Benign Disorders of the Perianal Area Flashcards
what are haemorrhoids?
enlarged vascular cushions in the lower rectum and anal canal
how do haemorrhoids present?
painless bright red bleeding
perianal itchiness
what is seen on PR exam with haemorrhoids?
nothing - normal
what does the classical position of haemorrhoids relate to?
the branches of the superior haemorrhoids artery
what investigations are done into haemorrhoids in patients under 50?
rigid sigmoidoscopy
proctoscopy
what investigation is done for haemorrhoids in patients over 50?
flexible sigmoidoscopy
when is management offered for haemorrhoids?
when symptomatic
name four management options for haemorrhoids
sclerosation therapy
rubber band ligation
haemorrhoidectomy
HALO/THD
what is used for sclerosation therapy for haemorrhoids?
5% phenol in almond oil
what are the two types of haemorrhoidectomy?
open
stapled
what is HALO/THD?
haemorrhoids artery ligation
what are the two types of rectal prolapse?
partial
complete
what is prolapsed in a partial rectal prolapse?
anterior mucosa
what is prolapsed in a complete rectal prolapse?
full thickness of the rectum
how does a rectal prolapse present?
protruding mass
bleeding + mucus PR
what is seen on PR examination in rectal prolapse?
poor tone
how is a complete prolapse managed in a frail patient?
bulking agents
education on manual reduction
what are three options for definitive management of a complete prolapse?
Delorme’s procedure
rectopexy
anterior resection
how is a partial rectal prolapse managed in children?
dietary advice
treatment of constipation
what is an anal fissure?
a tear in the anal margin due to passage of constipated stool
where do anal fissures usually occur?
in the midline posteriorly
what disease can result in multiple anal fissures?
Crohn’s disease
how does an anal fissure present?
acute onset severe pain usually following constipation
bright PR bleeding
how is an anal fissure managed?
dietary advice + stool softeners
sphincterotomy
botox
what are the two types of sphincterotomy that can be performed for an anal fissure?
pharmacological
lateral
how is a pharmacological sphincterotomy performed?
GTN ointment for six weeks
what is fistula in ano?
an abnormal communication between two epithelial surfaces
describe the structure of fistula in ano
an opening in the anal canal connected to one or more external openings on the peri-anal skin
what three diseases can cause fistula in ano?
Crohn’s
TB
carcinoma
