Rectum Problems Flashcards
What are the symptoms of haemorrhoids (vascular cushions that enlarge due to increased pressure)
What are symptoms of external thrombosis (strangulation)
Fresh painless bleeding after defaecation Itchy Mucous discharge Pruritus Lump in anus Anaemia may occur
Signifcant pain
Purple / oedematous
PR impossible
What are the RF for haemorrhoids
Obese Age Pregnant Weight lifting Excessive straining due to constipation Lack of fibre
How do you Dx haemorrhoids
For all rectal bleed - Digital rectal exam, abdominal exam + colonoscopy to exclude malignancy if >50
DRE
May need proctoscopy for internal
Grade 1 = not out of canal 2 = prolapse on defaecation 3 = manually reduce 4 = cannot reduce
Assess for red flags e.g. weight loss / change in bowel
How do you treat haemorrhoids
Increase fibre/ fluid / laxatives to often
Topical LA / analgesia
Topical steroid for short term only
Surgery US ligation of vessels Band litigation Miligan Morgan open Haemorrhoidectomy - gold standard Excise within 72 hours if thrombose
What are differentials for haemorrhoids
IBD Peri-anal haematoma Malignancy Fissure Abscess Unlikely to be abscess or fissure as painful
What are the risks of surgery
Bleeding Fistula Infection Incontinene Stenosis
What causes anal fissue
Constiption = most common Trauma IBD - Chron's Malignnacy STI - Syphillis Nicorandil - ulceration Haemorrhoids
What are the symptoms of anal fissue
Pain
Bleeding after defection
Itching
How do you Dx fissue
Digital rectal exam
How do you treat fissue
Laxatives / High fibre diet to bulk stool
Lubricant / Ointment
Topical anaesthetic
Steroid = no help
If no improvement / chronic
Continue above
Topical GTN
Topical NO / CCB
If no improvement after 8 weeks - refer 2
Botilum toxin
Sphincterotomy to losen
When is sphincter laparoscopy CI
Women of child bearing age as leads to incontinece
What causes peri-anal abscess
Anal tissue infected IBD STI Blocked anal gland E.coli / S.Aureus
What are the symptoms of abscess
Swelling Pain - constant Skin irritation Discharge Constipation Previous anal rectal condtions Fever + severe pain differentiate from fissure
What are general RF for abscess / bowel conditions
IBD
Diverticulitis
PID
DM
Steroids
Malignancy
How do you diagnose abscess
Digital rectal exam
Colonoscopy for underlying cause
MRI / USS if part of IBD etc
How do you treat abscess
Drain abscess
Pain relief
Ax not usually needed
Broad spec if DM
What are the complications of abscess
FIstula
What causes fistula in ano
Abscess = most common Chrons Diverticulitis HIV TB Cancer Surgery
What are the symptoms of fistula
Pain Skin irritation Smelly discharge Passing pus or blood in stool Bowel incontinece High output = ideal / jejunal Nutritional deficiency
How do you Dx fistula
Digital rectam exam Proctoscopy EUA USS MRI - see course CT Infection screen
How do you treat fistula (need to close primary opening before outer hole closes as abscess will form)
Conservative if no IBD / distal obstruction as should heal
Protect skin with stoma bag
TPN / nutrition if high volume
Octreoide - reduce volume of pancreatic secretions
Fistulotomy if superficial
Seton suture
FIstula plug
Permacol paste
Emergency if acutely unwell but better to investigate and know course
What causes solitary rectal ulcer
Constipation
Straining
Ulceration
Need to endoscopy + biopsy to exclude malignancy
What do you do for puriruts of anus
Check not related to bowel habit e.g. diarrhoea
Look for worms
Proctosigmoidoscopy for other cause
Exclude cancer
SUpportive
Mild topical corticosteroid if inflammation (max 2 weeks)
What causes pruritus and
Soiled anus / incontinence / poor hygiene Fissure Fistula Threadworm Lischen scloeriss Contact dermatitis
