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15208258084185Definition: localised infection in natal cleft; usually due to ingrowing hairsSymptoms: pain, fever, local infectionManagement: analgesia, antibiotics, excision00Definition: localised infection in natal cleft; usually due to ingrowing hairsSymptoms: pain, fever, local infectionManagement: analgesia, antibiotics, excision2463808084185Pilonidal Abscess00Pilonidal Abscess2463807377430Anal Fistula00Anal Fistula15195557377429Definition: abnormal connection between anus and skin; occurs in 50% abscessesSymptoms: discharge, itch, recurrent abscessesManagement: incision and drainage00Definition: abnormal connection between anus and skin; occurs in 50% abscessesSymptoms: discharge, itch, recurrent abscessesManagement: incision and drainage15195555770245Cause: Staph, E coli, Proteus; from anal fissure, perianal haematoma, haemorrhoid injection site, hair follice, anal glandRisk Factors: ulcerative colitis, Crohn’s disease, diabetes, cancerTypes: perianal (most common; superficial to anal margin); ischiorectal (between anus and sphincters medially, and obturator internus laterally); submucous / intersphincteric; pelvirectal / supralevator (above levator ani, below pelvic peritoneum)Symptoms: pain, fever, dischargeManagement: incision and drainage under GA; may need antibiotics if rheumatic heart disease, diabetes, immunocompromised, prosthetic device00Cause: Staph, E coli, Proteus; from anal fissure, perianal haematoma, haemorrhoid injection site, hair follice, anal glandRisk Factors: ulcerative colitis, Crohn’s disease, diabetes, cancerTypes: perianal (most common; superficial to anal margin); ischiorectal (between anus and sphincters medially, and obturator internus laterally); submucous / intersphincteric; pelvirectal / supralevator (above levator ani, below pelvic peritoneum)Symptoms: pain, fever, dischargeManagement: incision and drainage under GA; may need antibiotics if rheumatic heart disease, diabetes, immunocompromised, prosthetic device2463805770245Perianal Abscess00Perianal Abscess15195554858385Definition: acute rupture of tributary of inferior haemorrhoidal plexus under perianal skinSymptoms: pain after straining, lump; may rupture / ulcerateManagement: analgesia, ice, LA; usually resolve within 1//52; may need cruciate incision and drainage00Definition: acute rupture of tributary of inferior haemorrhoidal plexus under perianal skinSymptoms: pain after straining, lump; may rupture / ulcerateManagement: analgesia, ice, LA; usually resolve within 1//52; may need cruciate incision and drainage2463804858385Perianal Haematoma (external haemorrhoid)00Perianal Haematoma (external haemorrhoid)2463803456940Anal Fissure00Anal Fissure15201903456941Definition: triangular tear at anal verge after passage of constipated stools; often point away from anal verge; originate in skin and rarely extend to valvesPosition: posterior (90% males, 60% females)Acute: painful, superficialChronic: deepSymptoms: pain on defecation, small amounts of bright red bleeding, constipationManagement: LA ointment; GTN ointment has been used with some success; sphincterotomy or anal stretch for chronic00Definition: triangular tear at anal verge after passage of constipated stools; often point away from anal verge; originate in skin and rarely extend to valvesPosition: posterior (90% males, 60% females)Acute: painful, superficialChronic: deepSymptoms: pain on defecation, small amounts of bright red bleeding, constipationManagement: LA ointment; GTN ointment has been used with some success; sphincterotomy or anal stretch for chronic246380964566Haemorrhoids00Haemorrhoids1520190961390Definition: prolapse of mucosa of anal canal, associated with congestion of superior haemorrhoidal venous plexus; due to straining and high sphincter tonePositions: R anterior, R posterior, L lateral perianal > ischiorectal > intersphincteric, submucosal, high intermuscular > supralevatorDegrees: 1st degree (bleed, but no prolapse); 2nd degree (prolapse on straining); 3rd degree (persistently prolapsed); 4th degree (irreducible); internal occur proximal to dentate lineComplications: haemorrhage, thrombosis, perianal irritationInvestigations: indications for colonoscopy: Fe deficiency anaemia, +ive FOB, >40yrs with FH bowel cancer, >50yrs with no recent colonscopyManagement: reduce prolapse, warm baths, topical analgesia / steroid, stool softeners; injection for 1st and 2nd degree haemorrhage control (complications – pain, ulceration, intra-mucosal injection, haemorrhage from sup haemorrhoidal artery, abscess); thrombosed external haemorrhoids can be excised under LA Indications for OT: 3rd degree; 2nd degree when prolapse is major problem or failed sclerotherapy; strangulation00Definition: prolapse of mucosa of anal canal, associated with congestion of superior haemorrhoidal venous plexus; due to straining and high sphincter tonePositions: R anterior, R posterior, L lateral perianal > ischiorectal > intersphincteric, submucosal, high intermuscular > supralevatorDegrees: 1st degree (bleed, but no prolapse); 2nd degree (prolapse on straining); 3rd degree (persistently prolapsed); 4th degree (irreducible); internal occur proximal to dentate lineComplications: haemorrhage, thrombosis, perianal irritationInvestigations: indications for colonoscopy: Fe deficiency anaemia, +ive FOB, >40yrs with FH bowel cancer, >50yrs with no recent colonscopyManagement: reduce prolapse, warm baths, topical analgesia / steroid, stool softeners; injection for 1st and 2nd degree haemorrhage control (complications – pain, ulceration, intra-mucosal injection, haemorrhage from sup haemorrhoidal artery, abscess); thrombosed external haemorrhoids can be excised under LA Indications for OT: 3rd degree; 2nd degree when prolapse is major problem or failed sclerotherapy; strangulation246380330200Perianal Problems00Perianal Problems ................
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