Anorectal disrders Flashcards
What casues Haemorrhoids?
Mainly due to straining, which is usually due to constipation
Haemorrhoids treatment
Underlying cause - ie constipation
Rubber bands (RBL) or surgical: HALO/(Anopexy, not always used)/Haemorrhoidectomy
What is a fissure? what is the management?
A small tear in the anal canal. Produces a lot of bleeding and can be painful - “glass splinters”
Treatment:
Underlying cause eg constipation
Medical management - GTN/Diltiazem + Lignocaine
Surgical (botox/spincterotomy) - BUT MAY CAUSE INCONTINANCE
What do you need to exclude wutg regards to fissures?
Anal cancer
What is perianal abscess? Signs and treatment?
Pus filled boil like lump around the anal area.
Excruciatingly painful, may present with signs of sepsis
Treatment inc antibiotics, incision/draininage.
Do NOT go looking for fistulars as this can easily cause damage to the naal cushions and cause fecal incontinance
What are fistula in ano? Signs/symptoms and treatment
fitsular begining in rectum and heading towards skin (like a second anus, but not supposed to be there).
sings/symptoms inc:
-peri-anal sepsis
-persisting pus discharge with flare up
-possibe throbbing/faecal soiling
treatment:
-Seton – to drain sepsis/mature tract
-Sphincter preservation techniques
-Lay open: BEWARE Women
What does a fit postivie test mean?
Blood in poop. Not necessarily cancer, but it does mean that cancer needs to be excluded
What are the common investigation on ano-rectal of anorectal conditions
Colonoscopy. If CT conoloscopy will still get the images but won’t be able to get any biopsies
Anorectal manometry measures what?
Pressure, so if teh anal sphincter is working
Endoanal USS used for what, when?
Gives anatomy, so anal sphincter injuries, fistular disease, faecal incontinance of late onset
Defecating proctogram used fr waht?
x-ray lookinf at the defecating muscles
Used to measure rectal prolapse/anterior vector seal problems
EUA means what?
endoscopy under anastaetic
Causes of pelvic floor disfunciton
Parous women (women who have given birth) -pregnancy/childbirth
Others:
Abuse, surgical misadventure, neuro/connective tissue disorder, psychological issues
What is chroic consitpation
Difficult or reduced frequency of evacuation
.
What are the types of cosntipation
-Dietary (commonest)
-Drugs
-Organic (Hirshsprung - colon nerve issue /Ehlers-Danlos syndromes (EDS - connective tissue disorder)
-Functional (Slow transit (infrequent), Evacuation related (Common) or combination)
What are the initial treatments of CC
Exclude sinister pathology
Aggressive dietary management
Ensure adequate water intake (not just fluids/fizzy drinks)
Caffeinated coffee
Biofeedback for learning/relearning toileting habits/posture
Good trial of conservative measures and life style optimisation
WHich drugs can cause constifation?
Aluminium antacids
Antimuscarinics (e.g. procyclidine, oxybutynin)
Antidepressants (most commonly tricyclic antidepressants, but others may cause constipation in some individuals)
Antiepileptics (e.g. carbamazepine, gabapentin, oxcarbazepine, pregabalin, phenytoin) Sedating antihistamines
Antipsychotics
Antispasmodics (e.g. dicycloverine, hyoscine)
Calcium supplements
Diuretics
Iron supplements
Opioids
Verapamil
How to treat CC
Start with regular baseline laxatives
Ensure compliance
Consider combination therapy
Second line drugs:
Proculopride for women only: Failed tx with 2 or more regular laxatives from different classes at highest dose for 6 months and invasive measures considered
Lubiprostone for all adults: Failed tx with 2 or more regular laxatives from different classes at highest dose for 6 months and invasive measures considered
Linaclotide: For IBS related constipation
What are the types of faecal cincontinence and what are their causes?
Passive: Internal sphincter defect
Urge: Rectal pathology, functional
Mixed: Prolapse
Overflow: Constipation
Management of Feacal incontance
PELVIC FLOOR EXERCISES
Aggressive conservative measures
Low fibre diet
Loperamide
Pelvic floor exercises
EMG if required
Irrigation
Anal plug
