Perianal Abscess Flashcards
(14 cards)
What is Perianal Disease?
A condition affecting the perianal region, often involving abscesses or fistulas.
Perianal disease can include various complications, such as infections and chronic pain.
What disease is a risk factor for developing Perianal Disease?
Crohn’s Disease.
Crohn’s disease is an inflammatory bowel disease that can cause inflammation in various parts of the gastrointestinal tract, including the perianal area.
What are the types of Simple Perianal Fistula?
- Superficial - no external sphincter involved
- Low Transphincteric - lower 1/3 of external sphincter
- Interspincteric - between internal and external sphincter
Simple perianal fistulas involve less than 30% of the external sphincter.
What are the types of Complex Perianal Fistula?
- High Transsphincteric - >30% of external sphincter
- Suprasphincteric - anal crypt-ischiorectal fossa
- Extraspincteric - proximal to debate line
- Horseshoe fistula - posterior to anal space
Complex perianal fistulas involve more significant sphincter involvement and may have multiple tracts.
What are the common symptoms of Perianal Fistula?
- Intermittent pain during sitting, exercise, or defecation
- Malodorous drainage with or without pruritus
Symptoms can significantly affect the quality of life and may lead to further complications if untreated.
What are the signs of Perianal Fistula on a PR Exam?
- Non-healing abscess
- Chronic purple drainage
- Inflammation
- Excoriation
These signs indicate the presence of a fistula or abscess in the perianal area.
What laboratory finding is associated with Perianal Fistula?
Leukocytosis.
Elevated white blood cell count can indicate infection or inflammation.
What imaging techniques are used in the diagnosis of Perianal Fistula?
- Anoscopy
- Sigmoidoscopy
- MRI
- Endosonography
Imaging helps to locate internal openings and differentiate between simple and complex fistulas.
What is the treatment approach for Simple Perianal Fistula?
- Empiric antibiotics - Ciprofloxacin, Metronidazole
- Surgical consultation - SETON placement to allow drainge and healing
- Surgery: Fistulotomy, fistulectomy
- Post-surgery: patient education and Sitz baths
Simple fistulas generally require less complex management compared to complex ones.
What is a Seton in the context of Complex Perianal Fistula treatment?
A device that helps with drainage and prevents fistula closure while preserving sphincter function.
Seton placement is crucial in managing complex fistulas to avoid incontinence.
What are the symptoms of Perianal Abscess?
- Severe, constant pain associated with defecation
- Spontaneous drainage
- Fever/chills
Symptoms often indicate the presence of an infection requiring immediate attention.
What are the signs of Perianal Abscess on examination?
- Focal area of fluctuance with erythema
- **Tender mass palpable **on PR exam
These signs can help differentiate an abscess from other perianal conditions.
What is the management protocol for Perianal Abscess?
- Surgical consultation for incision and drainage
- ** Wound care** with packing using wet to dry dressings
- ** Empiric antibiotics** (IV/oral) for complex/immunocompromised patients: ciprofloxacin, metronidazole
Immediate surgical intervention is often necessary to manage abscesses effectively.
What should be considered if a patient with Perianal Abscess does not improve after 28-72 hours?
Consider refractory abscess.
Failure to improve may indicate complications or a need for further interventions.
