Perianal Disease

In this podcast we discuss haemorrhoids, fissures, abscesses, fistulae, prolapse and anal carcinoma

 

Lecture by

Video Duration: 28 minutes

  • Haemorrhoids
    Created by Dr Ed Wallitt
    General
    Epidemiology

    "A dilated and disrupted vascular anal cushion"

    50% of Western population

    Pathology

    Classified according to anatomical severity

    • 1st degree - never prolapses
    • 2nd degree - prolapses on straining
    • 3rd degree - constantly prolapsed

    Strangulation is the main complication due to the sphincter cutting off venous supply

    Top three causes

    Constipation, low fibre diet, impaired venous return

    Clinical Features
    Symptoms

    May be asymptomatic

    Common symptoms include a lump, fresh PR bleeding, pain and pruritus.

    Signs

    Visible prolapse, excoriations from bleeding and scratching.

    ALWAYS do an abdominal exam and PR

    Investigations
    Cultures

    None

    Bloods

    None

    Imaging

    None

    Scopic/Biopsy

    Flexible sigmoidoscopy/colonoscopy if other conditions suspected

    Functional

    None

    Treatment
    Conservative

    Improve fluid and fibre intake

    Medical

    Topical steroids and analgesics

    Laxatives if constipation

    Surgical
    • Injection with 5% phenol
    • Banding/cryotherapy
    • Haemorrhoidectomy