Perianal infection and fissure in ano

Question 1

What are the symptoms of patients with perianal infections?

Answer 1

Patients may experience:

• pain, swelling (95%)
• fever (18%)
• discharge (12%)
• a mass (abscess)

Question 2

What are the different types of perianal infections?

Answer 2

• Anorectal abscesses - caused by gut organaisms, 45% are perianal, 30% ischiorectal, 20% intersphincteric and 5% supralevator
• Pilonidal sinus - obstruction of natal cleft hair follicles around 6cm above the anus, with ingrowing of hair leading to a foreign body reaction
• Perianal warts

Question 3

Describe the physical examination of patients with perianal infections

Answer 3

• Diagnosis is usually straightforward, however sepsis higher up the anal canal may require examination under anaesthetic or imaging
• Any discharging area near the anus should be assumed to communicate with the anorectum until proven otherwise
• Operative exploration is often the first diagnostic test, although MRI can be used

Question 4

Define fissure in ano

Answer 4

• An anal fissure is a tear in the sensitive anal canal distal to the dentate line, producing pain on defecation, most commonly in males
• Most are due to hard faeces

Question 5

Describe the symptoms and signs of patients with fissure-in-ano

Answer 5

Symptoms:

• ​Pain, worse on defecation, lasting for hours afterwards
• Associated constipation
• Pruritis ani (irritation of anal skin - itching)
• Bleeding on defecation

Signs (O/E):

• Midline longitudinal tear in the rectal muscosa
• ‘Sentinal pile’ (skin tag outside edge of anus) or muscosal tag at the external aspect
• PR may not be possible due to pain and sphicter spasm

Question 8

List the common causes of acute hepatits

Answer 8

• Viral infection (Hepatitis A-E/Non A-E infections)
  
  • Hep A may cause infection in childhood, though 80% of those infections are asymptomatic
  • Hep D & E are rare in UK
  • Hep B and C infection is usually astmptomatic except in IV drug users, in whom 30% develop jaundice
• Autoimmune
• Drug reactions
• Alcohol