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Anal Problems

Anal Problems. First 15cm on rigid sigmoidoscopy Levator ani Internal sphincter (autonomic) External sphincter (voluntary) Vascular cushions. Anal Canal. Upper Superior rectal a&v (inf. mesenteric) Inf. mesenteric lymph. autonomic Lower Inferior rectal a&v (internal iliac)

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Anal Problems

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  1. Anal Problems First 15cm on rigid sigmoidoscopy Levator ani Internal sphincter (autonomic) External sphincter (voluntary) Vascular cushions

  2. Anal Canal • Upper • Superior rectal a&v (inf. mesenteric) • Inf. mesenteric lymph. • autonomic • Lower • Inferior rectal a&v (internal iliac) • Superf. inguinal lymph. • somatic

  3. Ano-rectal pain and bleeding

  4. Haemorrhoids • Symptoms and Signs • Bright red rectal bleeding, prolapse, mucus, pruritis ani, pain on thrombosis, anaemia • Management • Exclude other causes of bleeding • Conservative, Sclerotherapy, Banding, Haemorrhoidectomy

  5. Fistula in Ano • Symptoms and Signs • Initial abscess with discharge recurrent perianal infection and persistent discharge • Management • Examination under anaesthetic • Superficial and low-level fistulae laid open • High fistulae – low part laid open, upper part tied with seton

  6. Perianal Haematoma • Symptoms and Sign • Tense, smooth, dark blue, cherry-sized lump at anal margin • Acute onset, sudden pain • Management • Drainage under local anaesthetic • Hot baths

  7. Perianal Abscess • Symptoms and Signs • Painful, tender perianal swelling with discharge • Management • Examination under anaesthetic, MRI, US • Surgical incision and drainage • Antibiotics

  8. Perianal Warts • Symptoms and Signs • Cornified epithelial lesions often in clusters • Discomfort, pain, pruritis ani • Management • Most resolve spontaneously (2 years) • Silver nitrate / podophyllin • Curettage

  9. Anal Carcinoma • Symptoms and Signs • Anal verge – palpable mass, pain, bleeding, discharge, pruritis ani • Anal sphincter – incontinence • Management • EUA, sigmoidoscopy, biopsy • Early – radiotherapy (inc. inguinal lymphatics) • Late – surgery, colostomy

  10. Rectal Prolapse • Symptoms and Signs • Discomfort, bleeding and mucus on defecation, tenesmus, incontinence, protrusion • Management • Conservative • Surgical

  11. Problems in Childhood • Imperforate anus (with fistulation) • 1/5000 new-born infants, especially males • Partial rectal prolapse • Confined to the mucosa, self-curing • Congenital megacolon /Hirschprung disease • Absent distal autonomic ganglion cells in myenteric plexus

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