Anorectal Disease Flashcards
what is an anal fissure and how is it classified
tear in the mucosal lining of the anal canal commonly due to trauma from defecation of hard stool
- acute: < 6 weeks
- chronic: > 6 weeks
what are risk factors for anal fissures
- constipation
- dehydration
- IBD
how do anal fissures present
- intense pain post-defecation which can last several hours
- bleeding
- itching
- O/E: fissures visible/palpable on DRE mostly in the posterior midline (will be v painful so EUA may be needed)
what is the medical management of anal fissure
- analgesia
- increase fibre and fluid intake
- trial stool-softening laxatives
- topical anaesthetics e.g. lidocaine for short term symptomatic relief
- GTN/diltiazem in symptomatic patients
how does GTN/diltiazem cream work in anal fissures
↑ blood supply to the region and relaxes the internal anal sphincter putting less pressure on the fissure = promotes healing and ↓pain
what is the surgical management of anal fissures
- reserved for chronic fissures where medical management has failed
- Botox injections into internal anal sphincter which relaxes and promotes healing
- lateral sphincterotomy
how are haemorrhoids classified
how does a thrombosed prolapsed haemorrhoid present
purple/blue
oedematous
tense
tender perianal mass
how is diagnosis of haemorrhoid reached
proctoscopy
- colonoscopy often advised to exclude any other anorectal pathology
how are haemorrhoids managed conservatively
- ↑daily fibre and fluid intake to avoid constipation
- laxatives if necessary
- topical analgesia or oral opioid analgesia
how are thrombosed haemorrhoids managed
ice packs and topical lidocaine
- haemorrhoidectomy for a thrombosed haemorrhoid is not recommended, due to failure to resolve symptoms and higher risk of complications
how are symptomatic 1st/2nd degree haemorrhoids treated
rubber-band ligation
what is an extra surgical option for 2nd/3rd degree haemorrhoids
haemorrhoidal artery ligation
what is an extra surgical option for 3rd/4th degree haemorrhoids
haemorrhoidectomy, especially those not suitable for banding or injection
- haemorrhoidal tissue is excised, ensuring internal sphincter muscle remains
what are the main complications of surgical interventions for haemorrhoids
recurrence
anal stricturing
faecal incontinence
