Anorectal Disorders Flashcards
What are the common presentations of anorectal disorders? (3)
Pain
Haemorrhage
Dysfunction
What are some common acquired anorectal disorders? (6)
Haemorrhoids Fissure Abscess Anal Fistula Ulceration Cancer
Where are the anal cushions when viewed from a lithotomy position?
3, 7 and 11 O’clock
Why can the anal cushions become bulky and loose? (3)
Gravity
Straining at stool
Increased anal tone
Why do haemorrhoids become painful?
They become thrombosed
What are the common presentations of haemorrhoids? (4)
Bleeding after passing stool
Pruritus ani
A lump hanging down after defecation
Mucus discharge after defecation
What are the 4 stages of haemorrhoids?
- No prolapse, prominent blood vessels
- Prolapse upon bearing down, spontaneous reduction
- Prolapse upon bearing down requiring manual reduction
- Prolapse with inability to be manually reduced
Treatment for Stage 1 haemorrhoids (4)
Increased fibre and fluids
+/- Topical analgesics
Stool softener.
Topical steroids for a short period of time only.
Treatment for Stage 2 haemorrhoids (or refractory stage 1) (3)
Rubber band ligation
Sclerosants (1 or 2) – injecting phenol in almond oil
Infrared coagulation
What surgical options are available for haemorrhoids? (2)
Excisional haemorrhoidectomy
Stapled haemorrhoidopexy
What are the rarer causes of anal fissures? (6)
Syphilis Herpes Trauma Crohn’s Anal cancer Psoriasis
What is the most common cause for anal fissures?
Hard stools
What lifestyle advice will be offered to patients with anal fissures? (3)
More fibre
More fluid
Hygiene Advice
What are the medical options to treat anal fissures? (4)
- Topical nitric oxide
- 0.2% Glycerol Trinitrate paste
- 2% Dilitazem Calcium blocker
- Stool softener
What diseases are associated with peri-anal abscesses? (3)
Crohn’s
Malignancy
Fistulae.
What can cause an anal fistula? (7)
Peri-anal sepsis Abscesses Crohn’s TB Diverticular disease Rectal carcinoma Immuno-compromise
How do you treat peri-anal abscesses? (2)
Antibiotics
Surgical drainage
How do you treat a superficial anal fistula?
Laid open by fistulotomy
Heals by second intention
How do you treat a trans-sphincter anal fistula?
May need a Seton suture to maintain continence
What are the risk factors for anal cancer? (3)
Syphillis
Anal Warts
Ano-receptive homosexuals
What is the histological type that accounts for 85% of anal cancer?
Squamous
What can cause anal ulceration? (5)
Syphillis chancre Anal cancer Crohn's disease TB Treatment with Nicorandil
What are some pathological causes of pruritus ani? (6)
Incontinence Threadworm Fistula Dermatoses (skin condition) Lichen sclerosus (a long term skin condition) Anxiety
