Anal Fissure Flashcards

1
Q

def

A

an elongated ulcer on the long axis of the lower anal canal

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2
Q

aetiology

A
traumatic
-posterior anal lining - constipation (straining, passing hard stools)
-anterior anal lining - childbirth
inflammatory
-crohns disease
-ulcerative colitis
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3
Q

epi

A

common
<40yrs
incidence 1:350, male:female

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4
Q

history

A

severe burning pain on defaecation

bleeding per rectum (bright red, small in voiume, on paper)

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5
Q

examination

A

inspection reveals a sentinel pile (external lump associated with a tear)
chronic fissures may present with a firm ridge

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6
Q

pathogenesis

A

a mechanical tear occurs in the anal mucosa & the underlying sphincter muscle goes into spasm
the spasm worsens the problem by pulling the edges of the tear apart
poor wound healing due to reduced blood flow in the posterior midline of the anoderm

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7
Q

investigations

A

diagnosis made on history & examination

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8
Q

management

A

conservative
-soft, easily passable stools
medical
-topical GTN/diltiazem which reduce spasm or sphincter & increase blood flow to encourage wound healing
surgery
-lateral internal sphincterotomy (internal sphincter is partially divided to reduce spasm, this allows wound healing)
-botulinum toxin to paralyse part of the internal sphincter

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9
Q

complications

A

chronic fissure & chronic pain
complications of surgery
-faecal incontinence
-bleeding recurrence

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10
Q

prognosis

A

common recurrence
50% treated with topical nitrates
10% treated with lateral sphincterotomy

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