Anal Rectal Disorders Flashcards
when do haemorrhoids become palpable on digital examination?
when they are 3rd degree
how are haemorrhoids managed?
help symptoms (laxatives etc) sclerosation therapy (almond oil etc) rubber band ligation open haemarrhoidectomy (not common) stapled haemarrhoidectomy (not common) HALO/THD procedure (artery ligation - quite common)
what are the 2 types of rectal prolapse?
partial (anterior mucosal prolapse)
Complete (full thickness) - common in older females
how does prolapse present?
protruding mass from anus (esp. during defaecation) which may reduce spontaneously
bleeding/mucus is common
poor anal tone
how is complete prolapse managed?
if too frail for surgery - bulking agent and education on manual reduction
delormes procedure
perineal rectopexy
abdominal rectopexy (if fit)
In children - dietary advice and treat constipation
IN adults - similar to haemorrhoids
what is a stoma prolapse?
prolapse of bowel through stoma in the abdomen
what is an anal fissure?
tear in anal margin often posterior midline) due to passage of constipated stool
what might multiple fissures indicate?
crohns
how might anal fissures present?
acute pain like passing “glass” (can last 30 mins after)
bright rectal bleeding
what is the dentate? line and why is it significant?
line dividing anal canal
below line = very painful
above line = no pain
how are anal fissures treated?
dietary advice, stool softeners
pharmacological sphyncterotomy (GTN or diltiazem ointment)
lateral sphyncterotomy
Botox injection
what are fistula in ano?
abnormal communication between 2 epithelial surfaces
internal opening in anal canal and one or more openings on perianal skin
eg. colovescical, colovaginal etc
many fistula - think crohns
how will anal fistulas present?
often arise from delay in treatment or inadequate treatment of anorectal abscess
leakage from little opening that doesn’t really heal
what underlying disease can cause fistulas?
crohns
TB
carcinoma
how are anal fistulae investigated?
EUA of anorectum
rigid sigmoidoscopy, proctoscopy
flexible sigmoidoscopy
MRI (best)
how are anal fistulae managed?
laying open 2 stages procedure insertion of seton string(drainage, cutting) LIFT procedure Glue/permacol defunctioning colostomy
what is a fistulotomy?
cut open the fistula and lay it open
what are some possible complications of anal fistulae?
pain
bleeding
incontinence of flatus or stool
recurrence (further surgery)
what does blood dripping in the toilet indicate?
haemarrhoids
what are haemorrhoids?
enlarged vascular cushions in anal canal
how do haemorrhoids present?
painless bleeding
fresh, right red blood not mixed with stool often on paper or dripping
perianal itch
no assoc symptoms
how is the positioning of haemorrhoids determined?
usually corresponds to branches of superior haemarrhoidal artery:
- 3, 7 and 11 O’ Clock position with patient in lithotomy position
how are haemorrhoids investigated?
PR exam
rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy in patients above 50 yrs
