Problems around the anus Flashcards
what is a fissure
painful tear in squamous lining of lower anal canal. 90% posterior
causes fissure
most- hard faeces, spasm. rare causes- syphilis, herpes, trauma, crohns, anal cancer, psoriasis. groin nodes suggest immunosuppression, HIV
treatment fissures
5% lidocaine ointment + GTN ointment or topical diltiazem, increased dietary fibre. fluids and stool softener. surgical- lateral partial internal sphincterotomy
what is a fistula in ano
track communicates between skin and anal canal/rectum. blocked deep IM gland ducts- abscess
what is Goodsalls rule
path of track. anterior- in a straight line. posterior- internal opening at 6 o clock position.
causes anal fistula
peri anal sepsis, abscess, crohns, TB, diverticular, rectal carcinoma, immunocompromised
tests in fistula
MRI, endo anal US scan
treatment fistula
fistulotomy + excision
what are haemorrhoids
disrupted and dilated anal cushions which line the anus (spongy vascular tissue). attached by smooth muscle and elastic tissue. prone to displacement and disruption
what causes piles
effects of gravity, increased anal tone, straining- protrude to form piles. vulnerable to trauma and bleed. not painful unless they thrombose
causes haemorrhoids
constipation, congestion- tumour, pregnancy, CCF
classification haemorrhoids
1- remains in rectum. 2- prolapses through on defacatin but spontaneously reduces. 3- prolapses but requires digital reduction. 4- persistently prolapsed
symptoms haemorrhoids
bright red rectal bleeding, often coating stools, on tissue, or dripping into pan after defacation. mucous discharge and pruritus ani, severe anaemia
if haemorrhoids not palpable on PR what should you do
proctoscopy- internal haemorrhoids
treatment haemorrhoids
medical- incr fluid and fibre intake +- topical analgesics and stool softener. topical steroids for short periods only. non operative- rubber band ligation, infra red coag, cryotherapy. surgery- excisional haemorrhoidectomy
