Perianal Disease Flashcards
What are the common symptoms of perianal disease?
Bleeding Pain Prolapsed anal lumps - swellings Itchiness Discharge
What does a perineal examination involve?
Inspection Palpation of perineum - use KY/lignocaine gel DRE Sigmoidoscopy Proctoscopy
What is sigmoidoscopy?
Scope that reaches 1/2-2/3 of sigmoid colon
What is proctoscopy?
Can do with lubricant alone, without anaesthesia
See in colorectum
What are malignant conditions of the perineum?
Anal cancers - SCC - BCC - Melanoma Low rectal adenocarcinoma
What are non-malignant conditions of the perineum?
Anal skin tags Anal fissure Haemorrhoids Anal fibrous polyps Anal fistula Anal warts Rectal prolapse
What are painful perianal conditions?
Anal fissure Strangulated and prolapsed haemorrhoids Perianal haematoma Anal abscess Anal cancer invading sphincter Low rectal cancer invading sphincter Proctalgia fugax
What are painless perianal conditions?
Perianal skin tags 1st, 2nd, and 3rd degree haemorrhoids Rectal prolapse Anal fistula Anal margin cancer Low rectal cancer Anal fibrous polyps Anal warts Pruritis ani
What is an anal fissure?
Tear/ulcer of anal junction
What is the difference between an acute and chronic anal fissure?
Acute - no induration
Chronic - induration
What is the treatment for anal fissure?
Topical anaesthetics ointment Stool softeners - Coloxyl and senna Sitz bath Chemical sphincterotomy Surgical sphincterotomy
What is a sitz bath?
Sit in bowl with water and soap/salt for 10-15 min > dry area well
What is the treatment for a perianal haematoma?
Conservative - will resolve in a few days
Incisional drainage under local anaesthetic > don’t need to stitch
Of what are perianal skin tags a sequelae?
Perianal haematoma
Why can perianal skin tags be itchy?
May ooze mucus
What is the treatment for perianal skin tags?
Conservative
Excision
What are the different types of anal abscesses?
Superficial - Perianal Deep - Intersphincteric - Ischiorectal
Which anal abscesses cause fever?
Ischiorectal
What is the treatment for an anal abscess?
Drainage
May not need Abx, unless signs of spread or immunocompromise
What is the surgical procedure for an anal fistula?
Seton insertion
- Eradicate fistula
- Preserve sphincter function
Guides subsequent surgery/fistulotomy/repair
What is the most common cause of haemorrhoids?
Constipation
What is the classification of haemorrhoids?
1st degree = internal - seen only with endoscope
2nd degree = prolapse > reduce spontaneously
3rd degree = non-reducible
4th degree = thrombosed and painful
What is the treatment for first degree haemorrhoids?
High fibre diet > regulate bowel habit
Avoid straining
Injection sclerotherapy for bleeding
5% phenol in almond oil
What is the treatment for second degree haemorrhoids?
Diet
Rubber band ligation/injection sclerotherapy for symptomatic cases
What is the treatment for third degree haemorrhoids?
Diet
Haemorrhoidectomy
What is the treatment for fourth degree haemorrhoids?
Analgesia
Surgery
What is the treatment for partial rectal prolapse?
Do nothing
What is the treatment for complete rectal prolapse?
Sedate
Pack with sugar crystals > reduces oedema
Gently reduce
What are the symptoms of anal warts?
Bleeding
Discharge
Anal lumps
What causes anal warts?
HPV
What are the symptoms of anal cancer?
Bleeding
Pain
Lump
Discharge
What is the principle of management for anal cancer?
If in doubt, biopsy
What is the treatment for anal cancer?
Depends on staging
- Local excision if small and clear of sphincter
- Usually chemoradiotherapy
What are the symptoms of low rectal carcinoma?
Bright red bleeding
Mucous discharge
Tenesmus
What should be assessed on digital rectal exam in suspected low rectal carcinoma?
Soft/hard rectal mass
Position and distance from anal verge
What are the causes of pruritis ani?
Many
Moisture from soiling/discharge
Infestations
Dermatological
What is the treatment for pruritis ani?
Topical steroid Anti-fungals Oral antihistamine Avoid excessive wiping Diet Excise skin tags
