wk 8 5 Rectal Disorders Flashcards
questions to ask for bleeding
fresh/dark?
Mixed with stool?
Dripping in the toilet or just on paper?
define haemorrhoids
enlarged vascular cushions of the lower rectum and anal canal
haemorrhoids presentation
painless bleeding - fresh, bright red, not mixed with stool
perianal itchiness
no change in bowel habit/weight loss
expected clinical findings of haemorrhoids
external inspection may be normal
maceration of perianal skin (breakdown of skin due to moisture)
PR exam - normal unless thrombosed
which artery is haemorrhoids most likely to occur in
superior haemorrhoidal artery (occuring at 3,7,11 o’clock when patient in position)
suitable investigations of haemorrhoids 4
PR exam
rigid sigmoidoscopy
proctoscopy
flexible sigmoidoscopy if >50
management of haemorrhoids 3
symptomatic
sclerosation therapy (5% phenol in almond oil) (dissolves vein)
rubber band ligation
open/stapled haemorrhoidectomy
HALO (Haemorrhoidal Artery Ligation Operation)
anesthesia for HALO
general/spinal anesthesia
outline the HALO procedure
Miniature doppler ultrasound locates branches of arteries supplying the haemorrhoids, these are then ligated causing the haemorrhoid to shrink
t/f HALO procedure is pain-free
true
stitch is placed in lower rectum - virtually no sensory nerves
what are the two types of rectal prolapse
partial (anterior mucosal prolapse)
complete (full thickness)
presentatioin of rectal prolapse
protruding mass from anus - esp during defecation (may reduce spontaneously)
bleeding/mucus common
t/f poor anal tone usually noted on examination in a rectal prolapse
true
outline the management of complete prolapse
if too frail for surgery - bulking agent and education on manual reduction
delormes procedure
perineal/ abdominal rectopexy
anterior resection
management of incompplete prolapse
most likely due to constipation
in children - dietary advice
in adults - same as haemorrhoids
define anal fissure
teal in the anal margin due to passage of a constipated stool
multiple fissures indicates
crohns
anal fissure most likely to occur in the midline anterior t/f
false
can occur but usually in midline posteriorly
presentation of anal fissure
acute onset of severe anal pain following episode of constipation (lasting half an hour)
“glass passing through the back passage”
bright rectal bleeding
treatment of anal fissures
dietary advice
stool softeners (docusate sodium)
sphyncterotomy - pharmacological (GTN + Diltiazem ointment) or surgery (lateral internal sphyncterotomy)
botox injection
define fistula
abnormal communication between two epithelial surfaces (internal opening - 1+ external opening on peri-anal skin)
causes of anal fistula 6
most - arise in treatment delay of anorectal abscess crohns TB carcinoma diverticulitis surgery complication
investigations for anal fistula
PR exam (under anesthesia)
rigid sigmoidoscopy/proctoscopy
flexible if old
MRI
management of anal fistula
laying open procedure (fistula cut open and then left to heal, if fistula is at sphincter may cause incontinence)
seton (draining, cutting) if higher up
LIFT procedure
defunctioning colostomy
possibe complications of anal fistula
pain
bleeding
flatus/stool incontinence
recurrence
