Anal + Perianal Disease Flashcards
what are haemorrhoids
abnormal swelling/enlargement of anal vascular cushions
what is the function of the anal vascular cushions?
how many are there?
they assist the anal sphincter in maintaining continence
- 3
how are heamorrhoids classified
according to size:
1st Degree: remain in rectum
2nd Degree: prolapse through anus on defecation but spontaneously reduce
3rd Degree: prolapse through anus on defecation and require digital reduction
4th Degree: remain persistently prolapsed
risk factors for haemorrhoids
excessive straining (from chronic constipation) increasing age raised intra-abdominal pressure (e.g. pregnancy, chronic cough, ascites)
presentation of haemorrhoids
painless bright red PR bleeding
- post defecation
- on surface of stool, not mixed in
itch, rectal fullness, soiling due to impaired continence
presentation of a thrombosed prolapsed haemorrhoid
purple/blue, oedematous, tense, tender perianal mass
what investigation confirms haemorrhoids
proctoscopy
management of haemorrhoids
lifestyle advice: increase daily fibre + fluid intake to avoid constipation
laxatives + topical lignocaine for symptom relief
symptomatic 1st/2nd degree haemorrhoids can be treated with rubber band ligation
3rd/4th degree haemorrhoids may require haemorrhoidectomy
what is pilondial sinus disease
formation of a sinus in the inter-gluteal cleft
- due to inflammation + obstruction of hair follicle – pit + cavity formation
who gets pilondial sinus disease
caucasian males with course dark body hair
most commonly 16-30 years old
increased risk in those who sit for prolonged periods e.g. lorry drivers / office workers
presentation of pilondial sinus disease
intermittent, red painful, swollen mass in sacrococcygeal region
- commonly purulent discharge
non-surgical management of pilondial sinus disease
shaving of the affected region
plucking the sinus free of hair that is embedded
surgical management of pilondial sinus disease
abscesses: incision + drainage and washout is required
chronic disease: removal of sinus tract
what is a perianal fistula
abnormal connection between anal canal + perianal skin
what are the majority of perianal fistulas caused by
a perianal abscess
risk factors for a perianal fistula
IBD - Crohns or UC
Systemic disease - TB, HIV, Diabetes
Trauma to anal region
presentation of perianal fistula
either:
- recurrent abscesses
- discharge onto perineum