Perianal Disease Flashcards
How do haemorrhoids present?
Fresh painless PR bleed after dedication onto paper and into bowl.
Pruritis ani
(Can get extreme pain if thrombosis)
Often caused by high pressure 1’ constipation, and straining. also pregnancy, abdo tumours and portal HTN can contribute to venous congestion.
What’s the classification of haemorrhoids ?
1 - never prolapse
2 - prolapse with spontaneous reduction
3- prolapse with digital reduction
4- permanently prolapsed
What is found on DRE in someone with haemorrhoids?
Often nothing as can’t feel piles unless thrombosed.
What’s the Mx of haemorrhoids?
Conservative - diet and fluid. Topical anusol (hydrocortisone), analgesia, latatives
Interventional - injection, band ligation, cryotherapy,
Surgical - haemorrhoidectomy, (need pre op lactulose and metronidazole for 1 week)
What’s the location of fissures in ano?
90% midline 6 o’clock
What’s the triad of chronic anal fissure?
Ulcer, sentinel pile, enlarge anal papillae
What are the causes of proctitis?
Crohns
UC
C. Diff
How to determine anal fistula location?
Goodsalls rule
Anterior - straigh line tracking
Posterior - starts at 6 o’clock but has a curved track
Causes of pruritis ani?
Iodopathic 50% Poor hygiene Haemorrhoids Anal fissure Anal fistula Fungi, worms Crohns Neoplasm
What’s the comment type of anal neoplasm?
Squamous cell carcinoma
What are the risk factors for rectal prolapse?
Multiparity/ Poor O&G hx.
Children- cystic fibrosis
Large piles
Elderly females
Investigations for rectal prolapse?
Sigmoidoscopy Deficating proctogram Ano rectal manometry Endoanal US MRI If in doubt EUA
Treatment for rectal prolapse?
Partial - phenol injection, rubber band ligation, surgery - delormes procedure
Complete - altmeirs procedure which resects the colon via perineal route. Or delormes procedure which resects mucosa.
Rectopexy - elevate rectum and fix to sacrum with mesh
Organisms in perianal abcesses
Bowel - E. coli
Skin - staph A
Which cells are typical in anal cancer?
Squamous cell
