Ano-Rectal

Question 1

how do you treat an anal fissure?

Answer 1

Increased fiber, sitz bath

Acute = topical anesthetic (lidocaine)

Chronic = topical NTG, diltiazem ointment, nifedipine, botox injection, sphincterotomy

Question 2

How do you treat perianal abscesses and fistulas?

Answer 2

Abscess: Surgical drainage (local or OR)

Cellulitis, underlying immunosuppression, or systemic signs of infection :
→ metronidazole and ciprofloxacin
OR augmentin

Fistula: treat infection, surgery/fistulotomy

WASH: warm water cleansing, analgesics, sitz baths, high fiber

Question 3

How do you treat stage I/II hemorrhoids conservatively?

Answer 3

Decrease straining: high fiber diet, increase fluid intake with meals, avoid straining, limit time on toilet <5 min

Question 4

How do you treat stage I/II/III hemorhoids medically?

Answer 4

rubber band ligation, injection sclerotherapy, application of electrocoagulation

Question 5

how do you treat stage IV hemorrhoids?

Answer 5

prolapsed = topical creams, foams, suppositories with emollients, topical anesthetics, vasoconstrictors, astringents, steroids

Question 6

How do you treat thrombosed hemorrhoids?

Answer 6

Surgery for chronic severe bleeding, acute thrombosed stage IV (few people)

Excision for thrombosed hemorrhoids within 24-48 hours of onset or refer to surgeon!
>48 = resolves spontaneously

Question 7

How do you treat an anal carcinoma?

Answer 7

2-3cm = wide excision

Larger or involving deeper tissue → combo therapy (excision, radiation, chemo)

Question 8

How do you treat a rectal prolapse?

Answer 8

surgery