Anal Fissure Flashcards
Definition
Small tear in long axis of squamous mucosa in lower third of anal canal just at or inside anal verge
High anal maximum resting pressure and sphincter tone
Main part of anal canal with anal fissure
Posterior midline
Main causes
Overstretching of mucosa with passage of hard faeces
hypertonia of internal sphincter
Foreign objects like fish bone
Predisposing factors
Crohns
Tb
Syphilis
HIV
UC
Time it takes to resolve acute anal fissure
No more than 6 weeks
When can acute anal fissure become chronic ischemic ulcer
If get infected
Morphology of acute anal fissure
Edematous and indurated skin at base forming sentinel pile
Can chronic anal fissure heal on their own
No
Sex in which anal fissure are more common
Male
Presenting complaints
Anal pain during défalcation lasting several hours
Constipation worsened by fear of defaecating
Light bright red bleeding
Faeces with strikes of blood
Pruritus ani if secondary infection
Can you do rectal exam
No because painful so should defer
Treatment
High fiber diet
Topical local anesthetics
Sitz bath
Chemical sphincterectomy
Lateral sphincterectomy
Drugs used in chemical sphincterectomy
◦ CCB
‣ topical 2% diltiazem
◦ NO donor
‣ 0.2% glyceryl trinitrate
‣ Very short half life
‣ Causes headache
◦ Botulinum Toxin
‣ 2 to 3 months
