Peri-anal fun

Question 1

Difference between internal and external haemorrhoids?

Answer 1

internal originate above dentate line, external are below

Question 2

Grades of haemorrhoids?

Answer 2

I-IV 
I - non protruding 
II - protrude of defaecation but reduce spontaneously 
III - manually reducible 
IV - irreducible

Question 3

Causes of haemorrhoids?

Answer 3

Low fibre diet causing patient to overly strain when having a bowel movement
Pregnancy 
Prolonged sitting on the toilet
Obesity
Diarrhoea (both acute and chronic)
Colon cancer
Previous rectal surgery
Spinal cord injury and lack of erect posture

Question 4

Sx of haemorrhoids?

Answer 4

puritis ani
painless bleeding
soiling in III & IV
pain if thrombosed

Question 5

Tx of haemorrhoids?

Answer 5

• lifestyle - soften stool, healthy eating, increased fibre, increased fluids
• analgesia - topical anusol
• O/P - band ligation, injection sclerotherapy
• surgery - large symptomatic haemorrhoids

Question 6

What is an anal fissure?

Answer 6

• tear in the lower anal canal between dentate line and the external opening
• pain on defaecation
• Followed by deep pain that may last hours
• small amount of bleeding on toilTx et paper

Question 7

Causes of anal fissures?

Answer 7

• Hard stools and constipation
• IBD - fissures, anal abscesses, fistulae
• pregnancy/birthing
• persistent diarrhoea

Question 8

tx of fissures?

Answer 8

• stool softener
• botox
• topical anaesthetic
• lifestyle

Question 9

How does an anal fistulae present? Investigated? and treated?

Answer 9

• usually as abscess secondary to other GI disease
• endo-ano ultrasound OR MRI to better visual tracts
• surgical excision and drainage + Abx

Question 10

What bacteria cause peri-anal abscess or pilondinal sinus infection?

Answer 10

E.Coli or Sauerus