Anorectal Disease Flashcards
what are haemorrhoids?
enlarged vascular cushions in the lower rectum and anal canal
describe the bleeding associated with haemorrhoids
painless
fresh, bright red
describe the presentation of haemorrhoids
bleeding
perianal itchiness
no change in bowel habit
what four investigations are done for haemorrhoids?
PR exam
rigid sigmoidoscopy
flexible sigmoidoscopy
proctoscopy
when is a flexible sigmoidoscopy done when investigating haemorrhoids?
in patients over 50
what four procedures can be done to treat haemorrhoids?
sclerosation therapy
rubber band ligation
haemorrhoidectomy
HALO/THD procedure
what two methods of haemorrhoidectomy can be done?
open and stapled
what is used in sclerosation therapy?
5% phenol in almond oil
what does HALO stand for?
haemorrhoidal artery ligation
what two types of rectal prolapse are there?
partial and complete
what is a partial rectal prolapse?
prolapse of only the anterior mucosa
what is a complete rectal prolapse?
the full thickness prolapses
how does rectal prolapse present?
protruding mass from the anus
bleeding/mucus PR
what does PR examination in rectal prolapse show?
poor anal tone
how is complete prolapse treated if patients are too frail for surgery?
bulking agent
education on manual reduction
name four surgeries that can be done to treat complete prolapse?
delorme’s procedure
perineal rectopexy
abdominal rectopexy
anterior resection
how is partial prolapse in children treated?
dietary advice
treatment of constipation
how is partial prolapse in adults treated?
very similarly to haemorrhoids
what is anal fissure?
a tear in the anal margin due to the passage of a constipated stool
what disease may be associated with multiple fissures?
crohn’s disease
how does anal fissure present?
acute onset of severe pain following constipation
bright rectal bleeding
what conservative management of anal fissures can be done?
dietary advice
stool softeners
pharmacological sphincterotomy
how long does pharmacological sphincterotomy take?
6 weeks
what two chemicals are used in pharmacological sphincterotomy?
0.3% GTN ointment
2% diltiazem ointment
what two procedures can be done to treat anal fissures?
lateral sphincterotomy
botox injections
what is fistula in ano?
an abnormal communication between the anal canal and the perianal skin
what three conditions rarely cause fistula in ano?
crohn’s disease
TB
carcinoma
what four investigations can be done into fistula in ano?
EUA of anorectum
sigmoidoscopy
proctoscopy
MRI
what is an EUA of the anorectum?
a PR exam under anesthesia
