Painful anal conditions by zaid

Painful anal conditions by zaid

1. By: Zaid Rasheed Younis Superviser : Dr. Moafiq University of duhok College of medicine

2. 2 Painful anal conditions Anal fissure Anarectal abscess Perianal heamotoma Complicated hemorrhoids Anal cancer

3. Aetiology: Infection of anal glands (90 %) In 60% of cases caused by E.coli 23% due to staph. Aureus. - Extension of cutaneous boil - Blood born infction - Rectal CA. - crohn ’ s dis. Predisposing factor: D.M. AIDS

4. Classification

5. Perianal abscess Clinical features : all ages More common in male -Sever anal pain ( throbbing ) aggravated by walking,straining&coughing .(2-3 days) - examination 1-pyrexia 2-Tender round cystic lump at anal verge 3-urinary retension (rare) Ischiorectal abscess Clinical features similar to perianal abscess

6. 1-draining pus … C/S 2- biopsy to the wall of cavity to exclude specific cause

7. A)Drainage B) Antibiotics are only indicated 1- if there is extensive overlying cellulitis 2- if the patient i s immunocompromised Antibiotics alone are ineffective at treating perianal or perirectal infection.

8. Idefinition : s a longitudinal split (ulcer) in the anoderm of the distal anal canal Location :90% midline posterior Aetiology during defecation ..pressure of hard fecal mass … post. anal tissue (unsupported by muscle )----tear. -recent … ..ischemia Other causes : posthaemorrhoidectomy ..Infl. bowel dis., sexually trans. dis. Anal Fissure

9. Clinical features Symptoms : Pain: sharp agonizing Constipation Bleeding slight bright streaks on the stool Mucous Discharge and itching On exam.: Sentinel tag( external lump associated with the tear, as well as extra tissue just inside the anal canal) Longituidinal Ulcer

10. Treatment Conservative treat.: Laxatives e.g celevac tab Anal dilatation Nitric oxide Diltiazim 2% twice daily. Botulin toxin (paralysis of anal sphincter) Surgical management : if conservative treatment failed

11. Peri -anal Hematoma A perianal hematoma is a collection of blood under the surface of the skin at the edge of the anal opening .

12. 2.Physical Examination Position : The lump may be anywhere around the anal margin Color : deep red-purple color Tenderness : The lump is tender due to tension edema & ulceration of the skin  ↑ tenderness Shape & Size: The initial lump is spherical & up to 1 cm in diameter. 1.History: - peri -anal skin is moist & itchy . - It’s occasionally multiple & may be recurrent.

13. managment Acute phase: Evacuate the hematoma through a small incision under LA Discharging or absorbed hematoma  hot pathes

14. H emo r r h o i d s Painful hemorrhoids are: 3 rd degree hemorrhoid Hemorrhoids that prolapse but must be pushed back in by a finger. Thrombosed hemorrhoid (containing blood clots) Strangulated hemorrhoid Ulcerated hemorrhoid

15. managment • Conservative Avoid constipation increas e fiber content of the diet to ensure bulky stool with . Topical preparations containing local anesthetic agents & steroids. • Thrombosed external hemorrhoids: • • • • Bed rest. Application of ice packs. Oral analgesia + topical local anesthetic gel. excision of the hemorrhoid or clot evacuation if the patient presents less than 48 hours after the onset of symptoms

16. Anal malignancy is rare and accounts for less than 2% of all large bowel cancers which is usually a squamous cell carcinoma Associated with HPV More prevalent in patients with HIV infection Lymphatic spread is to the inguinal lymph nodes Treatment is by chemoradiotherapy in the first instance Major ablative surgery is required if the above fails

17. mass, bleeding, pain, discharge, itching, and tenesmus. more common in men

18. Small, well-differentiated lesions ( < 3cm ) are treated by wide local excision. Deep lesions that involve the sphincters require abdominoperineal resection