Anal fissure Flashcards

1
Q

anal fissure

A

Tear in the mucosa of the anal canal, just inside the anal margin, occurs below the dentate line so is somatic sensory

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2
Q

aetiology of anal fissure

A
  • Usually due to passage of a constipated stool
  • Multiple fissures may be due to Crohn’s disease
  • If older patient presents with their first episode of anal fissure, consider anal cancer as a posibility
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3
Q

symptoms of anal fissure

A
  • Acute onset of severe anal pain usually following an episode of constipation
    • Patients often say they feel like theyre shitting glass
  • Pain lasts for up to 30 mins after defecation
  • Bright red rectal bleeding
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4
Q

signs of anal fissure

A

The fissure can be seen on external examination of the anus - usually in the midline posteriorly but may occasionally be anterior

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5
Q

investigations of anal fissure

A

Diagnosis is clinical and further investigation is only required if there are features of underlying pathology

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6
Q

management of anal fissure

A
  • They normally heal on their own given the right conditions
  • Treatment usually involves dietary advice, an anaesthetic cream and a stool softener
  • Pharmacological sphincterotomy (GTN, diltiazem) may be used
  • Chronic – lateral sphincterotomy, Botox injection
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