the butttt Flashcards
where are the majortiy of anal fissures
posterior midline
what is a skin tag
Anal skin tags are benign skin growths around the anus. These are generally caused by various pathologies of the anus, most commonly hemorrhoids and anal fissures.
secondary causes of anal fssures
chrones diseases
malignancy like leukemia
acute .chronic anal fissure
6 weeks
chronic divided into A B C
its deeper than acute
A- raised lumpy borders
B- skin tag distal to tear
C- hypertophied papillae proximal to tear
acute .chronic anal fissure
6 weeks
chronic divided into A B C
A- raised lumpy borders
B- skin tag distal to tear
C- hypertophied papillae proximal to tear
rf
1.!! contsipation
pregnancy
anal cancer
psoarias , chrones
rf
1.!! contsipation
pregnancy
Management of anal fissures
Treatment of constipation – laxatives/fibre in diet
Topical analgesics – lidocaine cream / jelly
Topical vasodilators e.g. nifedipine or nitroglycerine
Second line treatments include topical calcium channel blockers (diltiazem), or oral nifedipine / diltiazem.
Treatment of constipation laxatives/fibre in diet
Topical analgesics – lidocaine cream / jelly
Topical vasodilators e.g. nifedipine or nitroglycerine
Second line treatments include topical calcium channel blockers (diltiazem), or oral nifedipine / diltiazem.
what kind of blood in anal fissure
fresh bright red
defintion OF ANAL FISSURE
A painful tear in the squamous lining of the lower anal canal below the pectinate line
Anal fissure is an ulcer in the lower portion of the anal canal.- NOV
complication of hemmorhoid- NOV
thrombosis of the hemorrhaid which can be very painful
anemia- chronic blood loss
Bleeding, inflammation, thrombosis, strangulation and necrosis.
rf for piles
spicy foods
constipation
portal hypertnsion
sitting for long periods of time
straining during bowel movements
obesity
pregnancy
low fibre
rf for piles
spicy foods
sitting for long periods of time
straining during bowel movements
obesity
pregnancy
anal sex + low fibre
management of piles conservative
sitz bath - warm water
topical CS to alleviate the itching
band ligation good for 2 + 3
laxatives to soften the stool
diety - increase fiber
injection of sclerosant (only for internal so 1+2)
surgical options piles
hemmoridectomy
LORDS
Internal sphincter is stretched widely , resulting in dilation _ disruption of fibers
BARONS
bands are applied at the neck of hemmoroids which undergo healing by fibrosis
surgical options piles
LORDS
Internal sphincter is stretched widely , resulting in dilation _ disruption of fibers
BARONS
bands are applied at the neck of hemmoroids which undergo healing by fibrosis
what do we divide hemorrhoids into
internal(arise from superior hemoroidal plexus)
and external (arise from inferior hemorroidal plexus)
difference between internal and external hemorrhoids
intenral - very little pain, but more bleeding in compariosn
external - more painful less bleeding
difference between internal and external hemorrhoids
intenral - very little pain, but more bleeding in compariosn
external - more painful less bleeding
novs def of hemorrhoids
Haemorrhoids are the angorgement of the hemorrhoidal vascular plexuses with redundancy of
their coverings. The word ‘piles’ is an alternative name for haemorrhoids.
novs def of hemorrhoids
Haemorrhoids are the angorgement of the hemorrhoidal vascular plexuses with redundancy of
their coverings. The word ‘piles’ is an alternative name for haemorrhoids.
symptoms
patients are systemically well!!!
bleeding on defecation - typically painless
can feel a lump (if thrombosed)
itchy- due to excessive mucus production
patients will compain of mucous discharge
pain is not typical except if an external thrombosed hemorrhoid
what is the criteria for a thrombosed h
it has to have been protruded to get thrombosed and it changes colour
what is the criteria for a thrombosed h
it has to have been protruded to get thrombosed and it changes colour
managemnt of thrombosed H
hrombosed haemorrhoids (which present as a painful purple protrusion) can be managed conservatively with ice packs, laxatives, and lidocaine gel. Patients require haemorrhoidectomy if conservative measures fail.
what medications can worsen the bleeding
heprain
wrafarin
aspirin (anti-platelet)
nsaids
what medications can worsen the bleeding
heprain
wrafarin
aspirin (anti-platelet)
nsaids
investigations for hemorrhoids- nOV
anoscope exam
protecotscopy
investigations for hemorrhoids
anoscope exam
protcoscopy
looks at rectum + anus
Y
