Peri-anal disorders Flashcards
What is pruritus ani?
Itching around the anus
What is a fissure-in-ano?
A tear in the squamous lining of the anal canal
What causes fissure-in-ano?
Stretching of anal mucosa beyond it’s capability:
- Hard faeces
- Childbirth trauma
- Sexual activity
Crohn’s
STD
Spasm of anal sphincter muscles causing ischaemia and meaning the fissure can’t heal as well
How would you diagnose fissure-in-ano?
Anal examination
From the symptoms
Clinical features of fissure-in-ano?
Pain on defaecation
Fresh blood in stool or seen on toilet paper
Prevention of fissure-in-ano?
Fibre rich diet to prevent constipation
Don’t strain when defaecating
Maintain good hygiene
Lubricating ointment
Treatment of fissure-in-ano?
Depends on the cause:
Botox injection to prevent spasm of sphincters
Lidocaine ointment
Surgical options
What is a fistula-in-ano?
The development of an abnormal track/connection from the anal canal to the perianal skin
What causes fistula-in-ano?
They usually develop from the anal glands, if they become blocked an abscess forms which can forge its way to the skin surface
Crohn’s disease
TB (since it causes abscesses)
Diverticular disease
Rectal carcinoma
What are the clinical features of fistula-in-ano?
Drainage of pus, blood, stool from the opening
Pain
Pruritus ani
Systemic features if abscess becomes infected
How do you diagnose fistula-in-ano?
Anal examination
Anoscopy to find the inner opening of the fistula
What is Goodsall’s rule?
It applies to fistula-in-ano
It determines the path of the fistula
If anterior, the track is usually in a straight line
If posterior, the internal opening is always at the 6 o’clock position
Treatment of fistula-in-ano?
Usually surgery
Many different types of surgery
Antibiotics to treat infection if there is one
What is a perianal abscess?
A collection of pus in the skin surrounding the anus often caused by infection from somewhere nearby
How does anal gland infection cause perianal abscess?
Glands may plug up, usually leading to bacterial infection. When the glands fill with pus, they may burst inward, releasing their infected contents into the spaces around the rectum and anus.
This pus causes an abscess in the spaces surrounding the anus.
Clinical features of perianal abscess?
Pain in the anal area or buttocks Pus drainage near the anus Fever A lump in the anal area Painful bowel movements Systemic features sometimes
What causes perianal abscesses?
Anal fistula
Infection in surrounding area
Gland infection
Crohn’s
Treatment of perianal abscesses?
Incise and drain
Antibiotics
What are haemorrhoids?
Disrupted and dilated anal cushions (capillary beds that surround the anal canal)
They protrude into the anal canal and can then be damaged by hard faeces, they bleed
What are anal cushions?
Spongy vascular tissue made up of capillaries that surrounds the anal canal
There are 3
What are the causes of haemorrhoids?
Gravity
Increased anal tone (due to stress)
Straining
Pregnancy
Pelvic tumour
Clinical features of haemorrhoids
Blood coating faeces, seen on tissue, drips out after defaecation
Anaemia
Weight loss
Tenesmus (urge to defecate)
What should you rule out when presented with a patient with suspected haemorrhoids?
Cancer
Investigations for haemorrhoids?
Abdominal exam: to rule out other pathologies
PR exam
Endoscopy
Are haemorrhoids painful? Why/why not?
No
There are no sensory fibres in the top layer of the anal wall so no pain is felt
Treatment for haemorrhoids?
Increase fluid + fibre intake
Local analgesics
Stool softener
Banding the haemorrhoids: using infra-red, all sorts of methods
Excision of haemorrhoids
Stapling haemorrhoids
What is a pilonidal cyst?
A cyst or abscess near or on the cleft of the buttocks (where the buttocks separate)
What is a pilonidal sinus?
A small hole or channel in the skin that occurs on or near the cleft of the buttocks
What are the symptoms of a pilonidal sinus?
None, unless it becomes infected and becomes a pilonidal cyst or abscess
What are the clinical features of a pilonidal cyst?
A visible abscess/cyst
Pain, redness, swelling
Pus draining from cyst
Pyrexia occasionally
What causes pilonidal sinuses?
Unclear
Thought to be a loose hair piercing the skin
What are the risk factors of pilonidal sinuses?
Being obese Having a lot of body hair Sitting down a lot Being aged 15-40 Family history Poor personal hygiene
How to treat a pilonidal sinus?
May not need to unless in becomes infected
Focus on prevention
How do you prevent a pilonidal sinus becoming infected?
Keep the area clean + hair free
How to treat pilonidal cyst?
Incision and drainage under general anaesthetic
Excision of problem area
Sealing the area with fibrin glue
Antibiotics
