Chapter 48: Anus- Anal Fissure Flashcards
1
Q
What is it?
A
Tear or fissure in the anal epithelium
2
Q
What is the most common site?
A
Posterior midline (comparatively low blood flow)
3
Q
What is the cause?
A
- Hard stool passage (constipation)
- hyperactive sphincter
- disease process (e.g.,Crohn’s disease)
4
Q
What are the signs/symptoms?
A
- Pain in the anus,
- painful (can be excruciating) bowel movement
- rectal bleeding
- blood on toilet tissue after bowel movement
- sentinel tag
- tear in the anal ski
- extremely painful rectal exam
- sentinel pile
- hypertrophic papilla
5
Q
What is a sentinel pile?
A
Thickened mucosa/skin at the distal end of an anal fissure that is often confused with a small hemorrhoid
6
Q
What is the anal fissure triad for a chronic fissure?
A
- Fissure
- Sentinel pile
- Hypertrophied anal papilla
7
Q
What is the conservative treatment?
A
- Sitz baths
- stool softeners
- high fiber diet
- excellent anal hygiene
- topical nifedipine
- Botox®
8
Q
What disease processes must be considered with a chronic anal fissure?
A
- Crohn’s disease
- anal cancer
- sexually transmitted disease
- ulcerative colitis
- AIDS
9
Q
What are the indications for surgery?
A
Chronic fissure refractory to conservative treatment
10
Q
What is one surgical option?
A
Lateral internal sphincterotomy (LIS)—cut the internal sphincter to release it from spasm
11
Q
What is the “rule of 90%” for anal fissures?
A
- 90% occur posteriorly
- 90% heal with medical treatment alone
- 90% of patients who undergo an LIS heal successfully
