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Gastro > Benign Disorders of perianal area > Flashcards

Benign Disorders of perianal area Flashcards

1
Q

Where do the nerve ending begin

A

Below the dentate line

Above - no pain

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2
Q

What does fresh blood suggest?

A

Bleeding low down

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3
Q

Glass through back passage

A

Fissure

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4
Q

What is a painless condition

A

Haemorrhoids

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5
Q

What is itchiness associated with

A

Haemorrhoids

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6
Q

What are Haemorrhoids

A

Enlarged vascular cushion in the lower rectum and anal canal

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7
Q

How much of the population will have symptomatic haemorrhoids

A

10% at some point in their lives

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8
Q

What are the common presentations of Haemorrhoids

A 
Painless bleeding 
Fresh, bright red blood, not mixed with stool, usually on the paper 
Perianal itchiness
No change in bowel habit, 
no weight loss
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9
Q

What are the clinical findings of haemorrhoids

A

External inspection can be normal
Often can’t be felt unless thrombosed
Have to do proctoscopy
Maceration of the perianal skin

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10
Q

What investigations do we do for haemorrhoids

A

PR examination
Rigid sigmoidoscopy
Proctoscopy - most useful
Flexible sigmoidoscopy in patients above 50

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11
Q

Where are the common places to find haemorrhoids in a PR exam

A

3,7,11 o clock

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12
Q

Where are the common places to find haemorrhoids in a PR exam

A

3,7,11 o clock

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13
Q

What is the management of haemorrhoids

A

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

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14
Q

What is the management of haemorrhoids

A

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

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15
Q

What is rectal prolapse

A

Can be partial or complete

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16
Q

What are the presentations of rectal prolapse

A

Protruding mass from anus especially during defecation
May reduce spontaneously
Bleeding and passing mucus per rectum is common
Examination usually shows poor anal tone

17
Q

What is management of complete prolapse

A

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

18
Q

What is the management of incomplete prolapse

A

In children - dietary advice

adults - avoid constipation

19
Q

What is an anal fissure

A

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

20
Q

What is the presentation of anal fissure

A

Acute onset of severe anal pain usually following episode of constipation
Bright red, painful bleeding
Could be half an hour after defecation

21
Q

What is the treatment for anal fissures

A

Dietary advice, stool softeners
Pharmacological sphyncterotomy (GTN ointment, 2% Diltiazem ointment)
Lateral sphyncterotomy
Botox injection

22
Q

How does GTN and diltiazem help

A

They relax the muscle around the fissure

23
Q

How often does a patient with anal fissure have to be reviewed

A

Every 6 weeks

24
Q

How does botox work

A

It paralyses the internal muscle allowing the fissure to heal

25
Q

How does botox work

A

It paralyses the internal muscle allowing the fissure to heal

26
Q

What is fistula in ano

A

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

27
Q

How do most patients present with fistula in ano

A

Majority arise

28
Q

What investigatoins do we do for fistula in ano

A

EUA of anorectum
Rigid sigmoidoscopy, proctoscopy
Flexible sigmoidoscopy
MRI

29
Q

How do we manage patients with filula in ano

A 
Laying open
Two stage procedure 
Insertion of Seton (draining, cutting)
LIFT procedure
Glue/ permacol
Defuncioning colonoscopy
30
Q

What are some of the common complication

A

…

Gastro (67 decks)

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