a grade 1 internal haemorrhoid?

A

No prolapse just prominent blood vessels

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15
Q

What is a grade 2 internal haemorrhoid?

A

Prolapse on bearing down but spontaneous reduction

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16
Q

What is a grade 3 internal haemorrhoid?

A

Prolapse on bearing down requiring manual reduction

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17
Q

What is a grade 4 internal haemorrhoid?

A

Prolapse with inability to be manually reduced

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18
Q

What increases the risk of haemorrhoids?

A

Straining
Constipation
Heavy lifting
Pregnancy
Childbirth
Increase intra-abdominal pressure
Aging
Chronic cough

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19
Q

What are the symptoms of haemorrhoids?

A

Bright red fresh rectal bleeding
Itching or irritation
Feeling of incomplete emptying, rectal fullness or discomfort
Palpable lump
Usually painless unless strangulated

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20
Q

What is seen clinically in external haemorrhoids?

A

Bluish swellings

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21
Q

When would you refer for haemorrhoids?

A

Acutely painful e.g strangulated
Symptoms are severe and likely need surgery
Diagnosis is unclear

22
Q

What is the use of astringents?

A

Reduce irritation

23
Q

What types of drugs are in anusol?

A

Astringent and emollient

24
Q

What types of drugs are in germoloids?

A

Lidocaine and astringent

25
Q

What drugs are in proctosedyl?

A

Anaesthetic and steroid

26
Q

How long is the maximum you should use steroid creams for?

A

7 days

27
Q

What 3 names of creams/ointments are used to treat haemorrhoids?

A

Anusol
Germoloids
Proctosedyl

28
Q

What are for non-surgical second line treatments of haemorrhoids?

A

Rubber band ligation
Injection sclerotherapy
Photocoagulation
Bipolar diathermy

29
Q

What are the 3 surgical second like treatments of haemorrhoids?

A

Haemorrhoidectomy
Stapled haemorrhoidectomy
Haemorrhoids artery ligation

30
Q

What is a perianal abscess?

A

Collection of pus in anal or perianal region

31
Q

What are the 2 types of perianal abscess?

A

Submucosal
Subcutaneous
(See pictures on OneNote)

32
Q

What are the 3 types of anal abscesses?

A

Supralevator
Intersphinteric
Ischiorectal
(See OneNote)

33
Q

What are the risk factors for anal abscesses?

A

Immunocompromised patients
IBD
Diabetics
Receptive anal sex

34
Q

What are the symptoms of anal abscesses?

A

Painful hard lump
Pain is constant and throbbing especially when siting
Discharge from pus
Systemically unwell with fever

35
Q

What is the management of anal abscesses?

A

Surgical
Very small abscess can resolve on their own
Antibiotics rarely help alone but can do in adjunct with surgery

36
Q

What can anal abscesses lead to?

A

Fistula-in-ano

37
Q

What is a fistula?

A

Tract from blocked internal gland to skin

38
Q

What are the symptoms of fistula-in-ano?

A

Pain
Discharge
Skin irritations
Bleeding

39
Q

What are the risk factors of fistula-in-ano?

A

Abscess
Crohns
Diverticulitis
Hidradenitis suppurative
Tb
HIV
Post-colorectal surgery

40
Q

What is the management for fistula-in-ano?

A

Surgical
- setons
- advancement flap procedure
- lift procedure
- endoscopic ablation
- laser surgery
- fibrin glue
- bioprosthetic plug

41
Q

What is proctalgia fugax?

A

Benign anal pain syndrome
Spasm of muscle
Recurrent episodes of sever cramping often at night

42
Q

What investigations should be done in suspected proctalgia fugax?

A

Abdo exam
DRE
Consider flexible sigmoidoscopy

43
Q

What type of cancer is anal cancer usually?

A

Squamous cell cancer

44
Q

What are the signs of anal cancer?

A

Irregular shape
Redness

45
Q

What is pruritis ani?

A

Itching around the anus

46
Q

What are some causes of pruritis ani?

A

Dermatological
Parasites e.g threadworms or scabies
Anal or colorectal cancer
Piles
Fissures
Fistulas
Incontinence
Medications (steroids, colchicine, abx, immunosuppressants)

47
Q

What is the management of pruritis ani?

A

Treat underlying cause
Avoid scratching
Avoid irritants
Wash and dry area properly
Mild steroids/antihistamines to provide relief

48
Q

What is proctitis?

A

Pain and inflammation of last 6 inches of rectum

49
Q

What are the symptoms of proctitis?

A

Faecal urgency
Diarrhoea
Consultation
Tenesmus
Cramping pain
Mucus on stool
PR bleeding
Pus

50
Q

What are the risk factors of proctitis?

A

Receptive anal sex
IBD
Infections e.g STIs
Radiation therapy

Gastroenterology (31 decks)

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