Anorectum Flashcards
What are haemorrhoids
Dilatations of anal veins surrounded by tissue
Where do internal haemorrhoids originate
Above the dentate line
Where do external haemorrhoids originate
Below the dentate line
How much of the population have haemorrhoids
Over half
What are first degree haemorrhoids
Internal haemorrhoids move into the anal canal
What are second degree haemorrhoids
Haemorrhoids prolapsed out of the anus on straining but spontaneously reduce
What are third degree haemorrhoids
Haemorrhoids prolapsed out of the anus on straining but need manual reduction
What are fourth degree haemorrhoids
Haemorrhoids prolapsed out of the anus on straining but cannot be reduced
What might be a typical presentation of haemorrhoids
Sensation of a lump at the anus with possible fresh rectal bleeding on the tissue paper
How are haemorrhoids diagnosed
Usually on anal inspection and asking the patient to to gently strain
What is the management for first and second degree haemorrhoids
Non-surgical as an outpatient
What is the management for third and fourth degree haemorrhoids
Usually need haemorrhoidectomy
What is an anal fissure
A tear of the skin of the anal canal
Where do anal fissures occur
Posterior midline where anal blood flow is lowest and the anal skin is least supported
In what 4 patients do the most commonly occur in
Constipated patients
Crohn’s disease patients
ANorectal infection
Haematological malignancy
What are the clinical features of an anla fissure
Pain which begins with defaecation but continues afterwards
Possible blood
How is the diagnosis of an anal fissure made
On inspection
What is the managent for anal fissures
Correct constipation (diet alteration or bulk laxative)
Avoid straingin
Local anaesthetic
suppositories or creams
What is a fistula
A pathological connection between the gut and skin
Who is more likely to have an anal fistual. Men or women
Men
What are the 4 at risk groups
Crohn’s disease
Prior anal surgery
Prior pelvic radiation
Prior pelvic trauma
What are the clinical features of an anal fistula
Anal discomfort
itching
Loss of faecal material and pus
Who are the at risk groups for anal carcinoma
HIV infection
HPV infection
Syphilis
People participating in anoreceptive intercourse
Prior perianal Crohn’s disease or fistulae
Prior pelvic irradiation
People who have received immunosuppression
Smokers
Who is susceptible to rectal prolapse
Women over the age of 50 who have had children Patients who chronically strain Patients with CF Spina bifida Congenital mesenchymal disorders
What is the usual presentation
The sensation of a mass on wiping
how is the examination carried out for rectal prolapse
With the patient straining - possibly needs to be done on the toilet
What is the treatment for severe rectal prolapse
Surgery
