Anorectal disorders Flashcards
What is pruritis ani?
Itch that occurs around the anus
What can cause pruritis ani?
- Moist/solied anus
- Fissures
- Incontinence
- Poor hygeine
- Tight pants
- Threadworm
- Fistula
- Dermatoses
- Lichen sclerosis
- Anxiety
- Contact dermatitis
How would you treat someone with pruritis ani?
- Avoid scratching
- Improve perianal hygeine
- Avoid foods which loosen stool
- Soothing ointment
- Topical steroids (max 2 weeks)
- Oral antihistamine
What are anal fissures?
Painful tears in the squamous lining of the lower anal canal. Often, if chronic, they will have a sentinal pile or mucosal tag at the external aspect
What sex do anal fissures occur more commonly in?
Males
What are causes of anal fissures?
- Hard stools - most common
- Syphillis
- Herpes
- Trauma
- Crohn’s
- Anal cancer
- Psoriasis
Why do anal fissures take a significant amount of time to heal?
Spasm around the area leads to relative ischaemia, meaning that fissures take longer to heal
What might you consider doing in someone with anal fissures if you suspected a sinister cause?
Proctoscopy/Sigmoidoscopy
How would you manage someone with anal fissures?
- Dietary fibre
- Fluids
- Stool softener
- Hygeine advice
-
Consider medical
- Topical 5% lidocaine + 0.2% GTN Paste
- Topical 2% Diltiazem
What medical treatment can be used to treat anal fissures?
- Topical 5% lidocaine + 0.2% GTN Paste
- Topical 2% Diltiazem
What would you consider dioing in a patient with anal fissures where conservative and medical management has failed?
Lateral partial internal sphinterectomy
What is a anorectal abscess?
Abscess which is usually caused by gut bacteria, which can occur in the perianal, ischiorectal, intersphincteric or supralevator regions
How would you manage a perianal abscess?
Incise and drain under GA
What diseases are perianal abscesses associated with?
- Diabetes mellitus
- CRohn’s
- Malignancy
- Fistulae
What is a fistula in ano?
A track communicating between the skin and anal canal/rectum. Often occurs following the development of an abscess
How do fistulae in ano form?
Blockage of deep intramuscular gland ducts thought to predispose to the formation of abscesses, which discharge to form fistulas
What are causes of fistula-in-ano?
- Perianal sepsis
- Abscesses
- Crohn’s Disease
- TB
- Diverticular disease
- Rectal carcinoma
- Immunocompromise
What is the following type of fistula-in-ano?
Transphincteric fistula
What is the following type of fistula-in-ano?
Intersphincteric fistula