Anorectal Disorders Flashcards
Do ano-rectal problems show up as malaena or haematochezia
No, they show up as dripping blood form back passage. Blood in stool in any form is associated with other parts of the GI tract
What are haemorrhoids also known as
Piles
What are haemorrhoids
Swellings comtaining engorged blood vessels found inside or around the bottom
Common presentation of haemorrhoids
Painless bleed
Perianal itch
Fresh, bright blood not mixed with faeces
No change in bowel habits, no weight loss
Examination of haemorrhoids
External inspection can be normal
Maceration of skin
Obvious if 3rd degree piles preset
What is maceration of skin
Softening and breaking down of skin resulting in prolonged exposrue to moisture
Investigation for haemorrhoids
PR examination
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy if patient > 50
Dreaded effect of surgery for haemorrhoids
Anal sphincters may be affected/damaged leading to incontinence
Management of haemorrhoids
Symptomatic
HALO - Haemmorhoid Artery Ligation Operation (or)
THD - Transanal Haemorrhoid Dearterialization
What does HALO/THD involve
A dopple is used to locate termiating branches of the haemorrhoidal arteries. Once the artery is located, surgeons use an absorbable suture to “tie-off” the arterial blood flow. Venous “out-flow” remains to shrink the cushion
Side effect of stapled haemorrhoidectomy
Can lead to a feeling of tenesmus and cause sepsis
Why is HALO procedure virtually painless
As the stitch is placed above the pectinate line where no sensory supply is present
Late stage stage anal cancer can often be mistaken for
3rd degree piles/haemorrhoides
Types of rectal prolapse
Partial - Anterior mucosal collapse
Complete - Full thickness
Prevalence of rectal prolapse
More common in females due to a wider girth of pelvis. Removal of uterus leads to more space available for prolapse.
Presentation of rectal prolapse
Protruding mass from anus especially during defaecation. Bleeding and passing mucus is common. May reduce spontaneously
Examination of rectal prolapse
Reveals poor anal tone
Perineal vs abdominal rectoplexy for rectal prolapse
Abdominal rectoplexy is preferred in younger patients as a perineal rectoplexy doesn’t last long.
Management of complete rectal prolapse in frail patients
Bulking agents and education on manual reeduction
Treatment for complete rectal prolapse
Derlome’s procedure
Perineal rectopexy
Abdominal rectopexy
Anterior resection
What are anal fissures
Tear in anal margins due to passage of a constipated stool
Cause of multiple fissures may be
Crohns
Presentation of anal fissures
Feels like glass passing through back passage
Acute onset of severe anal pain usually following episodes of constipation
Bright rectal bleeding
How can a sentinel pile be used clinicaly
Generally points in the directio of fissure
