Anal Fissures Flashcards

1
Q

What are anal fissures?

A

They are defined as longitudinal tears of the lining in the distal anal canal

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2
Q

What cells line the distal anal canal?

A

Non-keratinised stratified squamous epithelium

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3
Q

Where do anal fissures most commonly occur?

A

Posterior midline

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4
Q

What is indicated when anal fissures are located in an alternative location to the posterior midline?

A

Inflammatory bowel disease

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5
Q

What are the two classifications of anal fissures?

A

Acute Anal Fissures

Chronic Anal Fissures

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6
Q

What are acute anal fissures?

A

They are defined as those which are present for a period of less than six weeks

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7
Q

What are chronic anal fissures?

A

They are defined as those which are present for a period greater than six weeks

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8
Q

What are the six risk factors of anal fissures?

A

Constipation

Persistent Diarrhoea

Inflammatory Bowel Disease

Anal Cancer

Sexually Transmitted Infections

Childbirth

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9
Q

Which three sexually transmitted infections are associated with anal fissures?

A

HIV

Syphillis

Herpes

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10
Q

What are the four clinical features assoicated with anal fissures?

A

Bright Red Rectal Bleeding

Defecation Pain

Burning Anal Pain > Defecation

Anal Tear

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11
Q

How are anal fissures diagnosed?

A

Clinically

In most cases, investigations aren’t required

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12
Q

What are the three conservative management options of anal fissures?

A

High-Fibre Diet

High Fluid Intake

Regular Exercise

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13
Q

What are the two pharmacological managements of acute anal fissures?

A

Bulk-Forming Laxatives

Osmotic Laxatives

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14
Q

When are bulk-forming laxatives used to manage acute anal fissures?

A

They are the first line pharmacological management option

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15
Q

Name two bulk-forming laxatives used to manage acute anal fissures

A

Ispaghula husk

Methylcellulose

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16
Q

When are osmotic laxatives used to manage acute anal fissures?

A

They are the second line pharmacological management option

17
Q

Name an osmotic laxative used to manage acute anal fissures

A

Lactulose

18
Q

What is the pharmacological management option of chronic anal fissures?

A

Topical Glyceryl Trinitrate (GTN)

19
Q

When is topical GTN used to manage chronic anal fissures?

A

It is the first line management option of chronic anal fissures

20
Q

How long should topical GTN be trialled for? What is the next appropriate management step in cases where clinical features persist?

A

8 weeks

Secondary care referral

21
Q

What is the surgical management option of chronic anal fissures?

A

Sphincterotomy

22
Q

When is sphincterotomy used to manage chronic anal fissures?

A

It is the second line management option of chronic anal fissures when conservative management is deemed unsuccessful

23
Q

What is sphincterotomy?

A

It involves incision of the lateral internal anal sphincter