Haemrrhoids/fistula tutorial

Question 1

Potential Causes of rectal bleeding?

Answer 1

Anal Canal Bleeding:

• Haemorrhoids
• Fissures
• Trauma (anal)

Non-Anal Causes:

• Malignancy
• Ulcers
• IBD
• colitis (inflam, ischaemic, infective, iatrogenic)
• Angiodysplasia
• Fistulas (not excessive bleeding)
• Rectal varices

Question 2

Painful bleeding is a _______ until proven otherwise

Painless bleeding is a _______ until proven otherwise

Answer 2

Painful bleeding is a fissure until proven otherwise

Painless bleeding is a haemorrhoids until proven otherwise

Question 3

What does it mean if haemorrhoids are actually painful

Answer 3

The patient has a thrombosed haemorrhoid.

**purple swelling that is tender to palpate

Question 4

What is the one way to dx haemorrhoids

Answer 4

proctoscope device

you cannot palpate them

Question 5

Causes of Fissures

Answer 5

Constipation

**lifestyle factors, IBD, straining

Question 6

Two locations for fissures, on the clock

Answer 6

12 o’clock and 6 o’clock

Anywhere else you should think of different causes

Question 7

why is mucus in stools worrying?

Answer 7

Can indicate malignancy as adenomas produce excess mucus

Question 8

most common cause of non-malignant non-anal causes of bleeding?

Treatment

Answer 8

Diverticular
The vasculature is within the out-pouching.

95-98% resolve spontaneously w/o surgical, endoscopic or radiologic intervention.

Question 9

Characteristics of diverticular rectal bleeding

Answer 9

Huge volumes of darker blood. Can be multiple episodes

Question 10

Extra colonic manifestations of IBD

Answer 10

• Episcleritis
• uveitis
• erythema nodudosum
• pyroderma granulosum
• non-specific athralgia (unilateral)
• Clubbing

Question 11

What is angiodysplasia, where does it cause bleeding

Answer 11

malformations of the blood vessels, usually at the caecum

Question 12

ischaemic colitis tends to be in patients who are…

Answer 12

elderly and have a hx of vasculature disease