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Flashcards in GI - Perianal disease Deck (18)
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What are the (5) symptoms of perianal conditions?

•Prolapsed anal lumps, swellings


Differentiate between Malignant versus non-malignant perianal conditions

Malignant conditions: Anal cancers (SCC, BCC, melanoma), low rectal cancer

Non-malignant conditions: anal skin tags, anal fissure, haemorrhoids, anal fibrous polyps, anal fistula, anal warts, rectal prolapse


Differentiate between Painful versus Painless Perianal conditions

Painful conditions: anal FISSURE, strangulated/prolapsed haemorrhoids, perianal haematoma, anal abscess, anal cancer invading sphincter, low rectal cancer invading sphincter, proctalgia fugax

Painless conditions: perianal skin tags, haemorrhoids (1st, 2nd & 3rd degree), rectal prolapse, anal fistula, anal margin cancer, low rectal cancer, anal fibrous polyps, anal warts, pruritis ani


•30 y.o woman, 3 months post partum, presents with anal pain on defaection for several weeks.
•Associated symptoms of bright red bleeding per rectum
•What are the differential diagnoses?

anal fissure or perianal haematoma


(3) broad types of Mx of anal fissure

•Simple measures
–Topical anaesthetics ointment
–Stool softeners, coloxyl and senna
–Sitz bath

•Chemical sphincterotomy
–Rectogesic ointment, 0.2% GTN (headache)
–Nifedipine 0.5%/Lignocaine 5% gel
–Botulinium toxin injection (40-60units ito intersphincteric space)

•Surgical Sphincterotomy
–Lateral sphincterotomy
–Fissurectomy or mucosal flap repair
–Most effective but has a risk of minor flatus incontinence, esp in females
–Reserve for intractable cases and in males


Mx of perianal haematoma

conservative or incisional drainage under LA


Discuss perianal skin tags
- sequelae of ...
- Px
- associated with ...
- Rx

•Sequelae of perianal haematoma
•Perianal itch
•Perianal hygiene
•Treatment: conservative or excision


•25 year old man presents with a painful perianal swelling, unable to sit down, he has associated with fever
•What are the differential diagnoses?

Perianal abcess


Compare and contrast anal abscess from anal fistula. Symptoms for both

•Anal abscess
–Superficial perianal
–Deep, ischiorectal or supra-levator abscess

•Anal fistula
–Low, perianal
–High and complex: intersphincteric, trans-spshincteric/ extra-sphincteric, supra-levator

Symptoms: chronic discharge of pus, bleeding, irritation


Mx of complex anal fistula

Seton insertion -> provides drainage. Guides subsequent surgery, fistulotomy or repair


Px of haemorrhoids

Bleeding, prolapse, mucus discharge


Describe haemorrhoids classifications

Classification by extent of prolapse

•First degree-internal,bleeds
•Second degree-prolapse and reducible spontaneously
•Third degree-non reducible
•Fourth degree-thrombosed and FINALLY PAINFUL


Discuss Mx of haemorrhoids depending on its classification

•First degree
–High fibre diet to regulate bowel habit, avoid constipation, straining, injection sclerotherapy for bleeding, 5%Phenol in almond oil

•Second degree
–Diet, rubber band ligation or injection sclerotherapy for symptomatic cases

•Third degree
–Diet, surgery by haemorrhoidectomy

•Fourth degree
–Analgesia followed by surgery


Symptoms of rectal prolapse

anal lump, bleeding, discharge, Incontienence, unable to sit

rectal prolapse: full thickness vs Internal mucosal prolapse


Symptoms of anal warts, condyloma acuminata. What is it due to?

Bleeding, discharge, anal lumps

symptoms of a highly contagious sexually transmitted disease caused by some types of human papillomavirus (HPV).

It is spread through direct skin-to-skin contact, usually during oral, genital, or anal sex with an infected partner.

Warts are the most easily recognized symptom of genital HPV types 6 and 11 infection (low risk for cancer).


Describe anal cancer.
- Px
- Mx

Px: Bleeding, pain, lump, discharge

if in doubt, perform biopsy

Treatment dependent on staging- local excision if small and and clear of sphincter, usually chemo-irradiation therapy


Describe low rectal carcinoma
- Px
- DRE findings

–Bleeding, bright red
–Discharge mucus

•Digital rectal examination
–Important examination
–Soft or hard rectal mass
–Position and distant from anal verge


Describe pruritis ani
- Px
- Causes
- Rx

•Symptoms-common, mild to severe, intractable itch, bleeding
•Causes-many, moisture from soiling or discharge, infestations, dermatological
•Treatment-topical steroid, anti-fungal, oral antihistamine,avoid excessive wiping, diet excise skin tags

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