68. Anal fissuras

THEME X: BENIGN ANORECTAL DISEASES

1. What is the definition of haemorrhoids?

• Haemorrhoids → are the engorgement of the hemorrhoidal vascular plexuses with redundancy of their coverings.
• The word ‘piles’ is an alternative name for haemorrhoids.

2. It is customary to classify haemorrhoids by degrees. Describe shortly the degrees of haemorrhoids?

• 1st degree → haemorrhoids remain in their usual position in the anal canal (internal)
• 2nd degree → haemorrhoids descend to involve the skin of the distal anal canal so that they prolapsed on defecation.
• 3rd degree → haemorrhoids became of such a size that they are always partly outside the canal (external) and prolapsed requiring manual replacement
• 4th degree → there is permanent prolapsed of haemorrhoids.

3. Rectorrhagia is a symptom of haemorrhoids. Where is the typical character of bleeding?

• Fresh blood not mixed with stool during the defecation/ immediately after defecation
• Bright red in the pan /or on the toilet paper.

4. Which are definitive methods is diagnosing haemorrhoids?

• Anoscopy and flexible proctosigmoidoscopy.
• Anoscopy is the definitive examination, but a flexible proctosigoidoscopy should always be added to exclude proximal inflammation or neoplasia.

5. Which are the complications of haemorrhoids?

• Bleeding
• Inflammation
• Thrombosis
• Strangulation
• Necrosis.

6. Hemorrhoidectomy (open or closed) is the best means of curing hemorrhoidal disease. Where it should be considered?

• Patients that fail to respond satisfactorily to repeated attempts at conservative measures.
• When haemorrhoids severely prolapsed and require manual reduction
• When haemorrhoids are complicated by thrombosis, strangulation, necrosis, and severe bleeding.
• When haemorrhoids are complicated by associated pathology such as anal fissure, anal fistula, large anal tags.

7. What is the definition of anal fissure?

• Anal fissure → is an ulcer in the lower portion of the anal canal.

8. There are two types of anal fissure based on the etiology, what are they?

• Primary and secondary.
• Primary fissure → occurs without association with other local or systemic diseases.
• Secondary fissure → develops in association with other local or systemic diseases.

9. Based on the pathology, anal fissure is divided in two types. Which are they?

• Anal fissures are classified into → Acute and chronic.

10. What is the gross pathology appearance of acute anal fissure?

• Acute anal fissure is:
• Superficial, associated of oedema(inflammation)
• Small, fresh, linear cutes
• Usually heals spontaneously.

11. What is the gross pathology appearance of chronic anal fissure?

• In chronic anal fissure
• The Ulcer → is deep