GI - perianal

Question 1

what is a first degree haemorrhoid

Answer 1

haemorrhoid that bulges into the anal canal during bowel movements

Question 2

what is a second degree haemorrhoid

Answer 2

haemorrhoid that bulges from the anus during bowel movements then goes back inside itself

Question 3

what is a third degree haemorrhoid

Answer 3

haemorrhoid that bulges from the anus during bowel movements and needs to be replaced manually

Question 4

what are some s/s of haemorrhoids

Answer 4

painless bleeding
fresh bright red blood not mixed with stool, usually on paper
perianal itch
no change in bowel habit and no weight loss

Question 5

what would clinical examination of haemorrhoids show

Answer 5

external inspection may be normal
maceration of perianal skin (skin white and soft)
obvious haemorrhoids if 3rd degree

Question 6

what are some investigations fro haemorrhoids

Answer 6

PR exam (may be normal unless thrombosed)
sigmoidoscopy / proctoscopy

Question 7

what is the treatment for haemorrhoids

Answer 7

sclerosation therapy
rubber band ligation
open haemorrhoidectomy 
stapled haemorrhoidectomy
HALO/THD procedure - pain free
^ haemorrhoid artery ligation using U/S

Question 8

protruding mass from anus especially during defamation
blood and mucus per rectum
examination shows poor anal tone
what is a possible diagnosis?

Answer 8

rectal prolapse

Question 9

what is the treatment of complete rectal prolapse (full thickness)

Answer 9

bulking agent and education of manual reduction
Delorme's procedure
Perineal rectopexy
Abdominal rectopexy
anterior resection

Question 10

what is the treatment of a partial rectal prolapse (anterior mucosal)

Answer 10

children - dietary advice and treat constipation

adults - tx of haemorrhoids

Question 11

acute severe anal pain following constipation
“glass passing through the back passage”
pain lasts up to half an hour after defacation
bright rectal bleeding
what is a possible diagnosis

Answer 11

anal fissure

Question 12

where do anal fissures usually occur

Answer 12

midline

usually posterior but can be anterior

Question 13

what disease might show multiple fissures

Answer 13

crohns

Question 14

what is the treatment for anal fissures

Answer 14

dietary advice
stool softeners
pharmacological sphyncterotomy (GTN, diltiazem ointment)  PR for 6 weeks - relax muscle and improve BF
lateral sphyncterotomy
botox injection

Question 15

what is a fistula

Answer 15

abnormal communication between 2 epithelial surfaces

Question 16

what is an anal fistula

Answer 16

opening in anal canal and one or more external openings on perianal skin

Question 17

what can anal fistulas be the result of

Answer 17

abscess
crohns
TB
carcinoma

Question 18

what are some complications of anal fistulas

Answer 18

pain
bleeding
incontinence
recurrence

Question 19

what are some investigations of anal fistulas

Answer 19

EUA of anorectum
rigid/flexible sigmoidoscopy
proctoscopy
MRI

Question 20

what is the treatment of anal fistulas

Answer 20

Laying open and insertion of seton
- holds fistula open so it drains and then stitched closed
LIFT procedure
Glue/pemacol/defunctioning colostomy

Question 21

what questions should be asked about anal bleeding

Answer 21

fresh? old?
like tar?
dark? bright?
mixed with stool?
on pan?
on paper?

Question 22

what is an anal fissure

Answer 22

Tear in the anal margin during passage of (constipated) stool