perianal disorders

Question 1

ddx for perianal disease

Answer 1

haemorrhoids
anal fissue
anoreeectal fistula
proctitis, including chrons disease, UC, and infective proctitis
perianal infection, including perianal cellulitis, anoreectal abscess and pilonidal sinus
genital warts
skin inflammation
solitary rectal ulcer syndrome
rectal prolapse
colorectal polyps or cancer
anal cancer

Question 2

haemorrhoids

Answer 2

enlarged, displaced vascular anal cushions containing a rich arteriovenous network, which are subject to downward pressure during defacation
classified as internal or external based on their position above or below the dentate line

Question 3

dentate line

Answer 3

separates the anal canal from the rectum and is visible with the naked eye

Question 4

internal haemarhoids

Answer 4

originate above the dentate line and have columnar epithelium that is insensitive to touch or temperature, so they are not typically painful

Question 5

symptoms of internal haemarrhoids

Answer 5

bleeding, mucous discharge and pruritis
may or may not prolapse down the anal canal ie. protrude below the dentate line

Question 6

grade of internal haemorrhoids

Answer 6

classified according to degree of prolapse
grade 1: haemorrhoids o not protrude
grade 2: haemorrhoids prolapse during defecation and reduce spontaneously
grade 3: haemorroids prolapse and require manual reduction
grade 4: haemorrhhoids prolapse and are irreducible

Question 7

management of internal haemorrhoids

Answer 7

lifestyle
- ensuring adequate intake of fibre and noncaffeinated fluids to avoid constipation
- avoiding straining during defecation
- responding to the urge to defecate, and not trying to initiate defecation without this
OTC treatments

Question 8

OTC treatments for internal haemorrhoids

Answer 8

ointments and suppositories containing emolients and a mild astringent, local aneasthetic or corticosteroid
may relieve itch or discomfort but little evidence that they promote sustained improvement

Question 9

managemnt of treatment resistant internal haemorroids

Answer 9

refer to a gastroenterologist or a surgeon with expertise in managing haemorrhoids
specialist interventions include rubber band ligations, infection sclerotherapy or infrared coagulation.

Question 10

internal haemorrhoids that ddevelop during pregnancy

Answer 10

manage using lifestyle measures and OTC treatment because they usually resolve after delivery

Question 11

symptoms of thrombosed external hemorrhoids

Answer 11

originate below the dentate line aand are covered in squamous epithelium, which is pain sensitive
may become thrombosed, sometimes aas a result of straining during defecation
appears s an extremely painful tense blue swelling aat the anal margin

Question 12

management of thrombosed external haemorrhhoids

Answer 12

spontaneous rupture may occur, this may resolve symptoms without requiring symptoms
paain will settle in 1-2 weeks without treatment, the hematoma will resorb and leave a skin tag
for patients who present within 72 hours of onset of symptoms, severe pain can be relieved by excision of the hematoma under local anesthesia

Question 13

anal fissue

Answer 13

split in the skin of the anal canal
oftenn precipitated by the passage of hard stool
acute fissures present with anal pin that worsens with defecation, and a small volume of bright red blood from the rectum

Question 14

management of acute anal fissue

Answer 14

advise patient to avoid hard stool by using stool softening or bulk forming laxatves
use wrm salt baths after bowel movements
OTC topical preparations containing a local anaesthetic my help relieve pain or discomfort associated with acute anal fissures

Question 15

prolonged use of topical preparations contianing local anaesthetic

Answer 15

they can cause adverse effects such as local skin sensitisation or dermtitis

Question 16

topical preparations to prevent sphincter spasm to promote perfusion and healaing

Answer 16

glyceryl trinitrate ointment inserted into the anal canal
my cause headache or hypotension

Question 17

anorectal abscess is caused by

Answer 17

n infection of one of the nal glands that dran into the nal canal at the level of the dentte line

Question 18

symptoms of anorectal abscess

Answer 18

pain may be the only indication of a deeper abscess
signs of inflammation may not be visible

Question 19

management of anorectal abscess

Answer 19

urgent surgical drainage
antibiotic therapy is an adjunct to surgery
infection is often polymicrobial

Question 20

anorectal fistula

Answer 20

abnormal communication between the norectum and the perianal skin
occurs as a complication of an acute or chronic perianal abscess

Question 21

pilonidal sinus disease

Answer 21

acute or chronic infection in the natal cleft, which may lead to formation of an abscess

Question 22

pilonidal abscess

Answer 22

requires urgent surgery, seek expert advice