GI - perianal Flashcards
what is a first degree haemorrhoid
haemorrhoid that bulges into the anal canal during bowel movements
what is a second degree haemorrhoid
haemorrhoid that bulges from the anus during bowel movements then goes back inside itself
what is a third degree haemorrhoid
haemorrhoid that bulges from the anus during bowel movements and needs to be replaced manually
what are some s/s of haemorrhoids
painless bleeding
fresh bright red blood not mixed with stool, usually on paper
perianal itch
no change in bowel habit and no weight loss
what would clinical examination of haemorrhoids show
external inspection may be normal
maceration of perianal skin (skin white and soft)
obvious haemorrhoids if 3rd degree
what are some investigations fro haemorrhoids
PR exam (may be normal unless thrombosed) sigmoidoscopy / proctoscopy
what is the treatment for haemorrhoids
sclerosation therapy rubber band ligation open haemorrhoidectomy stapled haemorrhoidectomy HALO/THD procedure - pain free ^ haemorrhoid artery ligation using U/S
protruding mass from anus especially during defamation
blood and mucus per rectum
examination shows poor anal tone
what is a possible diagnosis?
rectal prolapse
what is the treatment of complete rectal prolapse (full thickness)
bulking agent and education of manual reduction Delorme's procedure Perineal rectopexy Abdominal rectopexy anterior resection
what is the treatment of a partial rectal prolapse (anterior mucosal)
children - dietary advice and treat constipation
adults - tx of haemorrhoids
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
anal fissure
where do anal fissures usually occur
midline
usually posterior but can be anterior
what disease might show multiple fissures
crohns
what is the treatment for anal fissures
dietary advice stool softeners pharmacological sphyncterotomy (GTN, diltiazem ointment) PR for 6 weeks - relax muscle and improve BF lateral sphyncterotomy botox injection
what is a fistula
abnormal communication between 2 epithelial surfaces
what is an anal fistula
opening in anal canal and one or more external openings on perianal skin
what can anal fistulas be the result of
abscess
crohns
TB
carcinoma
what are some complications of anal fistulas
pain
bleeding
incontinence
recurrence
what are some investigations of anal fistulas
EUA of anorectum
rigid/flexible sigmoidoscopy
proctoscopy
MRI
what is the treatment of anal fistulas
Laying open and insertion of seton
- holds fistula open so it drains and then stitched closed
LIFT procedure
Glue/pemacol/defunctioning colostomy
what questions should be asked about anal bleeding
fresh? old? like tar? dark? bright? mixed with stool? on pan? on paper?
what is an anal fissure
Tear in the anal margin during passage of (constipated) stool
