Ano-rectal disorders Flashcards
What are haemorrhoids?
Enlarged vascular cushions in the lower rectum and anal canal
What is the presentation of haemorrhoids?
Painless bleeding
Fresh, bright red blood, not mixed, usually on paper
Perianal itchiness
No change in bowel habit, no weight loss or other assoc symptoms
What clinical findings might you see in haemorrhoids?
External inspection might be normal
Maceration of the perianal skin
Obvious if the haemorrhoids are 3rd degree - piles present
Where are the classical position of haemorrhoids?
Correspond to the branches of the superior haemorrhoidal artery
- occurring at 3, 7 and 11 o’clock
What investigations might you do for someone with haemorrhoids?
PR exam
Rigid sigmoid
Proctoscopy
Flexible sigmoid in patients above 50
How do you treat/manage haemorrhoids?
Symptomatic
Sclerosation therapy with 5% phenol in almond oil
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy
HALO/THD procedure
What is the HALO/TDH procedure?
Hemorrhoidal artery ligation
Mini doppler ultrasound device locates branches of arteries supplying the haemorrhoids. Blood vessels tied off and haemorrhoids shrink over days and weeks.
(Pain free as stitch is placed in lower rectum where virtually no sensory nerves)
What 2 kinds of rectal prolapse can you get?
Partial - anterior mucosal prolapse
Complete - full thickness
What is the presentation of rectal prolapse?
Protruding mass from anus - especially during defecation
May reduce spontaneously
Bleeding and passing mucus per rectum - common
Examination - shows poor anal tone
What is the management of complete prolapse?
Most patients too frail for surgery - bulking agents and education on manual reduction
Delormes prcedure
Perineal rectopexy
Abdominal rectopexy
Anterior resection
What is the management of incomplete prolapse?
Children - diet advice and constipation treatment
Adults - similar to haemorrhoids treatment
What is an anal fissure?
Tear in the anal margin due to passage of a constipated stool
Where do you usually find the anal fissure?
In the midline posteriorly but may be occasionally anterior
What might multiple fissures be due to?
Crohns disease
What is the presentation of anal fissures?
Acute onset of severe anal pain usually following episode of constipation
Glass passing through the back passage
Pain lasts for up to 1/2 hour after defecation
Bright rectal bleeding
What is the treatment of anal fissures?
Stool softener and it advice
Pharmacological sphycterotcomy (diltiazem ointment)
Lateral sphyncterotomy
Botox injection
What is a fistula in ano?
Abnormal communication between 2 epithelial surfaces
There is an internal opening in the anal canal and one or more external openings on the peri-anal skin
What might the presentation of fistula in ano be?
Most arise from delay in treatment or inadequate treatment of anorectal abscesses
What investigations might you do for fistula in ano?
EUA of anorectic
Rigid sigmoidoscopy, proctoscopy
Flexible sigmoidoscopy
MRI
What is the management of fistula in ano?
Laying open 2 stage procedure Inception of seton (draining and cutting) LIFT procedure Glue/permacol Defunctioning colostomy
What are some complications of fistula in ano?
Pain Bleeding Incontience of flatus or stool Recurrence Further surgery
