Anorectal diseases Flashcards
What is an anal fissure ?
It is a eear in the anoderm distal to the dentate line due to trauma. Most occurs in the posterior midline. The acute ones heals in 6 weeks and the chronic fails conservative management. The primary cause is trauma and the secondary causes are IBD, malignancy, HIV.
What are the clinical manifestations of anal fissure ?
- Tearing or a ripping pain with defecation
- Bright red blood on toilet paper or on stool
- Perianal pruritis (itching)
- Chronic anal fissures may present as skin tags
What are the treatment in anal fissure ?
- Fibre
- Sitz baths
- Topical analgesics
- Stool softener
- Topical vasodilators such as Nefidipine, and nitroglycerine.
- Botox.
What are anorectal abscesses?
These are acute phase manifestation of a collection of purulent material
that originates from an infection. They arises in the crypto glandular epithelium lining the anal canal at
the dentate line.
What are the clinical features of anorectal abscesses?
– Severe perianal and rectal pain
– Temperatures and malaise
– Purulent discharge if the abscess spontaneously drains
What are the classification of anorectal abscesses ?
- Perianal 60%
- Intersphincteric 5%
- Ischeorectal 30%
What are the work-ups and management of anorectal abscesses ?
It is a clinical diagnosis CT or MRI pelvis can be helpful and the management is surgical drainage.
What is an anorectal fistula ?
It is a fistula often formed as a chronic complication of acute perirectal
process that forms an anorectal abscess. When the abscess ruptures an epithelised track can form
that connects the abscess with the perirectal skin.
What are the main causes of ARF?
– Anorectal abscess
– Crohn’s disease
– Radiation proctitis
What are the clinical features of ARF ?
– Intermittent rectal pain
– Malodorous purulent discharge
– Pustule like lesion in perineal area
What are the parks classification of ARF?
Type 01: Intersphincteric
Type 02: Transsphincteric
Type 03: Suprasphinctectric
Type 04: Extrasphincteric
What is the main goal and management of ARF ?
The Goal is to eradicate the fistula while persevering faecal continence. the management procedures are
– Fistulotomy
– Seton insertion (most common procedure)
– Advancement flap
What are internal haemorrhoids ?
These are haemorrhoids that occurs above the dentate line. They are often painless, bleed and prolapse.
What are external haemorrhoids ?
These are haemorrhoids below the dentate line and are covered by the anoderm and may thrombose, cause
pain and itching.
What are the causes of haemorrhoids ?
– Poor dietary habits and constipation
– Prolonged straining e.g. chronic constipation
– Increased intra-abdominal pressure
