Anorectal Pathology Flashcards
Fistula-in-ano:
Definition/Types:
. A chronic form of perianal abscess that fails to heal after draining and becomes an inflammatory tract characterized by primary internal & secondary external openings.
Categorized into 4 groups based on their relation to the sphincter muscles.
. Intersphincteric
. Transsphincteric
. Suprasphincteric
. Extrasphincteric
Causes:
Infectious diseases, malignancy, and trauma; associated with active pulmonary tuberculosis and Crohn’s disease
Symptoms/Signs:
. Purulent or serosanguinous drainage
. Palpable fistula tract may be evident
. External opening at skin level
. Internal opening
Diagnosis:
. Anoscopy
. Hydrogen peroxide injection study
. Fistulography
. Examination under anesthesia
. Probing of the fistula tract
. MRI (complex fistulas)
. Ultrasonography (complex fistulas)
Treatment:
. Fistulotomy
. Fistulectomy
. Placement of a section
Anal Fissures
. Tears in epidermis of anal canal from dentate line to margin of anus
. Primary Fissures: Trauma, Childbirth, passage of hard stools
. Superinfection in HIV and agranulocytosis
Definition/Types:
. Tears in the epidermis of the anal canal extending from the dentate line to the margin of the anus
. Primary fissures: trauma, childbirth, or the passage of hard stools
. Secondary fissures: associated with other systemic conditions, such as Crohn’s disease, leukemia, aplastic anemia, superinfection in HIV patients, and agranulocytosis
Symptoms/Signs:
. Pain in the anus during & after defecation
. Bleeding (over 70% of patients)
. Swelling that can form a “sentinel pile”
. Fibrosis, which may lead to skin tag formation
. Constipation
. Spasm
. Pain may be severe & incapacitating
Diagnosis:
. Visualization
. Anoscopy under anesthesia
. Digital examination
Treatment:
. Acute fissures usually heal spontaneously in 6 weeks
. Chronic tissues generally require surgical intervention
. Conservative treatment: application of topical anesthetics or hydrocortisone ointments; warm sit baths; addition of bulk-forming agents, such as bran or psylliumseed, to the diet to relieve constipation; anal hygiene
. Surgical treatment: lateral internal sphincterotomy
Pilonidal Disease:
. An acute abscess in the sacrococcygeal area, exclusively in the midline, that ruptures spontaneously, resulting in an unhealed sinus tract with chronic drainage
. Sinus tract is generally 2 to 5 cm & can be mistaken for a fistula-in-ano
. Lesions are often secondarily invaded by hair
Symptoms/Signs:
. More frequent in obese males in their 20s or 30s
. Acute abscess; pain can be severe
. Chronic sinus formation; pain is minimal, but a seropurulent drainage is present
. A pit is evident in the midline approximately 5cm above the anus
Diagnosis:
. Visual exam.
Treatment:
. Incision & drainage: wound may be left open & allowed to heal by second intention (granulation)
. Various tech. used for the sinus path
Hemorrhoids
. Congestion & dilatation of the submucosal & subcutaneous venous plexuses that line the anal canal; caused by persistent or repeated intro-abdominal pressure, heavy physical exertion, constipation, heredity, age, and diet
. Most common anal lesions
. Classified as external or internal and by location
Symptoms/Signs:
. Generally asymptomatic
. Painful protrusions that bleed and itch
. Mucoid discharge
. Inspection of the anal orifice reveals thickening of the columns of Morgagni that appear as blush lumps beneath the skin or as distinct, prolapsed purplish bodies
Diagnosis:
. Anoscopy
Treatment:
. Non-operative treatments: sitz baths, dietary supplements, topical medications, and injections
. Hemorrhoidectomy for severe prolapse or othe complications
. Rubber-band ligation is a conservative intervention that is usually done in the office setting
