perianal disease

Question 1

what should always be considered in someone presenting with perianal disease

Answer 1

crohns - consider sigmoidoscopy

Question 2

grading of haemorrhoids

Answer 2

1: non-prolapsing.
2: prolapse on straining but spontaneously reduce.
3: prolapse on straining but require manual reduction.
4: permanently prolapsed.

Question 3

s/s of haemorrhoids

Answer 3

pruritis
pain on defacation (usually painless, pain if thrombosed)
PR bleeding - fresh red on paper

Question 4

tx haemorrhoids conservative

Answer 4

o	Diet: increase fiber intake and fluid 
o	Pharmacological: bulking agents - Fybogel. 
o Non-surgical for grades 1 – 3:
	Band ligation. 
	Injection sclerotherapy.

Question 5

tx haemorrhoids not responding to conservative tx

Answer 5

open or stapled heamorrhoidectomy

Question 6

tx acutely thrombosed haemorrhoids

Answer 6

< 72 hours - refer for excision

otherwise stool softeners, ice packs and analgesia

Question 7

bright red rectal bleeding and severe pain on defacation that lasts for 30 minutes post defacation

Answer 7

anal fissure

Question 8

tx acute anal fissure <1 week

Answer 8

bulk forming laxative
if not tolerated - lactulose
lubricants
topical anaesthetic

Question 9

tx chronic anal fissue

Answer 9

topical GTN

+ lubricants, bulk forming laxative

Question 10

progressive pain redness and swelling around anus with fever
pain worse on sitting
may be pus

Answer 10

anal abscess

Question 11

gold standard Ix for anal abscess

Answer 11

MRI

Question 12

tx anal abscess

Answer 12

incision and drainage

antibiotics if systemic upset

Question 13

ix anal fistula

Answer 13

Examination under anaesthetic
endo-anal ultrasound +/- MRI
Barium and CT studies to deliniate anatomy

Question 14

what drug can reduce the volume of pancreatic excretions and so reduce outflow of a high output fistula

Answer 14

octreotide

Question 15

painful fluctuating mass with foul smelling discharge

Answer 15

pilonoidal sinus

Question 16

tx pilonoidal sinus

Answer 16

excision of sinus

Question 17

tx worms

Answer 17

mebendazole - whole family - 1 courses