W8: Benign Anorectal Disorders Flashcards
Haemorrhoids, Rectal Prolapse, Anal fissue, Fistula in ano
What are haemorrhoids?
Enlarged vascular swellings in the lower rectum and anal canal
How do haemorrhoids present? (3 main symptoms)
-painless bleeding -fresh bright red blood -perianal itchiness
What are 2 usual causes for pruritus ani? (anal itching)
-overactive sweat glands -haemorrhoids
What do the 3 degrees of haemorrhoids represent?
primary -> internal secondary -> prolapsing third -> prolapsed
When patient is in lithotomy position, the branches of what artery do haemorrhoids classically correspond to and at what points?
-branches of superior haemorrhoidal artery -3, 7 and 11 o’clock
What are 3 investigations used when diagnosing haemorrhoids?
-PR exam -flexible/rigid sigmoidoscopy -protoscopy
What is management of mild haemorrhoids?
-mild: suppositories containing a local anaesthetic and steroids -advice about constipation
What are 4 possible procedures for treating haemorrhoids?
-open/stapled haemorrhoidectomy -sclerosation therapy -HALO procedure -rubber band ligation
What is the HALO procedure and what does it involve?
-Haemorrhoidal artery ligation operation -involves using doppler ultrasound to identify arteries supplying haemorrhoid and ligating arteries
What is a particular benefit of the HALO procedure for the patient?
It is pain-free because stitch is placed in lower rectum where there are few sensory nerves
How does sclerosation therapy work for haemorrhoids?
-A sclerosing agent is injected into arteries supplying haemorrhoids -arteries swell and scar and cut of blood supply
What is an anal fissue?
Tear in the mucosa of the anus which is distal to the dentate line
What are 3 symptoms of anal fissures?
-pain upon defecations -fresh blood -visible crack/tear in skin
What age groups are haemorrhoids common in?
-young -old
What are 5 causes of anal fissure?
-constipation, large hard stools -recurrent straining -chronic diarrhoea -anal intercourse -pregnancy
What bowel disease are anal fissures linked to?
-IBD: Crohn’s & Colitis
What is the treatment for anal fissures?
-dietary advice, stool softeners -topical anaesthetic e.g. lidocaine -pharmalogical sphyncterotomy (topical diltiazem, topical GTN) -lateral sphyncterotomy -botox injection
What does a lateral sphyncterotomy involve?
small incision made into sphincter muscles to allow healing
What is a fistula in ano?
An abnormal opening that starts in the anal canal and ends in one or more external openings on the peri-anal skin
What are 3 rare causes of fistulae in ano?
-Crohn’s -TB -carcinoma
What is most common cause of fistulae in ano?
-late/inadequate treatment of anorectal abscess
What are the 4 types of fistulae in ano?
-extrasphincteric -suprasphincteric -intersphincteric -transphincteric
What are 4 investigations used when diagnosing fistulae in ano?
- endoanal ultrasound
- rigid/flexible sigmoidoscopy
- protoscopy
- MRI
What are 3 surgical management options for fistulae in ano?
- fistulotomy (fistulae opened, drained and stitched back shut)
- glue
- insertion of seton (material put in fistulae to encourage drainage)
List 4 complications of fistula in ano.
- pain
- bleeding
- infection
- incontinence of stool or flatus
How does rectal prolapse present? (4)
- Protruding mass from anus
- especially protruding during defecation
- blood and mucous
- tenesumus
What are the two types of rectal prolapse?
- Incomplete: only musocal prolapse
- complete: full thickness
What is treatment for complete rectal prolapse? (3)
- Rectopexy (rectum is surgically pulled back up and stitched in place)
- resection
- Delorme’s procedure (cutting away mucosa and stitching rectum to muscle)
What is management for incomplete rectal prolapse?
-dietary advice on constipation
