Benign Disorders of perianal area Flashcards
Where do the nerve ending begin
Below the dentate line
Above - no pain
What does fresh blood suggest?
Bleeding low down
Glass through back passage
Fissure
What is a painless condition
Haemorrhoids
What is itchiness associated with
Haemorrhoids
What are Haemorrhoids
Enlarged vascular cushion in the lower rectum and anal canal
How much of the population will have symptomatic haemorrhoids
10% at some point in their lives
What are the common presentations 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
What are the clinical findings of haemorrhoids
External inspection can be normal
Often can’t be felt unless thrombosed
Have to do proctoscopy
Maceration of the perianal skin
What investigations do we do for haemorrhoids
PR examination
Rigid sigmoidoscopy
Proctoscopy - most useful
Flexible sigmoidoscopy in patients above 50
Where are the common places to find haemorrhoids in a PR exam
3,7,11 o clock
Where are the common places to find haemorrhoids in a PR exam
3,7,11 o clock
What is the management of haemorrhoids
Symptomatic - alternating ice and hot baths
Sclerosation therapy with 5% phenol in almond oil (older treatment)
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy - lots of complications and now rarely done
HALO/ THD Procedure
What is the management of haemorrhoids
Symptomatic - alternating ice and hot baths
Sclerosation therapy with 5% phenol in almond oil (older treatment)
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy - lots of complications and now rarely done
HALO/ THD Procedure
What is rectal prolapse
Can be partial or complete
What are the presentations of rectal prolapse
Protruding mass from anus especially during defecation
May reduce spontaneously
Bleeding and passing mucus per rectum is common
Examination usually shows poor anal tone
What is management of complete prolapse
Many patient are too frail for surgery - bulking agent and education on manual reduction
Delorme’s procedure
Perineal rectopexy
Abdominal rectopexy (younger patients- safest)
Anterior resection
What is the management of incomplete prolapse
In children - dietary advice
adults - avoid constipation
What is an anal fissure
A tear in the anal margin due ot passage of a constipated stool
Usuallyi in the midline posteriorly but may be occasionally anterior
Commonly associated with Crohn’s
What is the presentation of anal fissure
Acute onset of severe anal pain usually following episode of constipation
Bright red, painful bleeding
Could be half an hour after defecation
What is the treatment for anal fissures
Dietary advice, stool softeners
Pharmacological sphyncterotomy (GTN ointment, 2% Diltiazem ointment)
Lateral sphyncterotomy
Botox injection
How does GTN and diltiazem help
They relax the muscle around the fissure
How often does a patient with anal fissure have to be reviewed
Every 6 weeks
How does botox work
It paralyses the internal muscle allowing the fissure to heal
How does botox work
It paralyses the internal muscle allowing the fissure to heal
What is fistula in ano
Abnormal communication between2 epithelial surfaces
There is an internal opening in the anal canal and one or more external openings on the perianal skin
Also rarely caused by Crohn’s disease, TB and carcinoma
How do most patients present with fistula in ano
Majority arise
What investigatoins do we do for fistula in ano
EUA of anorectum
Rigid sigmoidoscopy, proctoscopy
Flexible sigmoidoscopy
MRI
How do we manage patients with filula in ano
Laying open Two stage procedure Insertion of Seton (draining, cutting) LIFT procedure Glue/ permacol Defuncioning colonoscopy
What are some of the common complication
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