Anorectal Diseases Flashcards
(29 cards)
Causes of perianal pain
- Anal fissure
- Hemorrhoids
- Colitis
- Perineal abscess
- Anorectal carcinoma
Classification of haemorrhoids
1˚ inside rectum
2˚ prolapsed through anus on defecation but spontaneously reduces
3˚ Prolapses during defecation and reduces with manual reduction
4˚ remains prolapsed
Pathology of Haemorrhoids
Straining –> vascular cushion engorges (cushion = vascular and CT form plexus of dilated veins) –> epithelial lining torn –> bleeding –> bright blood on wiping
Risk factors for haemorrhoids
- Increased abdominal pressure (ascities, pregnancy, chronic cough)
- Straining/constipation
- Increased age
- HTN
Investigations and management of haemorrhoids
Ix: Proctoscopy (confirm diagnosis), FBC (anaemia), Flexible sigmoidoscopy or colonscopy
Mx: Lifestyle modification (fibre diet, weight loss, laxatives), topical analgesia (avoid opioids - cause constipation)
- Rubber band ligation - cut blood supply
- Hemorrhoidectomy if not responding to other treatment
Conservative management of anal fissure
- high-fibre diet
- Adequate fluid intake
- Stiz baths
- Topical analgesia
- Glycerin trinitrate intra-anal
- Stool softeners
Surgical treatment of anal fissure
Lateral internal anal sphincterotomy - chronic anal fissure - prevent internal sphincter spasm. divide distal internal sphincter up to dentate line
Definition & etiology of anal fissure
Tear in mucosal lining of anal canal/superficial ulcer extending below dentate line.
Due to trauma of passing hard stool - repetitive injury cycle
- Can be secondary to IBD.
- Lack of blood supply to posterior midline of anal canal leads to poor healing and increased breakdown of skin –> anal fissure
Risk Factors for anal fissure
Dehydration
Constipation
IBD
Diarrhoea
Symptoms of anal fissure
- “Feels like passing glass” - severe pain with defecation. Tearing sensation
- PR bleeding
- Pruritis
- Constipation
- Discharge
Outcome of chronic anal fissure
Fissure + sentinal skin tag and hypertrophied anal papillae
Types/classification of anorectal abscess
- Perianal
- Suprasphincteric
- Intersphincteric
- Extrasphincteric .
- Schiorectal, transphincteric
Etiology of Abscess
Blocked anal gland –>infection
Clinical features of perianal abscess
- Throbbing
- Swollen
- Erythematous
- Discharge
- Fever
Management of perianal abscess
- Analgesia
- Start fluids->keep NBM, surgical consult
- Surgical drain
- Have warm baths/clean 2-3 day
- Consider antibiotics if polymicrobial, immunocompromised, DM, elderly ->Gentamicin, ampicillin + metronidazole
- Fluids, fibre, avoid hard stools
Risk factors for anorectal abscess and differential
- Fistula
- Chron’s
- Male
Differential
- Chrohns
- Infected sebaceous gland
- Hydradenitis suppurativa
Management of high and low fistula
- Low(does not cross many spinchter muscles)->lay tract open with fistulotomy: can heal via secondary intention
- High (does cross sphincter muscles)->requires
a. seton procedure, or else with have flow incontinence, allows drainage of fistula + healing
b. Advancement flap->repair of internal gland with suture, then advancing skin to cover fistula
Clinical features of anal cancer
Pain Pruritis Bleeding Moisture Most commonly epidermoid type (SCC)
Risk Factors for anal cancer
Homosexual male HPV Anal sex Syphillis Tobacco
Define pilonidal sinus
Pilonidal sinus disease is a disease of the inter-gluteal region, characterised by the formation of a sinus in the cleft of the buttocks. Males aged 16-30 years.
Acquired chronic inflammatory condition - hair becomes embedded in midline pit between buttock and coccygeal region.
Pathophysiology of pilonidal sinus
- Forceful insertion of hair into skin of natal cleft in sacrococcygeal area
- Promotes chronic inflammatory reaction
- Epithelialized sinus formed
- Sinus cause deep communication via deep cavity
- Chronic discharge and infection
- Abscess
Symptoms of pilonidal sinus
- Sacrococcygeal discharge, pain and swelling
- offensive smell from natal cleft
- staining underwear
Management of pilonidal sinus
Non-surgical: shaving/hair removal. Washed out. If infected antibiotics and drainage
Surgical: excising tract and laying open wound - close by secondary intension or primary closure.
Common organisms causing anorectal abscess
E coli, strep cocci, staph cocci, bacteriods, anaerobes
