Benign Disorders of perianal area Flashcards Preview

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Flashcards in Benign Disorders of perianal area Deck (30):
1

Where do the nerve ending begin

Below the dentate line
Above - no pain

2

What does fresh blood suggest?

Bleeding low down

3

Glass through back passage

Fissure

4

What is a painless condition

Haemorrhoids

5

What is itchiness associated with

Haemorrhoids

6

What are Haemorrhoids

Enlarged vascular cushion in the lower rectum and anal canal

7

How much of the population will have symptomatic haemorrhoids

10% at some point in their lives

8

What are the common presentations of Haemorrhoids

Painless bleeding
Fresh, bright red blood, not mixed with stool, usually on the paper
Perianal itchiness
No change in bowel habit,
no weight loss

9

What are the clinical findings of haemorrhoids

External inspection can be normal
Often can't be felt unless thrombosed
Have to do proctoscopy
Maceration of the perianal skin

10

What investigations do we do for haemorrhoids

PR examination
Rigid sigmoidoscopy
Proctoscopy - most useful
Flexible sigmoidoscopy in patients above 50

11

Where are the common places to find haemorrhoids in a PR exam

3,7,11 o clock

12

Where are the common places to find haemorrhoids in a PR exam

3,7,11 o clock

13

What is the management of haemorrhoids

Symptomatic - alternating ice and hot baths
Sclerosation therapy with 5% phenol in almond oil (older treatment)
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy - lots of complications and now rarely done
HALO/ THD Procedure

14

What is the management of haemorrhoids

Symptomatic - alternating ice and hot baths
Sclerosation therapy with 5% phenol in almond oil (older treatment)
Rubber band ligation
Open haemorrhoidectomy
Stapled haemorrhoidectomy - lots of complications and now rarely done
HALO/ THD Procedure

15

What is rectal prolapse

Can be partial or complete

16

What are the presentations of rectal prolapse

Protruding mass from anus especially during defecation
May reduce spontaneously
Bleeding and passing mucus per rectum is common
Examination usually shows poor anal tone

17

What is management of complete prolapse

Many patient are too frail for surgery - bulking agent and education on manual reduction
Delorme's procedure
Perineal rectopexy
Abdominal rectopexy (younger patients- safest)
Anterior resection

18

What is the management of incomplete prolapse

In children - dietary advice
adults - avoid constipation

19

What is an anal fissure

A tear in the anal margin due ot passage of a constipated stool
Usuallyi in the midline posteriorly but may be occasionally anterior
Commonly associated with Crohn's

20

What is the presentation of anal fissure

Acute onset of severe anal pain usually following episode of constipation
Bright red, painful bleeding
Could be half an hour after defecation

21

What is the treatment for anal fissures

Dietary advice, stool softeners
Pharmacological sphyncterotomy (GTN ointment, 2% Diltiazem ointment)
Lateral sphyncterotomy
Botox injection

22

How does GTN and diltiazem help

They relax the muscle around the fissure

23

How often does a patient with anal fissure have to be reviewed

Every 6 weeks

24

How does botox work

It paralyses the internal muscle allowing the fissure to heal

25

How does botox work

It paralyses the internal muscle allowing the fissure to heal

26

What is fistula in ano

Abnormal communication between2 epithelial surfaces
There is an internal opening in the anal canal and one or more external openings on the perianal skin
Also rarely caused by Crohn's disease, TB and carcinoma

27

How do most patients present with fistula in ano

Majority arise

28

What investigatoins do we do for fistula in ano

EUA of anorectum
Rigid sigmoidoscopy, proctoscopy
Flexible sigmoidoscopy
MRI

29

How do we manage patients with filula in ano

Laying open
Two stage procedure
Insertion of Seton (draining, cutting)
LIFT procedure
Glue/ permacol
Defuncioning colonoscopy

30

What are some of the common complication

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