Ch.13 - Anal Fissure

Question 1

What % of anal fissure heal with dietary modification and supportive care?

Answer 1

~87%

Question 2

Most common location of anal fissure?

Answer 2

Posterior midline

Question 3

What are some physical exam findings associated with chronic anal fissure?

Answer 3

External sentinel tag at the external Apex
Exposed internal sphincter muscle.
hypertrophied anal papilla at the internal apex

Question 4

What’s the most common side effect of GTN? What’s the incidence?

What’s GTN?

How can you make this side effect better?

What’s the other side effect?

Answer 4

Headache. About 27% 10-20% quit because of this

Glycerine trinitrate ointment.

Apply endoanal as opposed to perianal.

Tachyohylaxis- acute sudden decrease in response to the medication.

Question 5

Why do you need a special pharmacy to prescribe topical ccb?

Answer 5

Because none of them are FDA approved for rx of anal fissure so it doesn’t come premade.

Question 6

Botox injections for anal fissure. Where do you exactly inject?

Answer 6

Anteriorinternal anal sphincter better than posterior

Question 7

Open vs closed internal sohincterotomy?

Answer 7

Open sohincterotomy associated with a significantly higher rate of complete sphincterotomies

Rate of treatment failure or incontinence were not different

Question 8

The Hallmark of chronic fissure is the triad of what?

Answer 8

Hypertrophied internal sphincter
Hypertrophied anal papilla
External sentinel tag

Question 9

What do you do for fissures with hypotonicity?

Answer 9

Simple cutaneous advancement flap

Question 10

What should you do first for lateral anal fissures?

Answer 10

Culture/biopsy. R/o Crohn’s, HIV, TB, leukemia, neoplasm

Question 11

First line treatment for acute anal fissure?

Answer 11

Hydration
Laxatives
Fiber
Topical lidocaine

Question 12

First line treatment for chronic anal fissure?

Answer 12

Medical therapy bid for 8 weeks

Topical ccb