Week 5.3 - Anorectal Disorders Flashcards
What is the anorectal function?
control defecation and maintain continence
What does anorectal function require?
- intact pelvic floor,
- compliance of rectal wall
- intact pelvic neurology
what are haemorrhoids?
bleeding, painless straining.
blood vessel cushions in lower rectum become enlarged due to pressure caused by straining
How do you treat haemorrhoids?
- commonest rubber band ligation
- HALO surgery - cut pedicle blood flow so it shrivels
- anopexy surgery - staple
- haemorrhoidectomy - take haemorrhoid off and ligate pedicle
What are fissures?
pain like glass splinters, wipe bleeding, tear due to passing hard faeces
How do you treat fissures?
- manage constipation
- GTN ointment and diltiazem local application. causes low BP so lay down 30mins after
- lignocaine ointment pain
- surgical - inject botox or sphincterotomy for damage
What do we need to ensure before treating haemorrhoids or fissures?
rule out cancer
What is a perianal abscess? risk factors?
- excruciating pain, very tender to touch, pass lots of pus, sometimes with pepsis
- risk factors are diabetes, high BMI, immunosuppresion and trauma. mostly idiopathic
How do you treat a perianal abscess
- antibiotics if septic
- incision and drain under anaesthetic
- dont look for fistula - will probs cause one
What is a fistula in ano?
anal fistula from inside to outer skin with different anatomical locations. usually results after pepsis. may cure itself 90% of time but other 10% causes incontinence so we treat it
How do you treat a fistula in ano?
- don’t leave open in woman as their muscle naturally weaker so will end up incontinent
- put seton in fistula to allow it to heal and mature
How do we investigate anal/rectal cancer?
- FIT test - not specific but if negative could mean problem is more proximal
- PR exam
- rigid sigmoidoscopy
- colonoscopy, CT colonoscopy, CT, MRI
What are some special functional investigations for anorectal disorders?
- colonic transit studies
- anorectal manometry
- endoanal USS
What is pelvic floor dysfunction?
- mostly women pregnant or had babies.
- wide range of symptoms relating to defacation
- often give patients reassurance - social limitation
How do you treat chronic constipation?
- modify diet, lifestyle, water intake
- bowel washout with irrigation or ACE
- if symptoms severe then ilestomy then ileorectal anastamosis or stoma
