Perineal abscesses and fistulae Flashcards

1
Q

Define Perineal Abscess?

A

a pus collection in the perineal region within the subcutaneous tissue of the anus.

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2
Q

define perineal fistula?

A

an abnormal chronically infected tract communicating between the perineal skin and either the anal canal or the rectum

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3
Q

what are the causes of perianal abscesses?

A

• Bacterial infection
o E.coli originating from GI
o Staph aureus originating from infection of skin

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4
Q

what are the causes of perianal fistulae?

A

• Fistulae develop as a complication of an abscess
• Fistulae can develop as a complications of Crohn’s disease
(pepper pit perineum)

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5
Q

risk factors of anal abscesses and fistulae?

A

o IBD
o Diabetes mellitus (bad wound healing)
o Malignancy (due to risk of bowel perforation)

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6
Q

epidemiology of anal abscesses and fistulae?

A
  • COMMON
  • More common in men
  • Average age is 40
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7
Q

what is the presenting complaint of abscesses and fistulae?

A
  • Constant throbbing pain in the perineum worse on sitting
  • Pus-like discharge from the anal region
  • Hardened tissue in the anal region
  • Personal or family history of IBD
  • Can present with spiking temperatures (for abscesses- SBA clue)
  • Patients may be unable to defecate due to pain
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8
Q

what are the signs of abscesses and fistulae on DRE?

A

o A thickened area over the abscess/fistula may be felt

o DREs are not always possible due to pain and anal sphincter spasm

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9
Q

what is goodsalls law?

A

o This is a rule that allows you to correlate the location of the internal fistula opening based on the location of the external fistula opening

  • openings anterior to anal canal run directly into anal canal
  • openings posterior to anal canals follow a curved path.
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10
Q

what investigations should be undertaken for perianal abscesses and fistulae?

A
•	Bloods 
o	FBC  
o	CRP 
o	ESR  
o	Blood culture  
•	Imaging 
o	MRI – gold standard (rarely used) 
o	Trans-perineal USS
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11
Q

management plan for perianal abscesses?

A
  • Requires SURGICAL treatment

* Incision and drainage of Abscess

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12
Q

management for perianal fistulae?

A
  • low fistula = fistulotomy

- high fistula = seton.

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13
Q

when are antibiotics used for abscesses and fistulae?

A
  • in cases of systemic infection
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14
Q

what are complications of perianal abscesses and fistulae?

A
  • Recurrence
  • Damage to internal anal sphincter
  • Incontinence
  • Persisting pain
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15
Q

prognosis for patients with perianal abscesses and fistulae?

A

• High recurrence rate without complete excision

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