Anorectal Disease Flashcards
Types of anorectal disease
Haemorrhoids, rectal prolapse, anal fissure, fistula in ano
What are haemorrhoids?
Swollen vessels, usually veins, in/around anus and rectum - can thrombose
Positions of haemorrhoids
3, 7 + 11 o’clock
What do the positions of haemorrhoids correspond to?
Branches of the superior haemorrhoidal artery
Symptoms of haemorrhoids
Painless bleeding (fresh blood on paper), discomfort, itchy bum
Inspection of haemorrhoids
Inspection, PR, proctoscopy, rigid/flex sigmoidscopy
Treatment of haemorrhoids
- Nothing if asymptotic
- Gel, cream, ice-pack
- Band-ligation, slcerosant therapy
- HALO procedure - pain free, spinal anaesthesia
Haemorrhoidectomy if emergency - open (causes incontinence) or stable (if urgent)
What is a rectal prolapse?
Protruding mucosal mass from anus, usually during/due defecation
Difference between partial and complete rectal prolapse
Partial - anterior muscle
Complete - all layers, full thickness
Symptoms of rectal prolapse
Loss of anal tone, bleeding + mucus stools, protruding mass
Treatment of rectal prolapse
- Nothing if asymptomatic
- Stop straining
- Stool softener
- Surgery - most can’t handle
What is anal fissure?
Tear in anal margin, distal to dentate line
What causes anal fissure
Passage of constipated stool
Symptoms of anal fissure
Painful defecation - shitting out shard of glass
Bright bleeding
Perianal abscess, fistula
Treatment of anal tissue
Stool softener, diet, anaesthetic gel
- Pharma sphincterotomy + diltiazem
- Botox - paralysis of internal sphincter to allow fissure to heal
