Perianal disorders + extra Flashcards
Definition of haemorrhoids (piles)
Swollen veins in walls of rectum and anus, disrupting anal cushions - parts of anal cushions prolapse through tight anal passage
MC of haemorrhoids
Constipation with in lots of straining
also anal sex
What are the 2 types of haemorrhoids?
Internal and external
Describe internal haemorrhoids
Where do they originate?
Painful?
Originate above internal rectal plexus (dentate line)
less painful as has much lower sensory supply , may feel ‘incomplete emptying’
Describe external haemorrhoids
Where do they originate?
Painful?
Originate below dentate line
so painful patients can’t sit down
Symptoms of Haemorrhoids
Bright red fresh PR bleeding & mucusy bloody stool + lumps on anus become painful and swollen
Pruritus ani - itchy
Diagnosis of haemorrhoids (internal and external)
External - PR exam (digital) - may be visible though
Internal - Proctoscopy
Treatments for haemorrhoids
stool softener (laxative for constipation)
Pain meds/numbing cream
Definitive=rubber band ligation
What is a perianal abscess?
Walled off collections of stool and bacteria around anus
MC cause of perianal abscess?
Anal sex, causing anal gland infection
Sx of perianal abscess?
Pus in stool, constant pain (tender)
Tx of perianal abscess?
surgical removal + drainage (walled off = resistant to Abx therapy - oral)
What is an anal fistula?
abnormal ‘tracks’ form between inside of anus to elsewhere
eg. submit skin (mostly)
What does it progress from?
perianal abscess
Also Crohns, rectal cancer
Abscess discharges (toxic substances) which aid fistula formation as abscess grows
Sx of anal fistula
Bloody/mucusy discharge, often visible and painful
Tx for anal fistula
Surgical removal + drainage (with Abx if infected)
What is An anal fissure?
Tear in anal skin lining along dentate line (therefore very painful , strong sensory supply)
MC Cause of anal fissure?
Hard faeces, also trauma (eg. childbirth), Crohns/UC
Sx of anal fissure
Extreme defacation pain, very itchy bum (pruritus ani) and anal bleeding
Tx for anal fissure
Stool softening; high fibre + more fluids + topical creams eg. lidocaine ointment
Definitive but not really done = surgery
What is a pilondial sinus/abscess?
Hair follicles get stuck in natal cleft (bum crack) which Form small tracts (sinuses)
Get infected (abscesses)
Who are they usually seen in?
Some very hairy ppl
eg. asians
Sx of pilondial
swollen pus filled smelly abscesses on bumcrack
Tx for pilondial
Surgery and hygiene advice
Zenkers diverticulum (pharyngeal pouch)
What is it?
Sx?
Some food goes down pouch instead off totally down oesophagus
Sx = smelly breath (food is accumulating in oesophagus)
Regurgitation + aspiration of food
CMV (cytomegalovirus)
What is it?
what does it cause?
Causes owl eye colitis (on histology) in immunosuppressed Px, an AIDs defining illness
