Peri-anal Flashcards
Where are anal fissures more often found?
Usually in the posterior midline; sometimes anterior in women
Secondary causes of anal fissures?
Constipation
Conditions which cause mucosal ulceration- e.g. inflammatory bowel disease, STDs, psoriasis, pruritus ani
Anal trauma
Pregnancy/childbirth
Lifestyle advice for management of anal fissure?
Management of constipation, adequate fluid intake, warm baths
When is rectal GTN indicated?
When symptoms persist for 1 week or more without improvement
Non-drug treatment of haemorrhoids?
Aim to keep stools soft and easy to pass
Why should preparations containing local anaesthetics only be used for a few days?
Can cause sensitisation of the peri-anal skin
Grading of internal haemorrhoids?
1st- non-prolapsing
2nd- prolapse on straining, reduce spontaneously
3rd- prolapse on straining; can be reduced manually
4th- permanently prolapsed; cannot be reduced
When do haemorrhoids cause pain/bleeding?
External- cause pain if thrombosed, rarely bleed
Internal- can cause pain/discomfort if prolapsed/strangulated, often present with painless bleeding
Management of haemorrhoids?
Simple analgesia
Various topical preparations available
Treatment of constipation
Management of perianal haematoma (thrombosed external pile)?
Analgesia
May be a role for incision if <1 day old
Characteristic sign of a peri-anal abscess?
Patients sit with one buttock off the chair
Management of peri-anal abscess?
Admit for incision and drainage
What should be considered if patients present with pruritis ani?
? whether patients have faecal incontinence- may not disclose this voluntarily
