Anal Fissure

Question 1

patho. what are they and where do they occur?

Answer 1

tear in the anoderm distal to the dentate line; most of these are longitudinal and occur at the posterior midline.

Question 2

cxfx and normal course

Answer 2

The tear then triggers cycles of recurring anal pain and bleeding, which lead to the development of a chronic anal fissure.

Question 3

etiologies

Answer 3

The majority of anal fissures are primary and are caused by local trauma, such as constipation, diarrhea, vaginal delivery, or anal sex.

Question 4

cxfx: anal pain that is often present at ____ but is

exacerbated by ____

Answer 4

rest

defecation

Question 5

dx how? any maneuver?

Answer 5

physical exam by either directly visualizing a fissure or reproducing the patient’s presenting complaints by gentle digital palpation of the posterior (or anterior) midline anal verge.

Question 6

Treatment initially

Answer 6

combination of sitz baths, increased fiber intake or stool softeners, and topical vasodilators such as nitroglycerin

Question 7

If the condition is not improved after __ weeks of treatment, and ______ is excluded , the next step in management is _______

Answer 7

8 weeks of conservative therapy
→ endoscopy to exclude IBD
lateral internal sphincterotomy.

Question 8

tx For older patients or multiparous women who are at high risk for developing fecal incontinence

Answer 8

botulinum toxin is injected

Question 9

classification of anal fissures

Answer 9

Anal Fissure Pain
<8 weeks = acute
>8 weeks = chronic