Ano-rectal sepsis Flashcards
What is an anal fissue?
Tear in epithelial lining of anal canal
What are some causes of atypical anal fissues?
Crohn’s, HIV or cancer
What are chronic fissures?
Where symptoms have lasted > 6 weeks. Typically sentinel tag at external apex
What are the causes of anal fissues?
Hypertonic anal sphincter precipitated by constipation and mucosal injury.
What is the treatment of anal fissures?
- High fiber diet, stool softners and sitz baths
- GTN ointment (can give headaches), diltiazem ointment or bottox
- Surgical - Lateral internal sphincterotomy
What are pilonidal sinus?
Hair follicles inserted into the skin creating a chronic sinus tract
What is the presentation of pilonidal sinus?
Can present as a simple cyst, acute abscess or a chronic draining sinus. Located 5cm superior from anus
What is the non operative treatment of a pilonidal sinus?
Local hair control, improved hygiene, treat abscess with abx or drainage.
What is the surgical treatment of a pilonidal sinus?
- Incision and drainage of cyst,
- Karydakis procedure
What are the presentation of anal fistula?
Discharge, pain and soiling
What are the presentation of anal abscess?
Pain, purulent discharge, symptoms of sepsis
What are the treatments of abscesses?
Incision and drainage
Treatment of fistula?
- Treat underlying problem
- Imaging via MRI
- Metronidazole for patient’s with Crohn’s
- Fistulotomy (repairing) or seaton drainage
What are the risk factors for anal abscess?
Anal fistula, Crohn’s disease and male sex
What is the treatment of anal prolapse?
- Abdominal approach - rectopexy
- Resectional rectopexy
