Disorders of peri anal area

Question 1

Haemorrhoids - definition

Answer 1

Enlarged vascular cushions in the lower rectum and anal canal

Question 2

Haemorrhoids - clinical presentation

Answer 2

Painless
PR blood - bright red on toilet paper
Perianal itch
NO weight loss/change in bowel habit

Question 3

Haemorrhoids - clinical examination

Answer 3

External inspection may be normal
Skin softened
Common position: 3,7,11 o’clock

Question 4

Haemorrhoids - causes

Answer 4

Raised pressure

• straining
• constipation
• pregnancy

Question 5

Haemorrhoids - investigations

Answer 5

PR exam
Sigmoidoscopy (flexible in pts over 50)
Proctoscopy

Question 6

Haemorrhoids - management

Answer 6

Symptomatic
Sclerosation therapy - to shrink and harden haemorrhoid
Rubber band ligation
Haemorrhoidectomy
HALO - using doppler US up bum

Question 7

Rectal prolapse - clinical presentation

Answer 7

Protruding mass from anus (esp during defecation)
PR bleeding
Mucous

Question 8

Rectal prolapse - examination

Answer 8

Poor anal tone

Question 9

Rectal prolapse - management

Answer 9

Complete - surgery

Incomplete - treat constipation, dietary advice, symptomatic

Question 10

Anal fissure - what is it?

Answer 10

Tear in the anal margin due to the passage of a constipated stool

Question 11

Anal fissure - clinical presentation

Answer 11

Severe pain usually following an episode of constipation
Pain lasts for around 30 mins after defecation
Bright red PR bleed

Question 12

Anal fissure - management

Answer 12

Dietary advice
Stool softeners
Sphyncterotomy

Question 13

Fistula in ano - what is it

Answer 13

Abnormal connection between 2 epithelial surfaces
Internal opening in the anal canal
One or more external openings on the perianal skin

Question 14

Fistula in ano - investigations

Answer 14

Rigid sigmoidoscopy
Rigid proctoscopy
Flexible sigmoidoscopy
MRI

Question 15

Fistula in ano - management

Answer 15

Insert seton
LIFT procedure
Glue
Colostomy