Anoreactal disorders Flashcards
(65 cards)
________cause pain on defecation and usually
develop after a period of constipation (may be a
brief period) and tenesmus
Anal fissures
Usual location of anal fissure
On inspection the anal fissure is usually seen in
the anal margin, situated in the midline posteriorly
(6 o’clock)—90% of fissures
If there are multiple fissures, ______should
be suspected. These fissures look different, being
indurated, oedematous and bluish in colour
Crohn disease
In chronic anal fissures a sentinel pile is common
and in long-standing cases a _________ is
seen at the anal margin, with fibrosis and anal stenosis
subcutaneous fistula
Anal fissure
A combined_________ointment applied
to the fissure can provide relief and promote healing
local anaesthetic and corticosteroid
Purpose of hot sitz bath
Hot
baths relax the internal anal sphincter
________ is indicated in
patients with a recurrent fissure and a chronic fissure
with a degree of fibrosis and anal stenosis
Lateral internal sphincterotomy
An alternative
__________ which is as effective as
surgical treatment, is injection of botulinum toxin
into the sphincter
‘chemical’ sphincterotomy,
- Episodic fleeting rectal pain
- Varies from mild discomfort to severe spasm
- Last 3–30 minutes
- A functional bowel disorder
- Affects adults, usually professional males
Proctalgia fugax (levator ani spasm)
These ulcers occur in young adults; they can present
with pain but usually present as the sensation of
a rectal lump causing obstructed defecation and
bleeding with mucus.
Solitary rectal ulcer syndrome
Solitary rectal ulcer syndrome findings of sigmoidoscopy
The ulcer, which is usually seen
on sigmoidoscopy about 10 cm from the anal margin
on the anterior rectal wall, can resemble cancer.
_______ is an unpleasant sensation of incomplete
evacuation of the rectum. It causes the patient to
attempt defecation at frequent interval
Tenesmus
MC cause of tenesmus
The most
common cause is irritable bowel syndrome.
Other causes of tenesmus
Cancer, functional
A _________ is a purple tender swelling at the
anal margin caused by rupture of an external
haemorrhoidal vein following straining at toilet or
some other effort involving a Valsalva manoeuvre
perianal haematoma (thrombosed external haemorrhoid)
Tx of hematoma depends on?
the time of presentation after the
appearance of the haematoma
Mx of perianal hematoma
________Perform simple
aspiration without local anaesthetic using a 19
gauge needle while the haematoma is still fluid.
Within 24 hours of onset.
Mx of perianal hematoma
________The blood
has clotted and a simple incision under local
anaesthetic over the haematoma with deroofing
with scissors (like taking the top off a boiled
egg) to remove the thrombosis by squeezing
From 24 hours to 5 days of onset.
Mx of perianal hematoma
______ The haematoma is best left alone
unless it is very painful or (rarely) infected.
Resolution is evidenced by the appearance of
wrinkles in the previously stretched skin
Day 6 onwards.
A marked oedematous circumferential swelling will
appear if all the haemorrhoids are involved
Strangulated haemorrhoids
Strangulated haemorrhoids Tx
Initial treatment is with rest and ice packs and then
haemorrhoidectomy at the earliest possible time
This is caused by infection by polymicrobial organisms
of one of the anal glands that drain the anal canal
Perianal abscess
Tx of perianal abscess
Drain via a cruciate incision, which may need to be
deep (with trimming of the corners) over the point of
maximal induration. A drain tube can be inserted for
7 to 10 days.
Abx for perianal abscess
• metronidazole 400 mg (o) 12 hourly for 5–7 days
plus
• cephalexin 500 mg (o) 6 hourly for 5–7 days
