Anal Lesions Flashcards
1
Q
What are causes of haemorrhoids?
A
- Constipation w/ prolonged straining
- Congestion from a pelvic tumour, pregnancy, CCF, or portal hypertension are important in only a minority of cases
2
Q
What are clinical features of haemorrhoids?
A
- Bright red rectal bleeding, often coating stools or on tissue or in pan
- May be mucous discharge and pruritus ani
- Severe anaemia can occur
3
Q
What 3 things should be done in patient with rectal bleeding?
A
- Abdominal examination
- PR examination (internal haemorrhoids not palpable)
- Colonoscopy / Flexi sigmoidoscopy to exclude proximal pathology if >50yrs
4
Q
How can haemorrhoids be classified?
A
- External → originate below dentate line / prone to thrombosis / may be painful
- Internal → originate above the dentate line / do not generally cause pain
5
Q
How do you grade internal haemorrhoids?
A
- Grade I → do not prolapse out of anal canal
- Grade II → prolapse on defecation but reduce spontaneously
- Grade III → can be manually reduced
- Grade IV → cannot be reduced
6
Q
What is the management of haemorrhoids?
A
- Soften stools → inc dietary fibre + fluids
- Topical local anaesthetics + steroids to help symptoms
- Outpt treatments → rubber band ligation is superior to injection sclerotherapy
- Surgery → reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
7
Q
What are key features of acutely thrombosed external haemorrhoids?
A
- Present w/ significant pain
- O/E → purpulish, oedematous, tender subcutaneous perianal mass
- If pt presents < 72hrs → referral for excision
- Otherwise pts can be managed w/ stool softeners, ice packs + analgesia
8
Q
What is an anorectal fistula?
A
- Communication between anorectal canal and perianal skin that is lined w/ granulation tissue
- Common in → anorectal abscess / Crohn’s / TB / diverticulitis
- Fistula may harbour chronic infection, which may discharge continuously or intermittently through opening onto skin
- Severe cases → faecal material may also pass through the tunnel and cause soiling of underwear and skin irritation
9
Q
What is the treatment for anorectal fistulae?
A
Fistulotomy and excision
- High fistulae (involving continence muscles of anus) require ‘seton suture’ tightened over time to maintain continence
- Low fistulae are ‘laid open’ to heal by secondary intention
10
Q
How might anorectal abscess present?
A
- Severe perianal pain and swelling
- Fever
- Chills
- Urinary retention
Usually caused by gut organisms
11
Q
What are features of anal fissures?
A
- Painful tear in squamous lining of lower anal canal
- Often, if chronic, w/ a ‘sentinel pile’ or mucosal tag at the external aspect
- 90% are posterior
- Most are due to hard faeces
- Rare causes → syphilis / herpes / trauma / Crohn’s / anal cancer
- Groin nodes suggest complicating factor (eg. immunosuppression)
12
Q
What is the treatment for anal fissues?
A
- 5% lidocaine ointment + GTN ointment or topical diltiazem
- Dietary fibre, fluids, stool softener + hygiene advice
- If conservative measures fail → surgical options incl lateral partial internal sphincterotomy
13
Q
What are the borders of anal canal?
A
- Anal cancer lies exclusively in anal canal
- Borders of which are anorectal junction and anal margin
14
Q
What are key features of anal cancer?
A
- Squamous cell carcinomas (SCCs)
- Lymph drainage varies in different parts
- anal margin tumours → inguinal lymph nodes
- more proximal tumours → pelvic lymph nodes
- Relatively rare; incidence 1.5 in 100,000 but rising, esp amongst MSM
- Average age of presentation is 85-89 Y
15
Q
What is the clinical presentation of anal cancer?
A
- Perianal pain
- Perianal bleeding
- Palpable lesion
- Faecal incontinence
- Neglected tumour in female may present w/ rectovaginal fistula
