Perianal disease Flashcards
Pruritis ani causes
Moist/soiled anus
threadworm
others
Pruritis ani rx
hygiene
anaesthetic cream,
moist wipe post-defecation,
avoid spicy food, steroid/antibiotic cream.
capsaicin
Fissure-in-ano def
tear in squamous cell lining of lower anal canal
mostly posterior
Fissure-in-ano cause
hard faeces
Fissure in ano 1st line rx
lidocaine+GTN ointment
or topical diltiazem
diet: high fibre, fluids
stool softner
Fissure in ano 2nd line
botox + diltiazem
Surgical rx of fissure in ano
lateral partial internal sphincterotomy
Fistula in ano pathophysiology
intramuscular gland ducts block
abscess formation
fistula
Causes of fistula in ano
perianal sepsis/abscess
crohns
TB
diverticular disease
Ix for fistula in ano
MRI
Endoanal US scan
Rx of fistula in ano
Fistulotomy + excision
If high (sphincter): seton suture tightened over time to maintain continence
If low: laid open to heal by secondary intention
Perianal haematoma def
thrombosed external pile
2-4 mm dark blueberry looking thing
Perianal haematoma rx
evacuated under LA or left to resolve spontaneously
Pilonidal sinus
obstruction of natal cleft hair follicles (6 cm above anus)
inflammation and secondary tracks opening laterally, d/c puss
Pilonidal sinus rx
excision of sinus tract + primary closure
hair removal advice
Rectal prolapse types
Type 1: Mucosa
Type 2: all layers
protruding through anus
Rx of rectal prolapse
Rectopexy (rectum fixed to sacrum) ± mesh insertion ± rectosigmoidectomy
Perianal warts types
Condylamata acuminata (viral)
Condylamata acuminata of Bushke & Loewenstein (low-grade, non-mets verrucous cancer)
Condylamata lata (2ndary to syphillis)
Condylomata acuminata rx
Podophyllotoxin
Imiquimod
Cryotherapy
Proctalgia fugax
Idiopathic, intense, brief, stabbing/crampy rectal pain, often worse at night
Proctalgia fugax rx
reassurance
inhaled salbutamol
topical GTN or diltiazem
RFs for anal cancer
Syphillis
Warts (HPV 6,11,16,18,31,33)
Homosexual receptive sex
Anal cancer cell type
mostly squamous cell
Differentiation of anal cancer
above dentate line: poorly differentiated, poor prognosis
Below dentate line/anal margin: well diff, good prognosis
Anal ca rx
Radiotherapy + chemo
(2nd line: anorectal excision+colostomy)
Haemorroids aka
piles
Haemorroids def
disrupted and dilated anal cushions
Anal cushion def
Three anal cushions at 3,7,11 o clock
Discontinuous masses of spongy vascular tissue that line the anus
Contribute to anal closure
Pathophysiology of haemorroids
Constipation -> vascular cushions protrude through tight anus -> congested -> hypertrophy ->protrude even more
Classification of haemorroids
1st degree: Remain in the rectum
2: Prolapse through the anus on defecation but spontaneously reduce
3: As for 2nd-degree but require digital reduction
4: Remain persistently prolapsed
Medical rx of haemorroids
Fluids + fibre
Topical analgesic + stool softner
+/- topical steroids
Non-operative rx of haemorroids
Rubber band ligation
Sclerosants
Infra-red coagulation
Cryotherapy
Surgical rx of haemorroids
Excisional haemorroidectomy (best, but 2wks off work)
Stapled haemorroidopexy
When to use medical rx of haemorroids
1st degree
When to use non-operative rx of haemorroids
2/3rd degree
resistant 1st degree
