Perianal disorders + extra

Question 1

Definition of haemorrhoids (piles)

Answer 1

Swollen veins in walls of rectum and anus, disrupting anal cushions - parts of anal cushions prolapse through tight anal passage

Question 2

MC of haemorrhoids

Answer 2

Constipation with in lots of straining
also anal sex

Question 3

What are the 2 types of haemorrhoids?

Answer 3

Internal and external

Question 4

Describe internal haemorrhoids
Where do they originate?
Painful?

Answer 4

Originate above internal rectal plexus (dentate line)
less painful as has much lower sensory supply , may feel ‘incomplete emptying’

Question 5

Describe external haemorrhoids
Where do they originate?
Painful?

Answer 5

Originate below dentate line
so painful patients can’t sit down

Question 6

Symptoms of Haemorrhoids

Answer 6

Bright red fresh PR bleeding & mucusy bloody stool + lumps on anus become painful and swollen
Pruritus ani - itchy

Question 7

Diagnosis of haemorrhoids (internal and external)

Answer 7

External - PR exam (digital) - may be visible though
Internal - Proctoscopy

Question 8

Treatments for haemorrhoids

Answer 8

stool softener (laxative for constipation)
Pain meds/numbing cream
Definitive=rubber band ligation

Question 9

What is a perianal abscess?

Answer 9

Walled off collections of stool and bacteria around anus

Question 10

MC cause of perianal abscess?

Answer 10

Anal sex, causing anal gland infection

Question 11

Sx of perianal abscess?

Answer 11

Pus in stool, constant pain (tender)

Question 12

Tx of perianal abscess?

Answer 12

surgical removal + drainage (walled off = resistant to Abx therapy - oral)

Question 13

What is an anal fistula?

Answer 13

abnormal ‘tracks’ form between inside of anus to elsewhere
eg. submit skin (mostly)

Question 14

What does it progress from?

Answer 14

perianal abscess
Also Crohns, rectal cancer
Abscess discharges (toxic substances) which aid fistula formation as abscess grows

Question 15

Sx of anal fistula

Answer 15

Bloody/mucusy discharge, often visible and painful

Question 16

Tx for anal fistula

Answer 16

Surgical removal + drainage (with Abx if infected)

Question 17

What is An anal fissure?

Answer 17

Tear in anal skin lining along dentate line (therefore very painful , strong sensory supply)

Question 18

MC Cause of anal fissure?

Answer 18

Hard faeces, also trauma (eg. childbirth), Crohns/UC

Question 19

Sx of anal fissure

Answer 19

Extreme defacation pain, very itchy bum (pruritus ani) and anal bleeding

Question 20

Tx for anal fissure

Answer 20

Stool softening; high fibre + more fluids + topical creams eg. lidocaine ointment
Definitive but not really done = surgery

Question 21

What is a pilondial sinus/abscess?

Answer 21

Hair follicles get stuck in natal cleft (bum crack) which Form small tracts (sinuses)
Get infected (abscesses)

Question 22

Who are they usually seen in?

Answer 22

Some very hairy ppl
eg. asians

Question 23

Sx of pilondial

Answer 23

swollen pus filled smelly abscesses on bumcrack

Question 24

Tx for pilondial

Answer 24

Surgery and hygiene advice

Question 25

Zenkers diverticulum (pharyngeal pouch)
What is it?
Sx?

Answer 25

Some food goes down pouch instead off totally down oesophagus
Sx = smelly breath (food is accumulating in oesophagus)
Regurgitation + aspiration of food

Question 26

CMV (cytomegalovirus)
What is it?
what does it cause?

Answer 26

Causes owl eye colitis (on histology) in immunosuppressed Px, an AIDs defining illness