Anal Disease Flashcards
(28 cards)
What is an anal fissure?
Tear in the mucosal lining of anal canal
What are some risk factors for developing anal fissures?
Constipation
Dehydration
IBD
Chronic diarrhoea
What are some clinical features of anal fissures?
Intense pain post-defecation
Bleeding - bright red on wiping
Itching
Can be visible and palpable - v painful
What is the most common location for anal fissures?
Posterior midline
Ant fissures more likely in females or if underlying cause is present
What is the medical management for anal fissures?
Reduce RF
Analgesia
Increase fibre and fluid intake
Stool softeners - lactulose
GTN cream or diltiazem cream - relaxes internal anal sphincter, promoting healing
Topical lidocaine
What surgical management is available for anal fissures?
Reserved for chronic fissures >8wks
Botox injections to relax internal anal sphincter
Lateral sphincterotomy
What is a perianal fistula?
Abnormal connection between anal canal and perianal skin?
How can anal fistulas be classified?
The Park’s Classification System:
inter-sphincteric fistula (most common),
trans-sphincteric fistula,
supra-sphincteric fistula (least common
extra-sphincteric fistula
What are some risk factors for developing perianal fistula?
IBD - more crohns
Systemic diseases e.g. diabetes
Hx of trauma to anal region
Prev radiotherapy to anal region
What is the typical way a perianal fistula forms?
As a consequence of anorectal abscess
What are some clinical features of perianal fistula?
usually present with either recurrent perianal abcesses, or intermittent or continuous discharge onto the perineum, including mucus, blood, pus, or faeces
external opening on the perineum may be seen; these can be fully open or covered in granulation tissue
fibrous tract may be felt underneath the skin on digital rectal examination
How are perianal fistulas investigated?
MRI
What is the management of perianal abscess?
Fistulotomy
Placing a seton
What is an anorectal abscess?
Collection of pus on anal or rectal region
What is the pathophysiology of anorectal abscess?
Plugging do anal ducts -> fluid stasis -> infection
What are some common causative organisms of anorectal abscess?
E.coli
Bacteriodes spp.
Enterococcus spp.
What are some clinical features of anorectal abscess?
Severe pain in perianal region
Perianal discharge or bleeding
If severe may have systemic features - rigors, fever, malaise etc
erythematous, fluctuant, tender perianal mass, may be discharging pus or have surrounding erythema and induration
Deeper abscesses may not have any obvious external signs, - produce severe tenderness on PR examination
What investigations are done for suspected anorectal abscess?
Bloods:
FBC
CRP
Clotting
G&S
U&Es
HbA1c
MRI pelvis scan
What is the management for anorectal abscess?
Abx
EUA Rectum and I&D (incision and drainage) - under GA
be left to heal by secondary intention(with or without packing)
Intra-operative proctoscopy - check for fistula
What is pilonidal sinus disease?
disease of the inter-gluteal region, characterised by the formation of a sinus in the cleft of the buttocks. It most commonly affects males aged 16-30 years.
What are some risk factors for Pilonidal sinus disease?
Caucasian male
Coarse dark body hair
Sitting for prolonged periods
Increased sweating
Buttock friction
Obesity
Poor hygiene
How does pilonidal sinus disease occur?
hair follicle in the intergluteal cleft becoming infected or inflamed
inflammation obstructs the opening of the follicle, which extends inwards, forming a ‘pit’
foreign body-type reaction may then lead to formation of a cavity, connected to the surface of the skin by an epithelialised sinus tract
cavities will often discharge serous fluid and can periodically become acutely infected to form an pilonidal abscess
What are some clinical features of pilonidal sinus disease?
a discharging and intermittently painful sinus in the sacrococcygeal region
pilonidal abscess-swollen and erythematous region. On examination, there will be a fluctuant and tender mass
