Anal-Rectal Pathology Flashcards
What are haemorrhoids?
Enlarged and congested mucosal vascular cushions around the anal canal
Describe grade 1 haemorrhoids
Do not prolapse outside the anal canal
Describe grade 2 haemorrhoids
Prolapse on defecation but reduce spontaneously
Describe grade 3 haemorrhoids
Can be manually reduced
Describe grade 4 haemorrhoids
Cannot be reduced
Give some predisposing conditions for haemorrhoids
Straining with defaecation
Pregnancy
How do haemorrhoids present?
Painless rectal bleeding, not mixed with stool
- Most common presentation
Painful rectal bleeding
- If thrombosed or external
Constipation
Pruritis
Lumps/swelling in anus
What are the types of haemorrhoids?
Internal
- Above the dentate line
External
- Below the dentate line
- Prone to thrombosis, may be painful
What is the dentate line?
Line that divides the upper two thirds and lower third of the anal canal
What is the lifestyle management of haemorrhoids?
Increase dietary fibre
Increase fluid intake
Stop straining
What is the management of grade 1-3 haemorrhoids?
Topical local anaesthetics and steroids
Band ligation
Injection sclerotherapy
What is the management of grade 4 haemorrhoids?
Haemorrhoidectomy
Name a complication of haemorrhoids
Strangulation
- Blood supply to a prolapsed haemorrhoid is restricted due to contraction of the anal sphincter, resulting in pain and swelling
- May become thrombosed
How do thrombosed haemorrhoids present?
Significant pain and a tender lump
Purplish, oedematous, tender subcutaneous perianal mass
How are thrombosed haemorrhoids managed?
If patient presents within 72 hours then referral should be considered for excision
Otherwise patients can usually be managed with stool softeners, ice packs and analgesia
Symptoms usually settle within 10 days
What is an anal fissure?
Longitudinal or elliptical tears of the squamous lining of the distal anal canal
How do anal fissures present?
Painful bright red rectal bleeding
Give risk factors for anal fissures
Constipation
IBD
STIs
Where is the most common location of anal fissures?
Posterior midline
How are acute anal fissures managed?
High fibre
High fluid
Laxatives
Topical anaesthetics
Analgesia
How are chronic anal fissures managed?
Topical GTN
Sphincterotomy or botulinum toxin if GTN not effective after 8 weeks
What is a perianal abscess?
Collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincte
How do perianal abscesses present?
Pain around the anus, which may be worse on sitting
Hardened tissue in the anal region
Pus-like discharge from the anus
If the abscess is longstanding, the patient may have features of systemic infection
What organism are perianal abscesses most commonly linked to?
E-coli
(Also staph aureus)
What investigations are used in perinanal abscess diagnosis?
Transperianal US
- Only used if part of more serious underlying issue such as IBD
How are perianal abscesses managed?
Incision and drainage
- Heals in 3-4 weeks
Antibiotics used if systemic upset secondary to abscess
Give a complication of perianal abscesses
Anal fistula
What organism is associated with Proctitis?
C Difficle
What is the most common histological subtype of anal cancer?
Squamous, unlike rectal which is Adenocarcinoma
Give risk factors for anal cancer
HPV infection
Gay men/anal intercourse
HIV
History of cervical cancer or CIN
Immunosuppressive drugs
Smoking
