Anal Disorders

Question 1

Symptoms of anal disorders

Answer 1

• fresh bleeding
• pain on defecation
• pain + inflammation
• prolapsing tissue
• ulcerated lesions

Question 2

Anal conditons

Answer 2

1. Anal fissure
2. peri-anal sepsis
3. haemorrhoids
4. anal carcinoma
5. anal sphincter damage

Question 3

Diagnosing anal disorders

Answer 3

1. clinical examination with DRE
2. examination under anaethetic
3. proctoscopy
4. biopsy for pathology
5. manometry and ultrasound of anal spincters

Question 4

Anal fissure definition

Answer 4

A small tear in the mucosa

Question 5

Symptoms of anal fissure

Answer 5

• Painful on defecation
• fresh bleeding

Question 6

Treatment of anal rectal fissures

Answer 6

laxatives, drugs to relax the anal spincter - diliitazem, GTN

surgery 0 lateral spincterotomy of internal sphincter

Question 7

Peri-anal sepsis definition

Answer 7

Also known as a perianal abscess represents an infection of the soft tissues surrounding the anal canal

Question 8

Symptoms/signs of peri-anal sepsis

Answer 8

• painful
• inflammation
• systemic upset e.g pyrexia, abscess formation
• obvious externally but abscess may be higher and need rectal examination to detect
• fistula

Question 9

Treatment of peri-anal abscess

Answer 9

Incision and drainage of abscess

fistula may be layed open if below sphincter but if above may need seton suture to allow drainage or more complex surgery

Question 10

Haemorrhoid definition

Answer 10

A swollen vein or group of veins in the region of the anus

Question 11

symptoms/signs of haemorrhoids

Answer 11

1. fresh rectal bleeding after defecation
2. may be prolapsed
3. unconfortable

Question 12

Treatment of haemorrhoids

Answer 12

• treated with banding/ injection sclerotherapy at out=patient clinic
• prolasping haemorrhoids may need surgical excision - haemorrhoidectomy

Question 13

Anacarinoma features

Answer 13

• ulcerated lesion at anal margin
• may bleed, painful
• sqamous carcinoma
• spread to inguinal LN

Question 14

Treatment of anal carcinoma

Answer 14

surgery- abdomino-perineal resection and/or radiotherapy

Question 15

Anal sphincter damage features

Answer 15

• previous vaginal deliverys with perineal tear
• can be caused by surgery for other conditions e.g anal fissure surgery
• causes faecal incontinence
• investigated with manometry/endo-anal ultrasound of sphincters
• surgical repair of disrupted sphincter