Perianal Problems

Question 1

What is this a presentation of?

Painful passage of stools, bright red blood, hard faeces.

Answer 1

Anal fissure

Question 2

What is the treatment for an anal fissure?

Answer 2

1. Lidocaine ointment and GTN ointment

2. Increase fibre and fluids, stool softener

Question 3

What is an anal fistula, how is it investigated, and how is it managed?

Answer 3

1. Track communicating between the skin and anal canal.
2. MRI
3. Fistulotomy and excision

Question 4

What is an anorectal abscess and how is it treated?

Answer 4

1. Blockage of deep intramuscular gland ducts (occurring commonly in fistulas).
2. Incise and drain under GA

Question 5

What are the types of rectal prolapse and what is the aetiology?

Answer 5

1. Type 1 - just the mucosa
2. Type 2 - all layers (more common)

Incontinence in 75%. Due to a lax sphincter, prolonged straining and related to chronic neurological disorders.

Question 6

What is the management for a rectal prolapse?

Answer 6

Fix rectum to sacrum (rectopexy) +/- mesh insertion

Question 7

What are the risk factors for anal cancer?

Answer 7

Anoreceptive intercourse, HPV 16, HIV.

Question 8

How do anal cancers spread depending on their position relative to the dentate line?

Answer 8

1. Above dentate line - pelvic lymph nodes

2. Below - inguinal

Question 9

How do anal cancers present?

Answer 9

Bleeding, pain, bowel habit change, Crohn’s disease.

Question 10

What is the treatment for anal cancer?

Answer 10

Chemo and radiotherapy

Question 11

What are the causes of haemorrhoids?

Answer 11

Constipation is main cause, also congestion due to pregnancy/malignancy/CCF/portal hypertension.

Question 12

What is this a presentation of?
Bright red rectal bleeding, often coating stools, on the tissue, or dripping into the pan after defecation. May be mucous discharge and pruritus ani. Visible mass in anus.

Answer 12

Haemorrhoid

Question 13

What is the management for haemorrhoids?

Answer 13

1. Fluid and fibre, topical analgesia, bulk-forming laxatives, topical steroids.
2. Rubber band ligation, sclerosants.
3. Excisional haemorrhoidectomy, stapled haemorrhoidopexy.

Question 14

What is the classification of haemorrhoids?

Answer 14

1. 1st degree - remain in rectum
2. 2nd degree - prolapse through the anus on defecation but spontaneously reduce.
3. 3rd degree - as for 2nd degree but requires digital reduction.
4. 4th degree - remain persistently prolapsed.