Perianal problems Flashcards
What are haemorrhoids?
When the vascular cushions become congested hypertrophy and strangulated, occurs in a vicious cycle
Where are haemorrhoids located in their normal state?
3,7,11 o’clock position
What is the main cause of haemorrhoids?
constipation and straining
What are the symptoms of haemorrhoids?
BRIGHT RED BLOOD on wiping, coating stool or dripping into pan, mucous discharge pruritis ani Pain if thromboses
What is the difference between external and internal haemorrhoids?
External - below dentate line, painful
Internal - above dentate line, no pain
Explain the grading of haemorrhoids
I - do not prolapse
II - prolapse on defecation and spontaneously reduce
III - manually reducible
IV - can’t be reduced manually
How would you investigate haemorrhoids?
- Abdo exam
- PR exam - internal not palpable
- Colonoscopy if ≥50 yrs
What is the medical management of haemorrhoids?
i. Increase fluid and fibre
ii. Stool softeners (bulk- docusate)
iii. Topical analgesia, steroids (anusol)
What are non-operative treatments of haemorrhoids?
- Rubber band ligation
- Sclerosants - 2ml 5% phenol oil injected above dentate line to induce fibrosis
- Infra-red coagulation
- Bipolar diathermy
What are the surgical treatments of haemorrhoids?
Excisional haemorrhoidectomy
What are thromboses piles? what is the management?
blood clot forms inside the piles causing exquisite pain and blue/black tinge to pile
management - analgesia, ice packs, sometimes surgery
What are anal fissures?
longitudinal or elliptical tears of squamous lining of distal anal canal
whAT ARE acute and chronic anal fissures defined as?
acute - <6 weeks
chronic >6 weeks
Where do most anal fissures occur?
posterior midline
What are RFs for anal fissures?
constipation
IBD
STIs e.g. HIV, syphilis, herpes
