Anorectal Flashcards
(44 cards)
what are haemorrhoids
defined as abnormal swelling or enlargement of the anal vascular cushions
what is the normal function of the anal vascular cushions
assist the anal sphincter in maintaining continence
describe the classification of haemorrhoids
type 1 = remain in the rectum
type 2 = prolapse through the anus on defecation but spontaneously reduce
type 3 = prolapse through the anus on defecation but require digital reduction
type 4 = remain persistently prolapsed
risk factors for haemorrhoids
excessive straining (from chronic constipation)
increasing age
raised intra-abdominal pressure (pregnancy, chronic cough)
clinical features of haemorrhoids
painless bright red rectal bleeding - commonly after defecation and often seen on the paper
pruritus and rectal fullness/anal lump
large prolapsed haemorrhoids can thrombose - these present as very painful and usually to the A&E department
investigations into haemorrhoids
proctoscopy is usually performed to confirm the diagnosis
colonoscopy is also advised to rule out any concurrent anorectal pathology
management of haemorrhoids
most managed conservatively; lifestyle advice (increase fibre intake, laxatives, increased fluid intake, avoid oral opioid analgesia) - all aim to avoid constipation
rubber band ligation can be used on type 1 and 2 haemorrhoids
haemorrhoidal artery ligation used on type 2 and 3 - same result as above - it infarcts and falls off
haemorrhoidectomy is another surgical option but carries a risk of faecal incontinence if any internal sphincter muscle is excised
if a haemorrhoid appears swollen and purple, what is the most likely diagnosis
thrombosed haemorrhoid
what is pilonidal sinus disease
formation of a sinus in the cleft of the buttocks - commonly affects men aged 16-30
pathophysiology of pilonidal sinus disease
starts from a hair follicle in the intergluteal cleft (bumcrack) becoming inflamed or infected
inflammation obstructs the opening of the follicle, which extends inwards, forming a pit (characteristic feature)
a foreign body type reaction may then lead to formation of a cavity, connected to the surface of the skin by an epithelialised sinus tract
risk factors for pilonidal sinus disease
caucasian males with coarse dark body hair
sitting for long periods of time e.g. lorry driver
increased sweating, buttock friction, obesity, poor hygeine
pilonidal sinus vs perianal fistula
pilonidal sinus doesn’t communicate with the anal canal like perianal fistulas do
clinical features of pilonidal sinus disease
discharging and intermittently painful sinus
if it becomes infected it can cause a pilonidal abscess - swollen and erythematous with systemic features of infection
management of pilonidal sinus disease
conservative; shaving affected region and plucking the sinus free of any hair that is embedded, wash sinus out to prevent infection
surgical; any abscess requires surgical drainage
(chronic disease is treated by the removal of the actual pilonidal sinus tract)
what is a perianal fistula
abnormal connection between the anal canal and the perianal skin
typically occurs as a consequence of an anorectal abscess
risk factors of perianal fistulas
associated with anorectal abscess
diabetes
inflammatory bowel disease - mainly crohn’s disease
trauma to anal region
previous radiation therapy to the anal region
clinical features of anorectal fistula
presents with either; recurrent anorectal abscesses, or discharge onto the perineum (mucus, blood, pus or faeces)
on examination, an external opening of the perineum may be seen
investigations into anorectal fistulas
MRI pelvis to view the anatomy of the tract
what management strategies are in place for an anorectal fistula
fistulotomy - cutting the tract open and allowing it to heal by secondary intention
placement of a seton drain - drains the fistula to prevent infection
what is most commonly associated with anorectal fistula formation
anorectal abscess
what is the pathophysiology of anorectal abscesses
thought to be caused by plugging of the anal ducts, which drain the anal glands in the anal wall (helping to ease the passage of faecal matter using mucous secretions)
blockage results in fluid stasis and consequently infection - most commonly by E. coli
what is the most common organism involved in anorectal abscesses
E. coli
where is the most common site of anorectal abscess
peri anal
clinical features of anorectal abscesses
severe pain in perianal region - worse on sitting down
discharge and bleeding - severe abscesses can also show systemic signs; fever, rigor, general malaise
on examination; an erythematous, fluctuant and tender perianal mass will be palpable
