Ano-rectal Disorders Flashcards
what are haemorrhoids
enlarged vascular cushions in the lower rectum and anal canal
presentation of haemorrhoids
painless bleeding - fresh, bright red blood, not mixed with stool, usually on the paper
perianal itchiness
clinical findings of haemorrhoids
maceration of perianal skin
3rd degree piles presents obvious haemorrhoids
rectal exam - normal unless thrombosed
classical position of haemorrhoids
corresponds to branches of superior haemorrhoids artery - occurring at 3, 7 and 11 o’clock position with the patient in lithotomy position
tests for haemorrhoids
PR examination
rigid sigmoidoscopy
proctoscopy
flexible sigmoidoscopy (patient > 50)
management for haemorrhoids
only if symptomatic; sclerosation therapy rubber band ligation open/stapled haemorrhoidectomy HALO/THD procedure
sclerosation therapy in haemorrhoid treatment
5% phenol in almond oil
HALO/THD procedure in haemorrhoid treatment
haemorrhoidal artery ligation causing haemorrhoid to shrink over subsequent days and weeks stitch is placed in lower rectum, no sensory serves, and so procedure is pain free
types of rectal prolapse
partial (anterior mucosal prolapse)
complete ( full thickness)
what is rectal prolapse
protruding mass from anus especially during defecation
clinical features of rectal prolapse
bleeding and passing mucus per rectum - common
por anal tone
may reduce spontaneously
management of complete rectal prolapse
too frail for surgery - bulking agent and education on manual reduction
surgery
surgery for complete rectal prolapse
Delorme’s procedure
perineal rectopexy
abdominal rectopexy
anterior resection
management of incomplete prolapse - children
dietary advise
treatment of constipaiton
management of incomplete prolapse - adults
similar to haemorrhoids; sclerosation therapy rubber band ligation open/stapled haemorrhoidectomy HALO/THD procedure
what is an anal fissure
tear in anal margin due to passage of constipated stool
where do anal fissures occurs
usually in the midline posteriorly but may be occasionally anterior
cause of multiple anal fissures
Crohn’s
clinical presentation of anal fissure
acute onset of severe anal pain - following episode of constipation
pain lasts up to half an hour after defection
bright rectal bleeding
treatment for anal fissures
dietary advice stool softeners pharmacological sphyncterotomy lateral sphyncterotomy botox injection
pharmacological sphyncterotomy treatment in anal fissures
GTN ointment
diltiazem ointment
what is a fistula in ano
abnormal communication between 2 epithelial surfaces;
internal opening in anal canal and one or more external openings on peri-anal skin
rare causes of fistula in ano
Crohn’s
TB
carcinoma
causes of fistula in ano
arise from delay in treatment, or inadequate treatment of anorectal abscess
tests for fistula in ano
EUA of anorectic
rigid sigmoidoscopy, proctoscopy
flexible sigmoidoscopy
MRI
management of fistula in ano
laying open fistulotomy 2 stage procedure insertion of seton LIFT procedure glue/permacol defuncitoning colostomy
insertion of seton procedure in management of fistula in ano
draining and cutting
complications of fistula in ano
pain bleeding incontinence of flatus or stool recurrence further surgery
