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Gastroenterology > Perianal disease > Flashcards

Perianal disease Flashcards

1
Q

What are fissures?

A

Ulcers consequent upon tears of the mucosa at the anal margin.

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2
Q

Aetiology of anal fissures?

A

Constipation, trauma at childbirth, anal intercourse.
Additionally, sustained hypertonicity of internal anal sphincter.
Poor blood supply to posterior midline may exacerbate poor healing of ulcer.

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3
Q

Describe the pathology of an anal fissure.

A

Commonly posterior midline location.
Depth from simple superficial to exposure of internal sphincter fibres.
Chronic lesions may have associated skin tag (sentinel pile).

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4
Q

What are the symptoms of an anal fissure?

A
  • Pain on defecation
  • Constipation (may be due to pain - unwilling to defecate)
  • Bleeding (not usually severe)
  • Discharge of pus (uncommon but may occur)
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5
Q

How should an acute fissure be managed?

A

-Topical local anaesthetic gel (1% lidocaine) prior to defecation
-Stool softeners: coloxyl & senna.
-Rectogesic: 0.2% GTN
(relieves sphincter spasm)
-Nifedipine 0.5% / lignocaine 5% gel
-Botox injection (40-60units)
-Recurrent: surgical sphincterotomy

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6
Q

What is the operative management of chronic fissure?

A

Division of fibres of internal sphincter distal to line of anal valves (partial internal sphincterotomy).
Risk of finite passive incontinence (usually to flatus).

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7
Q

What is a pilonidal sinus?

A

Pilonidal sinus is caused by the forceful insertion of hairs into the skin of the natal cleft in the sacrococcygeal area -> foreign body type chronic inflammation -> epithelialised sinus (may form communicating cavity).

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8
Q

What is the epidemiology of pilonidal sinus?

A

26 per 100,000.
80% patients male.
Onset: 20y.
Often hirsute.

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9
Q

What is the surgical management of pilonidal sinus?

A

Pilonidal sinus excision.

+/- secondary laser hair removal.

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10
Q

Hx associated features to ascertain in perianal disease?

A
  • Bleeding
  • Pain
  • Prolapsed lumps
  • Itching
  • Discharge
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11
Q

What are the non-malignant perianal conditions?

A
  • Anal fissure
  • Anal Fistula
  • Haemorrhoids
  • Anal skin tags
  • Anal fibrous polyps
  • Anal warts
  • Rectal prolapse
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12
Q

What are the malignant perianal conditions?

A
  • Anal cancers (SCC, BCC, melanoma)

- Low rectal cancer

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13
Q

What are the painful perianal conditons?

A
  • Anal fissure
  • Strangulated, prolapsed haemorrhoids
  • Perianal haematoma
  • Peri-/Anal abscess
  • Anal/low rectal Ca invading sphincter
  • Proctalgia fugax
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14
Q

What is proctalgia fugal?

A

Severe episodic rectal and sacrococcygeal pain caused by cramp of levator anti muscles, esp pubococcygeus.

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15
Q

What are painless perianal skin conditions?

A
  • Perianal skin tags
  • Haemorrhoids (1/2/3”)
  • Rectal prolapse
  • Anal fistula
  • Anal margin /Low rectal Ca
  • Anal fibrous polyps
  • Anal warts
  • Pruritus ani
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16
Q

What is a perianal haematoma? Rx?

A

Acutely painful perianal swelling. Rx: conservative or incisional drainage under LA.

17
Q

What are perianal skin tags?

A
  • Sequelae of perianal haematoma
  • Benign and painless
  • May give perianal itch
18
Q

Rx perianal skin tags?

A

Conservative or excision.

19
Q

What are the types of anal abscess?

A
  • Superficial perianal

- Deep: ischioanal or supralevator

20
Q

Symptoms of anal fistula?

A
  • Chronic discharge of pus
  • Bleeding
  • Irritation
21
Q

What is the principle of complex anal fistula treatment?

A

Eradicate fistula and preserve sphincter function.

22
Q

Why is a seton used in management of complex anal fistula?

A

Provides drainage and guides subsequent surgery.

23
Q

What are the symptoms of anal warts?

A

Bleeding, discharge and lumps

24
Q

What is the alternative name for anal warts?

A

Condyloma acuminata

25
Q

Who commonly gets anal warts?

A

Common in young adults, infants, children.

26
Q

Treatment anal cancer?

A

Local excision if small and clear of sphincter; usually chemoirradiation therapy.

27
Q

What are the symptoms of pruritus anti?

A

Common, mild-severe intractable itch +/- bleeding.

28
Q

what are the causes of pruritus ani?

A

Many!

  • moisture from soiling or discharge
  • infestations
  • dermatological
29
Q

treatment of pruritus ani?

A
  • Topical steroid
  • anti fungal
  • oral antihistamine
  • avoid excessive wiping
  • excise skin tags

Gastroenterology (54 decks)

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