Flashcards in Perianal Disease Deck (37):
What are the common symptoms of perianal disease?
Prolapsed anal lumps - swellings
What does a perineal examination involve?
Palpation of perineum - use KY/lignocaine gel
What is sigmoidoscopy?
Scope that reaches 1/2-2/3 of sigmoid colon
What is proctoscopy?
Can do with lubricant alone, without anaesthesia
See in colorectum
What are malignant conditions of the perineum?
Low rectal adenocarcinoma
What are non-malignant conditions of the perineum?
Anal skin tags
Anal fibrous polyps
What are painful perianal conditions?
Strangulated and prolapsed haemorrhoids
Anal cancer invading sphincter
Low rectal cancer invading sphincter
What are painless perianal conditions?
Perianal skin tags
1st, 2nd, and 3rd degree haemorrhoids
Anal margin cancer
Low rectal cancer
Anal fibrous polyps
What is an anal fissure?
Tear/ulcer of anal junction
What is the difference between an acute and chronic anal fissure?
Acute - no induration
Chronic - induration
What is the treatment for anal fissure?
Topical anaesthetics ointment
- Coloxyl and senna
What is a sitz bath?
Sit in bowl with water and soap/salt for 10-15 min > dry area well
What is the treatment for a perianal haematoma?
Conservative - will resolve in a few days
Incisional drainage under local anaesthetic > don't need to stitch
Of what are perianal skin tags a sequelae?
Why can perianal skin tags be itchy?
May ooze mucus
What is the treatment for perianal skin tags?
What are the different types of anal abscesses?
Which anal abscesses cause fever?
What is the treatment for an anal abscess?
May not need Abx, unless signs of spread or immunocompromise
What is the surgical procedure for an anal fistula?
- Eradicate fistula
- Preserve sphincter function
Guides subsequent surgery/fistulotomy/repair
What is the most common cause of haemorrhoids?
What is the classification of haemorrhoids?
1st degree = internal - seen only with endoscope
2nd degree = prolapse > reduce spontaneously
3rd degree = non-reducible
4th degree = thrombosed and painful
What is the treatment for first degree haemorrhoids?
High fibre diet > regulate bowel habit
Injection sclerotherapy for bleeding
5% phenol in almond oil
What is the treatment for second degree haemorrhoids?
Rubber band ligation/injection sclerotherapy for symptomatic cases
What is the treatment for third degree haemorrhoids?
What is the treatment for fourth degree haemorrhoids?
What is the treatment for partial rectal prolapse?
What is the treatment for complete rectal prolapse?
Pack with sugar crystals > reduces oedema
What are the symptoms of anal warts?
What causes anal warts?
What are the symptoms of anal cancer?
What is the principle of management for anal cancer?
If in doubt, biopsy
What is the treatment for anal cancer?
Depends on staging
- Local excision if small and clear of sphincter
- Usually chemoradiotherapy
What are the symptoms of low rectal carcinoma?
Bright red bleeding
What should be assessed on digital rectal exam in suspected low rectal carcinoma?
Soft/hard rectal mass
Position and distance from anal verge
What are the causes of pruritis ani?
Moisture from soiling/discharge