- Anterior- common in women (10:1) - Posterior- frequently affected

Anorectal Flashcards by Prabashwari Karunathilake

What s anal fissure

Longitudinal split in the anoderm of the distal anal canal

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Extension of anal fissure

anal verge to the dentate line. Not beyond that.

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Anal fis common at wht age

Common in young adults

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Common sites of AF

Anterior- common in women (10:1)

- Posterior- frequently affected

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Wht are ectopic siites of anal ffis

Crohn’s disease
– Anal intercourse
– TB
– Sexually transmitted disease – HIV
– Squamous cell carcinoma

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Causes for anal fissures

Strained evacuation of a hard stool
• Repeated passage of diarrhea
• Vaginal delivery-anterior anal fissure

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What are types of anal fissures

Acute

Chronic

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Three features of chronic af

Hypertropic anal papilla
Fissure with heaped up scarred edges
Sentinalskin tag

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Two mx tyes of anal fissure

Conservative

Surgical

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Outcome of conservative mx af

healing of almost all acute and the majority of chronic fissures

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What are used in conservative mx of AF

Analgesics oral and local
Stool bulking agents
Stool softners
Adequate water i take
Chemical agrnts -GTN 0.2%bd tds
-CCB =dilitiazem 2%
Botox injections

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What are Surgical Management options AF

Lateral internal sphincterotomy

Anal advancement flap

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What are complications of internal sphincterectomy in AF

Haemorrhage
Haematoma
Bruising
Perianal abscess and fistula
Faecal incontinence- particularly in women

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What’s haemorroids

Dilalated anal cushions increased venous pressure within them
Common in elderly
Situated in 3, 7,11 O’clock positions

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How haemorrhoids get Development

Man’s upright posture
Lack of valves in the portal venous system
Raised abdominal pressure

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What are types of haemorroids

Primary

Secondary

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Reasons for primary haemorroids

Constipation
• ProfuseDiarrhea
• Pregnancy
• Obesity

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Reasons for secondary haemorroids

Portalhypertension
Rectalcancer
Pelvictumours

What are clinical featurs of haemorroids

Bleeding per rectum
Lump at anus on
defecation
Mucous discharge
Anaemia- not rare
Pain- in complicated haemorrhoids
DRE-Cannotbepalpable

What are 4 degrees of hemorroids

1st D- Bleeding only
2nd D- Prolapse, reduce spontaneously
3rd D- Prolapsed, Manually reduced
4th D- Permanently prolapsed

What are Complications of haemorrhoids

Strangulation and thrombosis

Ulceration

Gangrene

Portal pyaemia

Fibrosis

How to Assessment of haemorrhoids

Proctoscopy

Flexible sigmoidoscopy- to exclude underlying malignancies in elderly

What are types of Management in haemorroids

Conservative
Minimal invasive
Operative

What are Conservative Management types

Advice about defecatory habits
Stool softeners
Stool bulking agents

What are minimal invasive management for hemorrhoids

Injection sclerotherapy | Banding

What will be done in the injection sclerotherapy

5% phenol in Archies or Almond oil

For what degree of hemorrhoids operative management used

Third and fourth- degree hemorrhoid second-degree not cured by nonoperative tx

What are the types of operation management in hemorrhoids

Hemorrhoidectomy | Hemorrhoidal artery ligation

What are the complications of the hemorroids

``` Bleeding acute urinary retention anal fissure and submucous abscess Fecal incontinence Anal stenosis and stricture ```

What are . adynamic intestinal obstructions A

Paralytic ileus. Pseudo obstruction- colonic & intestinal

What's paralytic ileus.

Faliure of transmission of peristaltic wave | secondary to neuromuscular faliure

In whom gallstones are common

Fat fertile frothy fair female 5F

Gallstones more common in whom

24% female abd 12% male

Is old age gallstones common

Yes

Types of gallstones

Cholesterol 15% mixedstones 80% pigment stones 5%

How cholesterol stones appear

Solitary, more than 2.5cm , round shape

How mixed stones appear

Multiple a faceted, cholesterol, calcium phosphate, calcium carbonates s proteins

What's least % of stones

5% pigmented stones , black or brown, small size.

What's %.gallstones that radio opaque

10%

What are condition which precipitate gallstones

Billiary infections , billiary stasiss , altered gb function.

What happen to gb when gallstones present

30% get affected by infections, gram -.bacteria.

Clinical features of gallstones inside gallbladder.

Acute cholecytitis, emphyma-sepsis, mucocele, billiary colic , mucocele, billiary colic, carcinoma.

What are clinical features when gallstones in neck of gb

Mirrizi syndrome