Perianal conditions -BW 2 Dr Alex Croese Flashcards
Todays lecture:
What important factors on history?
Examination?
Rectal Bleeding
DDx?
Basic anal Anatomy:
Much shorter length in women:
Transition of intestinal mucosa to squamous cell
Lymph Drainage–
Dentate line- Sensation changes, pain, tenesmus, - below is super painful (anoderm) /also change in cell types at this line.
Also have anal crypts - glands- release mucus for lubrication
Perianal patholgies:
Perianal anatomy
— Known as ischiorectal fossae - can hold alot of pus-
–> Also posterior horshoe abscess- (back of
What is a Haemorrhoid?
What are the different cell types at internal haemorrhoid: Submucosal vascular cushion
External: more common with
External dont bleed! - banding does not
What are the different 4 grades of Haemorrhoids and associated symptoms and management:
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Haemorrhoids:
Grades? Risk factors?
Haemorrhoids: DDx, investigations
Management of Haemorrhoids?
Perianal haemotoma:
What is it?
How is it best managed?
What is an Anal fissure?
What does it cause (PAINFUL PR bleeding should be your no 1 ddx)
Pathogenesis?
How is it treated?
What are side effects to treatment?
Management: Include stool softeners+ fibre +GTN creams
What is an ANAL skin tag?
Clinical features?
How to differentiate it? (anal SCC etc) Pts with Crohns
IF skin tag- dont need to do anything, it is very painful, and can have a fissure (more pain)
What is a rectal prolapse? Types? (top photo full thickness)
What are the common causes?
What are the clinical features?
Management?
What are the major management of all these benign perianal conditions?
all causes; by poorly coordinated
Think- Bulking agents, psylium, lots of water+benefibre,
Stool softeners: Coloxyl, Movicol, lactulose (you dont get addicted/dependent on stool softeners or fibre supplements)
- Mnay patients get better with fibre and or a stool softener
- fissures and Haemorrhoids reoccur if problems arent addressed:
BOWEL MANAGEMENT!
What are risk factors for Anal fissures?
What is anal Condylomas?
What causes it?
What can it progress to?
What is An ANAL SCC?
What do you need to differentiate when evaluating them?
What is the lymph node drainage (mesenteric nodes) - also drains inguinal and pelvic nodes.
What are risks factors for anal SCC?
What is the treatment modalities?
Anal SCC risk factors?
Clinical features?
DDx?
Anal cancer DDX?
Investigations
Perianal and ischiorectal abscess:
Think; is it fluctuant; means its deeply
Drainage is key as perianal sepsis can have severe consequences
Who are they common in?
Abscess continued:
What are the theories?
What are the 4 major types
What is crohns associated with? (perianal abcess, malignancy, trauma)
Severe pain; Associated with bowel movements: intersphincteric abscess
What is a Fistula?
What is a Fistula in ano?
Where do they commonly occur?
What are the clinical features?
What is the most important component of managing them (GOOD PATIENT EXPLANATION) 1/3 reoccur in
What are they commonly associated with- Crohns/Malignancy
What are the different types of fistulas you have?
What is inital management aiming at?
What do you need to explain to patient with fistula
Take home messages:
What is the management of anal cancers - CHEMO radiation first
