Perianal Disease

Question 1

What are the main complaints on presentation in a patient with perianal disease?

Answer 1

• Pain
• Bleeding
• Masses
• Discharge
• Itch
• Continence

Question 2

Where are haemorrhoids most commonly found?

Answer 2

3, 7, 11 o’clock

Question 3

How are haemorrhoids graded?

Answer 3

1. Bleeding, no prolapse
2. Non-manual reduction of prolapse
3. Manual reduction of prolapse
4. Unreducable

Question 4

How are haemorrhoids generally managed?

Answer 4

• Increase fibre in diet, avoid constipation (Grade 1/2)
• Banding (Grade 2)
• Haemorrhoidectomy (Grade 3/4)
  
  • Care with taking too much skin - anal stenosis

Question 5

Where are anal fissures generally found? How are they managed?

Answer 5

12 and 6 o’clock

• Decrease straining
• Topical anaesthetic
• Rectogesic (GTN - headache)
• Lateral sphincterotomy

Question 6

What is Goodsall’s rule in relation to the formation of anal fistulas?

Answer 6

• External opening below 3-9 o’clock?
  
  • Internal opening at 6 o’clock
• External opening above 3-9 o’clock?
  
  • Internal opening at same radiant line

Question 7

How are anal fistulas generally managed?

Answer 7

• Low fistulas - lay open and allow to granulate
• High fistulas - seton (draining rubber tubing)