Anal Disorders

Question 1

How long does an acute anal fissure last?

Answer 1

< 6 weeks

Question 2

Where are the majority of anal fissures located?

Answer 2

Posterior midline

Question 3

What are some causes of anal fissures?

Answer 3

Tearing from passage of hard stool
Anal trauma
Drugs
IBD
STIs
Dermatological conditions
Pregnancy/childbirth

Question 4

What are the 2 main symptoms of anal fissures?

Answer 4

Localised pain (sharp, can be persistent, tearing sensation)
Bleeding (small amount, bright red, on wiping)

Question 5

When would you consider referral for an anal fissure?

Answer 5

Atypical looking
Elderly
Severe symptoms
Diagnosis unclear

Question 6

What pain relief can be given for anal fissures?

Answer 6

Simple analgesia
Warm bath
Lidocaine ointment (before defecation)

Question 7

What are some management options for anal fissures? (Not medications)

Answer 7

Keep stools soft and easy to pass
Anal hygiene
Avoid straining
Avoid stool withholding
Manage underlying causes

Question 8

What are the medical managements for anal fissures?

Answer 8

GTN 0.4% recital ointment applied BD for 6-8 weeks
Diltiazem 2% topical
Botox
Surgical management

Question 9

What is the main side effect of GTN 0.4% rectal ointment?

Answer 9

Headache/dizziness

Question 10

What are haemorrhoids?

Answer 10

Abnormal enlargement of mucosal fissions in the anal canal

Question 11

What is the function of the mucosal cushions in the anal cavity?

Answer 11

Help maintain continence

Question 12

What cells usually cover external piles?

Answer 12

Modified squamous epithelium

Question 13

What cells often cover internal piles?

Answer 13

Columnar epithelium

Question 14

What is a grade 1 internal haemorrhoid?

Answer 14

No prolapse just prominent blood vessels

Question 15

What is a grade 2 internal haemorrhoid?

Answer 15

Prolapse on bearing down but spontaneous reduction

Question 16

What is a grade 3 internal haemorrhoid?

Answer 16

Prolapse on bearing down requiring manual reduction

Question 17

What is a grade 4 internal haemorrhoid?

Answer 17

Prolapse with inability to be manually reduced

Question 18

What increases the risk of haemorrhoids?

Answer 18

Straining
Constipation
Heavy lifting
Pregnancy
Childbirth
Increase intra-abdominal pressure
Aging
Chronic cough

Question 19

What are the symptoms of haemorrhoids?

Answer 19

Bright red fresh rectal bleeding
Itching or irritation
Feeling of incomplete emptying, rectal fullness or discomfort
Palpable lump
Usually painless unless strangulated

Question 20

What is seen clinically in external haemorrhoids?

Answer 20

Bluish swellings

Question 21

When would you refer for haemorrhoids?

Answer 21

Acutely painful e.g strangulated
Symptoms are severe and likely need surgery
Diagnosis is unclear

Question 22

What is the use of astringents?

Answer 22

Reduce irritation

Question 23

What types of drugs are in anusol?

Answer 23

Astringent and emollient

Question 24

What types of drugs are in germoloids?

Answer 24

Lidocaine and astringent

Question 25

What drugs are in proctosedyl?

Answer 25

Anaesthetic and steroid

Question 26

How long is the maximum you should use steroid creams for?

Answer 26

7 days

Question 27

What 3 names of creams/ointments are used to treat haemorrhoids?

Answer 27

Anusol Germoloids Proctosedyl

Question 28

What are for non-surgical second line treatments of haemorrhoids?

Answer 28

Rubber band ligation Injection sclerotherapy Photocoagulation Bipolar diathermy

Question 29

What are the 3 surgical second like treatments of haemorrhoids?

Answer 29

Haemorrhoidectomy Stapled haemorrhoidectomy Haemorrhoids artery ligation

Question 30

What is a perianal abscess?

Answer 30

Collection of pus in anal or perianal region

Question 31

What are the 2 types of perianal abscess?

Answer 31

Submucosal Subcutaneous (See pictures on OneNote)

Question 32

What are the 3 types of anal abscesses?

Answer 32

Supralevator Intersphinteric Ischiorectal (See OneNote)

Question 33

What are the risk factors for anal abscesses?

Answer 33

Immunocompromised patients IBD Diabetics Receptive anal sex

Question 34

What are the symptoms of anal abscesses?

Answer 34

Painful hard lump Pain is constant and throbbing especially when siting Discharge from pus Systemically unwell with fever

Question 35

What is the management of anal abscesses?

Answer 35

Surgical Very small abscess can resolve on their own Antibiotics rarely help alone but can do in adjunct with surgery

Question 36

What can anal abscesses lead to?

Answer 36

Fistula-in-ano

Question 37

What is a fistula?

Answer 37

Tract from blocked internal gland to skin

Question 38

What are the symptoms of fistula-in-ano?

Answer 38

Pain Discharge Skin irritations Bleeding

Question 39

What are the risk factors of fistula-in-ano?

Answer 39

Abscess Crohns Diverticulitis Hidradenitis suppurative Tb HIV Post-colorectal surgery

Question 40

What is the management for fistula-in-ano?

Answer 40

Surgical - setons - advancement flap procedure - lift procedure - endoscopic ablation - laser surgery - fibrin glue - bioprosthetic plug

Question 41

What is proctalgia fugax?

Answer 41

Benign anal pain syndrome Spasm of muscle Recurrent episodes of sever cramping often at night

Question 42

What investigations should be done in suspected proctalgia fugax?

Answer 42

Abdo exam DRE Consider flexible sigmoidoscopy

Question 43

What type of cancer is anal cancer usually?

Answer 43

Squamous cell cancer

Question 44

What are the signs of anal cancer?

Answer 44

Irregular shape Redness

Question 45

What is pruritis ani?

Answer 45

Itching around the anus

Question 46

What are some causes of pruritis ani?

Answer 46

Dermatological Parasites e.g threadworms or scabies Anal or colorectal cancer Piles Fissures Fistulas Incontinence Medications (steroids, colchicine, abx, immunosuppressants)

Question 47

What is the management of pruritis ani?

Answer 47

Treat underlying cause Avoid scratching Avoid irritants Wash and dry area properly Mild steroids/antihistamines to provide relief

Question 48

What is proctitis?

Answer 48

Pain and inflammation of last 6 inches of rectum

Question 49

What are the symptoms of proctitis?

Answer 49

Faecal urgency Diarrhoea Consultation Tenesmus Cramping pain Mucus on stool PR bleeding Pus

Question 50

What are the risk factors of proctitis?

Answer 50

Receptive anal sex IBD Infections e.g STIs Radiation therapy