Haemorrhoids and Anorectal Disease

Question 1

What is Haemorrhoids?

Answer 1

The swelling and inflammation of the veins of the rectum and anus

Question 2

Describe when Haemorrhoids commmonly presents?

Answer 2

Associated with constipation

Common during pregnancy

Question 3

Clinical Features of Haemorrhoids?

Answer 3

Bright Red Blood
Painless
Pruritus Anus (Itching)

Question 4

Different types of Haemorrhoids?

Answer 4

Primary (Internal) - Bleeding but not externally visible
Secondary (Prolapsing) - Bleed, can pop in and out spontaneously
Third (Prolapsed) - Needs manual replacement after prolapse

Question 5

Where on the anus are haemorrhoids most common?

Answer 5

3,7 and 11 on the clock (This is where the arteries come out)

Question 6

Investigations for Haemorrhoids?

Answer 6

PR Exam
Rigid Sigmoidscopy
Flexible Sigmoidoscopy (Over 50)

Question 7

Treatment for Haemorrhoids?

Answer 7

Sclerotherapy
Band Ligation
Haemorrhoidectomy

Question 8

What is rectal prolapse?

Answer 8

This is when the walls of the rectum protrude through the opening of the anus

Question 9

Describe the two types of rectal prolapse?

Answer 9

Partial (Anterior Muscle Prolapse) or Complete (Full thickness)

Question 10

Describe the sequence of events leading to prolapse?

Answer 10

Usually there is intusussception of the bowel (Small bowel telescopes into the large) which gets bigger and bigger until it finally prolapses

Question 11

Presentation of Anal prolapse?

Answer 11

Protruding mass from the anus
Worse on defaecation
Bleeding and passing mucus
Tenesmus

Question 12

Causes of Anal Prolapse?

Answer 12

Constipation

Straining

Question 13

Treatment of Asymptomatic Anal Prolapse?

Answer 13

Advice to stop straining

Take stool softeners

Question 14

Treatment of Symptomatic TOTAL Anal Prolapse?

Answer 14

Surgery - Delome’s Procedures, Rectopexy

Question 15

Treatment of Symptomatic PARTIAL anal prolapse?

Answer 15

Kids = Dietary Advice, Treat constipation
Adults = Similar to haemorrhoids - Sclerotherapy and Band Ligation

Question 16

What is an anal fissure?

Answer 16

This is a tear in the skin that lines the anus below the dentate line

Question 17

Where do anal fissures commonly present?

Answer 17

Usually in the midline and posterior

Question 18

What would be the cause of multiple anal fissures?

Answer 18

Crohn’s Disease

Question 19

Presentation of anal fissures?

Answer 19

Acute onset of severe anal pain usually following constipation
Feels like passing glass
Pain lasts for half an hour after daefacation
Bright red bleeding

Question 20

Treatment of anal fissures?

Answer 20

Dietary Advice
Antiseptic Cream
Stool Softener
Botox Injection

Question 21

What is an Anal Fistula?

Answer 21

This is an abnormal communication between two epithelial surfaces - a track between the internal opening and an opening in the perianal skin

Question 22

What causes Anal Fistulas?

Answer 22

Abscess/Ulcer
Crohn’s
TB
Carcioma

Question 23

Investigations of Anal Fistula?

Answer 23

Sigmoidoscopy

Question 24

Treatment of Anal Fistula?

Answer 24

Seton Insertion (To drain all pus)
Corrective Surgery

Question 25

What is an anal abscess?

Answer 25

Collection of pus that may be tender, swollen and discharging

Question 26

Which group of people have anal abscesses?

Answer 26

Gay men who indulge in penetrative anal sex

Question 27

Treatment for anal abscess?

Answer 27

Surgical Excision

Drainage

Question 28

What are anal abscesses associated with?

Answer 28

Crohn’s
UC
TB