IBS + Rectal Prolapse, Hemorrhoids + Abscesses Flashcards
What is IBS?
Chronic relapsing remitting disorder of lower GI tract with no discernable structural/ biochemical cause
S+S of IBS
Abdo pain associated with change in stool form and/or frequency
Bloating
When is a diagnosis of IBS made?
Abdo pain related to defecation or change in bowel habit AND:
Other conditions excluded
Passage of rectal mucus
Symptoms worse on eating
Abdo bloating, distension or hardness
Altered stool passage (straining, urgency, incomplete evacuation)
Investigations for IBS
FBC, ESR, CRP, celiac serology
Management of IBS
Manage stress + anxiety Healthy diet with fibre OTC probiotics for 4 weeks Foods high in soluble fibre Bulk forming laxatives for constipation Loperamide for diarrhea Antispasmodics TCA for refractory abdo pain, then SSRI
What are the is rectal procidentia vs intussusception?
Rectal procidentia = rectal prolapse
Intussusception = occult rectal prolapse
S+S of rectal procidentia
Abdo discomfort, incomplete bowel evacuation, rectal mass, mucus or stool discharge, altered bowel habits
Full thickness protrusion of rectum through anus
What are the differentials for rectal prolapse?
Prolapsing internal hemorrhoids, partial (mucosal) rectal prolapse, occult rectal prolapse (intussusception), and solitary rectal ulcer syndrome
Associated conditions with rectal prolapse
Cystocele, enterocele or vaginal vault prolapse
What are haemorrhoids?
Abnormally swollen vascular mucosal cushions present in anal canal
Classification of haemorrhoids
External = originate below dentate line, covered in modified squamous epithelium (anoderm)
Internal - above dentate line, covered in columnar epitheliam
Internal are further divided into:
1st degree = project into lumen of anal canal, don’t prolapse
2nd degree = prolapse on straining
3rd degree = prolapse on straining + require manual reduction
4th degree = cannot be reduced
Difference between internal + external haemorrhoid S+S
External are painful + itchy, internal have no pain fibres
RF for development of haemorrhoids
o Constipation. o Straining while trying to pass stools. o Ageing. o Heavy lifting. o Chronic cough. o Conditions that cause raised intra-abdominal pressure (such as pregnancy and childbirth).
Complications of hemorrhoids
Ulceration; skin tags; maceration of the perianal skin; ischaemia, thrombosis, or gangrene; and rarely, perianal sepsis and anaemia from bleeding.
S+S of haemorrhoids
Bright red, painless bleeding
Itching/ irritation, discomfort, feeling of rectal fullness, soiling, incomplete evacuation
Management of hemorrhoids
Laxatives if needed Minimise straining Topical hemorrhoid preparations Rubber band ligation, injection sclerotherapy, infrared coagulation, bipolar diathermy, direct current electrotherapy Surgery
Management of pilonidal abscess
Same day incision and drainage
Paracetamol +/- NSAID
Abx if cellulitis is present
How to prevent abscess in future
Good hygiene
Buttock hair removal techniques
What are the classifications of anal fissures?
Acute - less than 6 weeks
Chronic - over 6 weeks
Primary - no clear underlying cause
Secondary - has clear underlying cause such as constipation, IBD, STD, cancer
S+S of anal fissure
Anal pain with defecation, bright red rectal bleeding, anal spasm
Where do anal fissures usually occur?
In posterior midline
10% in anterior
Secondary = lateral
Management of anal fissures
High fibre diet + fluids
Pain relief
GTN ointment
Review after 6-8 weeks - surgery if not healed
Pathology of perianal haematoma
Pool of blood collecting in tissue around anus
Usually caused by ruptured/ bleeding vein
Management of perianal hematoma
Cool compress, sitz bath, donut pillow
High fibre diet
Drainage
