Anal Problems Flashcards
What is an Anal Fissure?
Longitudinal or elliptical tears of the squamous lining of the distal anal canal.
Where does a fissure occur?
Below the level of the dentate line
How does an anal fissure present?
Painful on defaecation- tearing sensation
PR bleeding on stool or toilet paper
What would you see next to the lesion with an anal fissure?
Adenomatous skin tag
What is another name for the adenomatous skin tag?
Sentinel pile
What is the main RF for an Anal fissure?
Constipation
inflammatory bowel disease
STI’s e.g. HIV, syphilis, herpes
What is an anal fistula?
An abnormal cavity that forms between the anal canal to the skin near the anus
Usually get infected and result in an abscess
Which condition is an anal fistula common in?
Crohn’s disease
How does an anal fistula present?
Pass blood or pus when poo
Smelly discharge around anus
Constant throbbing- worse when sit
Discharge and discomfort
What would you see in the poo of someone with an anal fistula?
Pus or blood
What is the main investigation of an anal fistula?
DRE
Complex fistula-MRI
What is the management of an anal fistula?
Surgical
What is the surgical management of an anal fistula?
Fistulotomy
Seton procedure
How does an anal abscess present?
Perianal pain and swelling
Fluctuant tender peri anal swelling
Is there PR bleeding with an anal abscess?
No
If blood, suspect fissure
What other symptoms does an anal abscess present with?
Low grade fever and tachycardia
What is an anal abscess associated with?
Crohn’s
Ulcerative colitis
TB
What is the management of an anal abscess?
Surgical excision and drainage
Done under local anaesthetic
What is classed as an acute anal fissure?
Less than 6 weeks
What is classed as a chronic anal fissure?
Lasts longer than 6 weeks
What is the management of an acute anal fissure?
soften stool
–dietary advice: high-fibre diet with high fluid intake
–bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
What is the management of a chronic anal fissure?
Topical glyceryl trinitrate (GTN)
What can you give for a chronic anal fissure if GTN isn’t effective after 8 weeks?
Refer to secondary care for
–Surgery (sphincterotomy)
or
–Botulinum toxin
How is an anal fissure diagnosed?
On history alone
(too painful to do exam)
Where do majority of anal fissure occur?
On the posterior midline
If there is an anal fissure on somewhere other than the posterior midline what should be considered?
An underlying cause e.g. Crohn’s
What investigation can be used for a complex anal fistula?
MRI (to evaluate complex fistulae)
What can be used to determine the location of an anal fistula?
Goodsall’s rule
What is there usually a history of in someone presenting with an anal fistual?
History of anorectal abscess
What are the possible complications of an anal fistula?
- recurrence
- faecal incontinence post-operatively
What are the main features of an anorectal abscess?
- anal or rectal pain, often worse on defection
- pus-like discharge from anus
- fever, rigors
- erythematous, indurated or fluctuant mass around anus
