Anorectal Disorders Flashcards
Anorectal fissure definition
Linear tear in anoderm distal to the dentate line
Should you do a DRE for an anorectal fissure?
NO! They are very painful!
An anorectal tear causes…
sustained spasm of the anal sphincter, resulting in decreased blood flow and delayed healing
Location of anorectal fissures
Posterior or anterior midline.
Posterior more common due to poor perfusion.
Anal fissure treatment
Break cycle of constipation, pain and tearing.
- Stool bulking/softeners
- Warm sitz baths
- Topical anesthetics
- Nifedipine (calcium channel blocker that relaxes internal sphincter and promotes blood flow plus healing)
- Botox
- Surgical sphincterectomy
Hemorrhoids become problematic if…
thrombosed or prolapsed
Location: internal vs external hemorrhoids
Internal: above dentate (pectinate) line
External: below dentate (pectinate) line
Pain: internal vs external hemorrhoids
Internal: NOT painful (visceral innervation)
External: Painful (somatic innervation)
Prolapsed or thrombosed: internal vs external hemorrhoids
Internal: prolapsed
External: thrombosed
Internal hemorrhoids treatment
A. Stool bulking/softeners. warm sitz baths
B. Rubber band ligation, sclerotherapy, infrared coagulation
C. Surgical excision
External hemorrhoid treatment
If thrombosed <48 hours: surgical excision
If thro,bosed > 48 hours: stool bulking/softeners, sitz baths
What can you do to prevent hemorrhoids?
Eat a lot of fibre, stay hydrated, avoid straining and prolonged pressures.
