Benign anorectal conditions Flashcards
What is the function of the anus
Physiological functions: complex integrated mechanism
- Continence maintenance: solid/liquid/gas
Integrity of the sphincter is complex, including anorectal mucosa and cushions
What are the different classes of benign anorectal conditions
Congenital
Traumatic
Infective
Explain what is perianal abscesses
Also referred to as cryptoglandular adscesses
6 - 14 ducts pass through internal sphincter and open at the dentate line. When these ducts become occluded it leads to infection
What are the different classifications of a perianal abscesses
Perianal
Intersphincteric
Ischiorectal
Supralevator
Explain the presentation of perianal abscess in terms of:
- History
- Exam
History
- Pain, swelling, anal discomfort
- Spontaneous drainage/discharge of puss
What is the treatment of a perianal abscesses
Incision and drainage under anaesthesia
- Surgical incsion into abscess
- Evacuation of al puss
- Debridement of the abscess cavity
- Irrigation of cavity
- Application of dressings
Antibiotics are adjunct to I&D
What are the complications of perianal abscesses
Necrotising fasciitis
Pay special attention to diabetic patients
- sepsis spreads early
- Glucose control impossible in sepsis
Chronic fistula
What are the different types of fistula in ano
Type 1: Intersphincteric fistula
Type 2: Transsphincteric fistula
Type 3: Suprsphincteric fistula
Type 4: Extrasphincteric fistula
Explain
Explain Crohn’s disease
What is an anal fissure
A split/tear in the anoderm
- May be acute
- Often in the posterior midline just distal to the dentate line
- When chronic it is associate with a skin tag
Explain the pathogenesis of anal fissure
Forceful dilatation of the anal canal during defaecation resulting in a disruption of the anoderm.
Exposure of the underlying smoothmuscle leads to muscle spasm which leads to relative ischaemia of the anoderm and poor healing
What are the clinical features of anal fissures
Anal pain during defaecation
Blood on tissue
Examination - gentle….
How are anal fissures treated
Conservative:
- Stool softners, Bulk agents
- Topical application of 2% nitroglyceryl ointment, this causes smooth muscle relaxation
- Botulinum toxin: injection into the internal sphincter inhibits the release ….
Surgical:
- Lateral internal sphincterotomy
Explain what is haemorrhoids
It is normal anatomical clusters of vascular and connective tissue, smooth muscle and overlying epithelial lining of the anal canal
- When they bleed blood is bright red
