Benign Anorectal Disease Flashcards
anal fissure - why so hard to heal?
like a paper cut, muscles keep splitting it open
which muscles are important for pelvic floor strength and continence?
levator ani + puborectalis
sharp, razor-blade like ano-rectal pain during and after BMs
fissure-in-ano
dull, achy, burning anorectal pain
hemorrhoids
what is the optimal exam of the anorectum?
anoscopy
*indicated for any anal or perianal condition
fissure-in-ano epi
any age. most common in young & middle age adults.
sx of fissure-in-ano
- sharp pain during and after defecation (knife-like, tearing, fear of moving bowels)
- minor –> moderate bleeding during & after BM’s (on paper)
- sentinel skin tag
most common location for an fissure-in-ano
other locations?
usually posterior midline, b/c blood flow isn’t as good there
lateral: think Crohn’s or HIV
tx for fissure-in-ano
- lifestyle modification: fiber, fluids
- Meds: relieve IAS spasm, increase blood flow
- Sitz bath, topical nitro or Ca-channel blockers, Botox
- surgery: lateral internal sphincterotomy
what surgery do you do for fissure-in-ano? how does it work?
lateral internal sphincterotomy
remove internal sphincter - but just the section under the fissure
Hemorrhoid epi
everyone has them, but <5% symptomatic
peak incidence: age 45-65
etiology of hemorrhoid
constipation –> chronic straining
- tissue engorgement
- fragmentation of muscular attachments
- prolapse, ulceration, bleeding
how to tx thrombosed external hemorrhoid
w/in first 48 hrs: cut the hemorrhoid, squeeze out clot
later: send home on Sitz bath, reassure that it will go away
perianal skin tags
pts hate them, but they are just a nuisance and shouldn’t be excised unless a hygiene problem
definitely don’t excise in a Crohn’s Pt
internal hemorrhoids sx
painless bleeding
protrusion/prolapse
mucous seepage
how to distinguish b/t prolapse and hemorrhoids
prolapse = uniformly concentric + circumferential mucosal folds
hemorrhoids = radial
hemorrhoids tx
lifestyle: fiber, fluids, bathroom behavior
office tx: rubber band ligation
surgery: excisional hemorrhoidectomy = gold standard
* very very painful, need to take care of the wound meticulously for 4-6 wks afterwards
tx for perianal abcess
NOT ANTIBIOTICS ALONE
operative incision and drainage ASAP
seton drain
a tx for fistula-in-ano
like a earring to keep tract open and keep pus draining (prevent abcess formation)
pilonodular disease
intergluteal cleft - usually far from anal verge > several centimeters
ruptured hair follicle –> cyst
tx for pilonodular cyst
gold standard = wide local excision
- put in probe to find pits
- cut it out
- marsupialize
