Perianal

Question 1

Haemorrhoids

Answer 1

Engorged vasc cushions
Ano rectal junc
Netw of CT and BV, keep anus closed and sense solid vs air
Graded by amnt prolapse

Question 2

chronic haemorrhoids

Answer 2

Bleeding
Constipated stool
Itching
Prolapse

Question 3

acute haemorrhoids

Answer 3

Thrombosed prolapse, pain-
Try to reduce early. If late px then ice, resolves few wks.
Perianal haematoma-
Drain if under 24hr, analgesia if late,

Question 4

Haemorrhoid ix

Answer 4

Proctoscopy

Sigmoidoscopy if symps sugg more than haemorrhoids AND for all rectal bleed over 50.

Question 5

Haemorrhoid mx

Answer 5

Diet- fibre and water
Creams
Stool softener
Fibre supplems
Banding
Injection, rare
HALO artery ligation, rare
Haemorrhoidectomy for large, prolapsed, lot pain

Question 6

Fissure in ano px

Answer 6

Sev pain

Hx of constipation

Question 7

fissure mx

Answer 7

Diet
GTN 0.2% cream, headache s/e
Diltiazem 1st line, 4-6wk, reduc int sphincter tone to impr BS
80% get better with creams
If not botox, not perm
Surg- lat sphincterectomy- s/e passive incontin so not for wom as short int sphinct and child birth

Question 8

Perianal abcess mx

Answer 8

Drain

Question 9

Necrotising fasciitis RFs

Answer 9

Imm comprom
Eld
Steroid
DM
Obese

Question 10

Perianal sepsis

Answer 10

Can lead to fistula- connec btw 2 epith surfs

Anal gl block, then abcess, then pus tract forms fistula

Question 11

Fistula mx

Answer 11

Lay open- can reduce tone and contin, deps on amnt musc inv.
seton drain
Lift procedure

Question 12

Pilonidal sinus

Answer 12

Nest of hairs
Abces acute
Disch gran tiss, inflamed
Mx- remove affected tiss and close with flap