Colorectal surgery: Anal fissures; Diverticulitis Flashcards
Define what is meant by an anal fissure [1]
Anal fissure is a split in the skin of the distal anal canal characterised by pain on defecation and rectal bleeding.
They are longitudinal or elliptical tears of the squamous lining of the distal anal canal
What makes an anal fissure acute or chronic? [1]
Acute: less than 6 weeks
Chronic: more than 6 weeks
What are risk factors for anal fissures? [5]
constipation
inflammatory bowel disease
sexually transmitted infections e.g. HIV, syphilis, herpes
pregnancy
opiate analgesia
Describe the treatment algorithm for acute fissures
1st line: soften stool
- high fibre intak
- Bulk forming laxatives
- lubricants like petroleum jelly
2nd line:
- Glyceryl trinitrate
3rd line:
- topical diltiazem (if headaches from glyceryl trinitrate are too much)
Why might glyceral trinitrate cause headaches? [1]
Some patients experience a headache due to glyceryl trinitrate entering the bloodstream and causing cerebral vasodilatation
Describe the treatment algorithm for chronic anal fissures [3]
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
Botulinum toxin or sphincterotomy is used after failure of topical treatment for 8 weeks
sphincterotomy:
The operation usually takes about 15 minutes. Your surgeon will make a small cut on the skin near your back passage. They will cut the lower part of the internal sphincter muscle. This will relieve the spasm in the sphincter, allowing a better blood supply to heal the fissure.
almost all diverticula are found in the []
almost all diverticula are found in the sigmoid colon
Which patient population are diverticuli likely to be found in right colon? [1]
Asian patients
Patients with diverticular disease typically present with a chronic history of what? [3]
Intermittent abdominal pain: particularly in the left lower quadrant
Bloating
Change in bowel habit: constipation or diarrhoea
How does acute diverticulitis present? [5]
Severe abdo pain in LLQ
N&V
Constipation (more common than diarrhoea)
Urinary frequency & urgency
PR bleeding
How do you determine diverticultis vs UC?
UC:
- Bloody diarrhoea
Diverticultis:
- Fever
- Constipation
- LLQ pain
Describe two symptoms of complications of diverticulitis [2]
pneumaturia or faecaluria may suggest a colovesical fistula
vaginal passage of faeces or flatus may suggest a colovaginal fistula
What might erect CXR show in a ptx with divertcultis? [1]
pneumoperitoneum in cases of perforation
Which investigation method should be avoided in diverticulosis and why? [2]
Colonoscopy: should be avoided initially due to the increased risk of perforation in diverticulitis
What might an AXR show in diverticulosis? [3]
AXR: may show dilated bowel loops, obstruction or abscesses
Describe the treatment regime for diverticulitis? [4]
mild cases of acute diverticulitis may be managed with oral antibiotics, liquid diet and analgesia CKS
dicycloverine: antispasmodic
if the symptoms don’t settle within 72 hours, or the patient initially presents with more severe symptoms, the patient should be admitted to hospital for IV antibiotics
Consider open or laparoscopic resection for patients who have recovered from complicated acute diverticulitis but have continuing symptoms (such as stricture or fistula)
What is a thrombosed haemorrhoid? [1]
How do you determine if an anal presentation is a thrombosed haemorrhoid? [3]
Thrombosed haemorrhoids occur when either an internal or external hemorrhoid fills with blood clots.
Thrombosed haemorrhoids are characterised by anorectal pain and a tender lump on the anal margin. It does not normally present with bleeding but this can occur if the haematoma spontaneously bursts.
An anal longintudinal tear and fresh rectal bleeding is the diagnosis of? [1]
Anal fissure
What is an anal fistula? [1]
abnormal connection that develops between the perianal skin and the anal or rectal lumen.
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