Anal Fissure Flashcards
1
Q
Presentation?
A
- Severe anal pain/ tearing sensation (passing stool + hours later)
- Anal spasms (70%)
- Bright red PR bleed (stool or paper)
- Children - pain/crying when passing stool
2
Q
Common locations?
A
- 90% posterior midline (spread but cheeks)
- anterior line rare but more likely in females
3
Q
What may be visible if chronic fissure?
A
- sentinel pile (skin tag)
4
Q
What do you want to exclude?
A
- Thrombosed Haemorrhoid
- colorectal cancer
5
Q
Risk factors?
A
(1) constipation
(2) pregnancy
6
Q
Causes of secondary anal fissures?
A
(1) constipation
(2) colorectal cancer
(3) STI
(4) IBD
(5) Sexual abuse in children
7
Q
Would you perform digital rectal examination?
A
Not in primary care, usually not possible due to pain/spasm.
Can consider under anaesthesia in secondary.
8
Q
First line treatments?
A
(1) Laxatives/fibre - constipation
(2) Lidocaine cream/jelly - pain
(3) Nifedipine/nitroglycerine - vasodilate
9
Q
Second line treatments?
A
CCB’s = topical/oral diltiazem OR oral nifedipine
10
Q
Next step if signs of Crohn’s?
A
Refer to gastroenterologist
