GI - Perianal disease Flashcards
What are the (5) symptoms of perianal conditions?
- Bleeding
- Pain
- Prolapsed anal lumps, swellings
- Itchiness
- Discharge
Differentiate between Malignant versus non-malignant perianal conditions
Malignant conditions: Anal cancers (SCC, BCC, melanoma), low rectal cancer
Non-malignant conditions: anal skin tags, anal fissure, haemorrhoids, anal fibrous polyps, anal fistula, anal warts, rectal prolapse
Differentiate between Painful versus Painless Perianal conditions
Painful conditions: anal FISSURE, strangulated/prolapsed haemorrhoids, perianal haematoma, anal abscess, anal cancer invading sphincter, low rectal cancer invading sphincter, proctalgia fugax
Painless conditions: perianal skin tags, haemorrhoids (1st, 2nd & 3rd degree), rectal prolapse, anal fistula, anal margin cancer, low rectal cancer, anal fibrous polyps, anal warts, pruritis ani
- 30 y.o woman, 3 months post partum, presents with anal pain on defaection for several weeks.
- Associated symptoms of bright red bleeding per rectum
- What are the differential diagnoses?
anal fissure or perianal haematoma
(3) broad types of Mx of anal fissure
•Simple measures
–Topical anaesthetics ointment
–Stool softeners, coloxyl and senna
–Sitz bath
•Chemical sphincterotomy
–Rectogesic ointment, 0.2% GTN (headache)
–Nifedipine 0.5%/Lignocaine 5% gel
–Botulinium toxin injection (40-60units ito intersphincteric space)
•Surgical Sphincterotomy
–Lateral sphincterotomy
–Fissurectomy or mucosal flap repair
–Most effective but has a risk of minor flatus incontinence, esp in females
–Reserve for intractable cases and in males
Mx of perianal haematoma
conservative or incisional drainage under LA
Discuss perianal skin tags
- sequelae of …
- Px
- associated with …
- Rx
- Sequelae of perianal haematoma
- Benign
- Painless
- Perianal itch
- Perianal hygiene
- Treatment: conservative or excision
- 25 year old man presents with a painful perianal swelling, unable to sit down, he has associated with fever
- What are the differential diagnoses?
Perianal abcess
Compare and contrast anal abscess from anal fistula. Symptoms for both
•Anal abscess
–Superficial perianal
–Deep, ischiorectal or supra-levator abscess
•Anal fistula
–Low, perianal
–High and complex: intersphincteric, trans-spshincteric/ extra-sphincteric, supra-levator
Symptoms: chronic discharge of pus, bleeding, irritation
Mx of complex anal fistula
Seton insertion -> provides drainage. Guides subsequent surgery, fistulotomy or repair
Px of haemorrhoids
Bleeding, prolapse, mucus discharge
Describe haemorrhoids classifications
Classification by extent of prolapse
- First degree-internal,bleeds
- Second degree-prolapse and reducible spontaneously
- Third degree-non reducible
- Fourth degree-thrombosed and FINALLY PAINFUL
Discuss Mx of haemorrhoids depending on its classification
•First degree
–High fibre diet to regulate bowel habit, avoid constipation, straining, injection sclerotherapy for bleeding, 5%Phenol in almond oil
•Second degree
–Diet, rubber band ligation or injection sclerotherapy for symptomatic cases
•Third degree
–Diet, surgery by haemorrhoidectomy
•Fourth degree
–Analgesia followed by surgery
Symptoms of rectal prolapse
anal lump, bleeding, discharge, Incontienence, unable to sit
rectal prolapse: full thickness vs Internal mucosal prolapse
Symptoms of anal warts, condyloma acuminata. What is it due to?
Bleeding, discharge, anal lumps
symptoms of a highly contagious sexually transmitted disease caused by some types of human papillomavirus (HPV).
It is spread through direct skin-to-skin contact, usually during oral, genital, or anal sex with an infected partner.
Warts are the most easily recognized symptom of genital HPV types 6 and 11 infection (low risk for cancer).
