GI - Anal + Rectal Disease Flashcards
Definition - Anal Fissure
A tear in the anal margin
Causes - Anal Fissure
Constipation
Crohn’s
Anal intercourse
Childbirth
Presentation - Anal Fissure
Acute, severe pain
Bright red rectal bleeding
Visible crack in the skin
Diagnosis - Anal Fissure
Clinical
Management - Anal Fissure (Acute)
Soften stool (diet changes, stool softeners)
Topical anaesthetics
Analgesia
Management - Anal Fissure (Chronic)
- Topical GTN
- Sphincterotomy/botox after 8 weeks
Typical Location - Anal Fissure
Posterior midline (90%)
Definition - Fistula in Ano
An abnormal connection between the rectum and the perianal skin
Causes - Fistula in Ano
Anal abscess
Crohn’s
TB
Carcinoma
Presentation - Fistula in Ano
Discharge
Pain
Pus/blood PR
Skin irritation
Diagnosis - Fistula in Ano
PR exam/EUA
Sigmoidoscopy
MRI
Management - Fistula in Ano
Surgical correction
Complications - Fistula in Ano
Incontinence
Recurrence
Definition - Haemorrhoids
Enlarged vascular cushions in the lower rectum/anal canal
Cause - Haemorrhoids
Increased pressure in the lower rectum
Presentation - Haemorrhoids
Painless bright red rectal bleeding
Perianal itchiness
Palpable anal mass
Diagnosis - Haemorrhoids
Clinical examination including PR
Sigmoidoscopy
Management - Haemorrhoids
Increase fibre intake
Ligation
Complications - Haemorrhoids
Anaemia
Thrombosed/strangulated haemorrhoid
Types - Haemorrhoids
Internal = proximal to the dentate line
External = distal to the dentate line
Definition - Rectal Prolapse
Rectum prolapsing outside of the anus
Presentation - Rectal Prolapse
Altered bowel habit
PR blood/mucous
Faecal incontinence
Protruding mass from the anus
Diagnosis - Rectal Prolapse
Examination
Colonoscopy
Management - Rectal Prolapse
May reduce spontaneously
Manual reduction
Some require surgery (anterior resection or rectopexy)
