Benign conditons of the ano-rectal area Flashcards
What is a haemorrhoid?
Enlarged vascular cushions in the lower rectum and anal canal
What is the classic presentation of haemorrhoids?
Painless bleeding
Fresh, bright red blood, not mixed with stool, usually on the paper
Perianal itchiness
No change in bowel habit, no weight loss or other associated symptoms
What is the classical positioning of haemorrhoids?
corresponds to the branches of the superior haemorrhoidal artery occuring at 3 , 7 and 11 o’clock position
What are the investigations for heamorrhoids?
PR examination
Rigid sigmoidoscopy
Proctoscopy
Flexible sigmoidoscopy in patients above age of 50
What is the best procedure for symptomatic haemorrhoids?
HALO (haemorrhoidalartery ligation operation) or
THD (transanal haemorrhoidal dearterialisation)
Describe the HALO procedure?
Miniature Doppler ultrasound device locates branches of arteries supplying the haemorrhoids.
These blood vessels are tied off, and the haemorrhoid shrinks
What is a rectal prolapse?
Protruding mass from anus especially during defecation - bleeding and mucus
Examination usually shows poor anal tone
What are the two kinds of rectal prolapse?
Partial
Complete
What is the best treatment for complete rectal prolapse?
Abdominal rectopexy
What is the best treatment for complete rectal prolapse in a frail patient?
bulking agent and education on manual reduction
Describe anal fissures?
Tear in the anal margin due to passage of a constipated stool
Usually in the midline posteriorly but may be occasionally anterior
What may multiple fissures be due to?
Crohn’s disease
What is the clinical presentation of anal fissures?
Acute onset of severe anal pain usually following episode of constipation
“Glass passing through the back passage”
Pain lasts for up to ½ h after defecation
Bright rectal bleeding
What is the treatment anal fissures?
Dietary advice, stool softeners
Pharmacological sphyncterotomy (0.3% GTN ointment, 2% Diltiazem ointment)
Lateral sphyncterotomy
Botox injection
What is a fistula in ano?
Abnormal communication between two epithelial surfaces
There is an internal opening in the anal canal and one or more external openings on the peri-anal skin