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Gastrointestinal > Peri-anal disorders > Flashcards

Peri-anal disorders Flashcards

1
Q

What is pruritus ani?

A

Itching around the anus

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2
Q

What is a fissure-in-ano?

A

A tear in the squamous lining of the anal canal

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3
Q

What causes fissure-in-ano?

A

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

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4
Q

How would you diagnose fissure-in-ano?

A

Anal examination

From the symptoms

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5
Q

Clinical features of fissure-in-ano?

A

Pain on defaecation

Fresh blood in stool or seen on toilet paper

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6
Q

Prevention of fissure-in-ano?

A

Fibre rich diet to prevent constipation

Don’t strain when defaecating

Maintain good hygiene

Lubricating ointment

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7
Q

Treatment of fissure-in-ano?

A

Depends on the cause:

Botox injection to prevent spasm of sphincters

Lidocaine ointment

Surgical options

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8
Q

What is a fistula-in-ano?

A

The development of an abnormal track/connection from the anal canal to the perianal skin

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9
Q

What causes fistula-in-ano?

A

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

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10
Q

What are the clinical features of fistula-in-ano?

A

Drainage of pus, blood, stool from the opening
Pain
Pruritus ani
Systemic features if abscess becomes infected

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11
Q

How do you diagnose fistula-in-ano?

A

Anal examination

Anoscopy to find the inner opening of the fistula

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12
Q

What is Goodsall’s rule?

A

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

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13
Q

Treatment of fistula-in-ano?

A

Usually surgery
Many different types of surgery

Antibiotics to treat infection if there is one

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14
Q

What is a perianal abscess?

A

A collection of pus in the skin surrounding the anus often caused by infection from somewhere nearby

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15
Q

How does anal gland infection cause perianal abscess?

A

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.

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16
Q

Clinical features of perianal abscess?

A 
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
17
Q

What causes perianal abscesses?

A

Anal fistula
Infection in surrounding area
Gland infection

Crohn’s

18
Q

Treatment of perianal abscesses?

A

Incise and drain

Antibiotics

19
Q

What are haemorrhoids?

A

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

20
Q

What are anal cushions?

A

Spongy vascular tissue made up of capillaries that surrounds the anal canal

There are 3

21
Q

What are the causes of haemorrhoids?

A

Gravity
Increased anal tone (due to stress)
Straining

Pregnancy
Pelvic tumour

22
Q

Clinical features of haemorrhoids

A

Blood coating faeces, seen on tissue, drips out after defaecation

Anaemia
Weight loss

Tenesmus (urge to defecate)

23
Q

What should you rule out when presented with a patient with suspected haemorrhoids?

A

Cancer

24
Q

Investigations for haemorrhoids?

A

Abdominal exam: to rule out other pathologies

PR exam

Endoscopy

25
Q

Are haemorrhoids painful? Why/why not?

A

No

There are no sensory fibres in the top layer of the anal wall so no pain is felt

26
Q

Treatment for haemorrhoids?

A

Increase fluid + fibre intake

Local analgesics

Stool softener

Banding the haemorrhoids: using infra-red, all sorts of methods

Excision of haemorrhoids
Stapling haemorrhoids

27
Q

What is a pilonidal cyst?

A

A cyst or abscess near or on the cleft of the buttocks (where the buttocks separate)

28
Q

What is a pilonidal sinus?

A

A small hole or channel in the skin that occurs on or near the cleft of the buttocks

29
Q

What are the symptoms of a pilonidal sinus?

A

None, unless it becomes infected and becomes a pilonidal cyst or abscess

30
Q

What are the clinical features of a pilonidal cyst?

A

A visible abscess/cyst

Pain, redness, swelling

Pus draining from cyst

Pyrexia occasionally

31
Q

What causes pilonidal sinuses?

A

Unclear

Thought to be a loose hair piercing the skin

32
Q

What are the risk factors of pilonidal sinuses?

A 
Being obese
Having a lot of body hair
Sitting down a lot
Being aged 15-40
Family history
Poor personal hygiene
33
Q

How to treat a pilonidal sinus?

A

May not need to unless in becomes infected

Focus on prevention

34
Q

How do you prevent a pilonidal sinus becoming infected?

A

Keep the area clean + hair free

35
Q

How to treat pilonidal cyst?

A

Incision and drainage under general anaesthetic

Excision of problem area

Sealing the area with fibrin glue

Antibiotics

Gastrointestinal (20 decks)

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