Anal Fissure Flashcards
Pertinent Anatomy
(1) Anus, Usually posterior midline 6 o’clock
(2) Rectum
Anal fissures are linear or rocket shaped ulcers that are usually ____mm in length
<5mm
Occur most commonly in the posterior midline, but 10% occur anteriorly.
Fissures that occur off of the midline should raise suspicion, as they could be symptomatic of what?
more serious diseases or sexual assault.
Anal fissures are confirmed by visual inspection of the ____ while gently separating the buttocks.
anal verge
Acute fissures look like
cracks in the epithelium
Chronic fissures result in
fibrosis and the development of a skin tag at the
outermost edge.
True/False
Digital and anoscopic examinations for fissures may be painless
False
may cause severe pain and may not be possible
Differential Diagnosis for fissure
(1) Perianal abscess
(2) Inflamed or thrombosed hemorrhoids
(3) Condyloma acuminate
(4) Skin tag
(5) Crohn’s disease
Labs for fissures
Unless a more serious disease is expected, in that case, the patients should be referred
RADS for fissures
Unless a more serious disease is expected, in that case, the patients should be referred
Treatment
Management is directed at promoting
effortless, painless bowel movements
Treatment options
- Fiber supplements and sitz baths
- Topical anesthetics may provide temporary relief (5% viscous lidocaine; 2.5% lidocaine plus 2.5% procaine).
- Oral Analgesics such as Tylenol or NSAIDS
Healing occurs within__ months in up to ___% of patients with conservative management
2
45%
Chronic fissures should be ______. They may be treated with topical _______ or with an injection of botulinum toxin into the internal anal sphincter
referred
nitroglycerin (0.2- 0.4%) or diltiazem (2%)
Initial Care
1) Upon identifying utilize treatment plan and consider stool softeners for effortless bowel movements during healing process.
2) Discuss with patient the importance of keeping the area clean.
