Perianal Infection Flashcards

1
Q

What are the anal sinuses/crypts?

A

SMall recesses that release mucous when compressed by faeces

-aids evacuation of anal canal

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2
Q

What is the most common site of perianal infection?

A

Anal crypts

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3
Q

How do perianal infections typically present?

A

Visibly red, exquisitely tender swelling next to the anus

Typically ano-receptive males

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4
Q

What are the three main types of perianal infection?

A

Anorectal abscesses
Pilonoidal sinus
Perianal warts

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5
Q

What are the management options for perianal warts?

A

Podophyllin
Cryotherapy
Surgical excision
If 2o to syphillis treat w/ penicillin

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6
Q

With what conditions are anorectal abscesses most commonly associated?

A

Associated w/ Chron’s, DM & malignancy

-caused by gut organisms e.g. E.coli

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7
Q

What are the most common sites for anorectal abscesses to form?

A

Perianal (45%)
Ischiorectal (30%)
Intersphincteric (20%)
Supralevator (5%)

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8
Q

What are the management options for anorectal abscesses?

A

Incision/drainage under LA
-to prevent rupture/fistula formation

Only give abx if signs of systemic infection

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9
Q

What causes a pilonoidal sinus?

A

Obstruction of natal cleft hair follicles

Ingrowing of hair causes FB reaction –> abscess formation OR tracs to skin in a ‘pilonoidal sinus’

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10
Q

How does a pilonoidal sinus typically present?

A
Obese males
Asian/middle eastern
Foul discharge
Pain
Fluctuant swelling

Can have asymptomatic periods

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11
Q

What are the management options for a pilonoidal sinus?

A

Incision and drainage with healing via secondary intention

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12
Q

How are perianal infections diagnosed?

A

Examination/Hx
Examination under anaesthetic/imaging (higher infections)
Operative exploration/MRI

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13
Q

What is a fistula in ano?

A

A track that communicates b/w the skin and the anal canal/rectum

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14
Q

What causes a fistula in ano?

A

Usually an abscess discharging to form a fistula

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15
Q

How do fistula in ano present?

A

Initially as an anorectal abscess

Recurrent episodes of infection

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16
Q

What are the risk factors for fistula in ano?

A
TB
Chron's
Diverticular disease
Rectal carcinoma
Immunocompromise
17
Q

What investigations are appropriate in suspected fistula in ano?

A

Examination under anaesthetic (v. painful)
MRI
Endoanal USS

18
Q

What is Goodsall’s rule?

A

Relates external opening of anal fistula to internal opening

  • post fistulas have curved track w/ opening in post midline
  • ant fistulas have direct opening into anal cavity
19
Q

What is the exception to Goodsall’s rule?

A

Ant fistulas >3cm from anus

-may drain w/ curved track to opening in post midline

20
Q

What are the management options for fistula in ano?

A

Fistulotomy (healing by 2o intention)
Fibrin glue (fistula plug)
Seton suture
Metronidazole (if Chron’s)