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Anal fissures, abscesses and fistulae (Anal abscesses (Risk factors…
Anal fissures, abscesses and fistulae
Anal fissures
Defination
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Painful linear separation or tear of anal canal mucosa distal to dentate line and extending either superficial or deep into anal mucosa
Fissures are most commonly located at posterior commissure overlying external and internal sphincter bifurcation as it divides to circle the rectum, implying that the sphincter cuff is weakest at posterior anal wall
Most commonly post traumatic and located in midline; nonmidline anal fissures should raise suspicion of malignancy, inflammatory bowel disease or infection
Trauma may be due to constipation, instrumentation, childbirth or sexual abuse
Nontraumatic cases include infections (tuberculosis, cytomegalovirus, herpes, syphilis, gonorrhea, chlamydia), inflammatory bowel disease (4% of Crohn's disease patients have fissures as initial manifestation) or malignancy involving anal mucosa
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Pathophysiology
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The fissure may, however cause bleeding if healing does not occur. Infection may also set in, causing anal abscesses.
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Rain is a primary feature of anal fissures and abscesses because of the pressure exerted on the somatic nerves in the perianal area
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Anal fistulae
Defination
Abnormal fistulous (hollow like a pipe) communication that opens within anal canal, usually at or above dentate line (primary opening)
Primary opening usually leads to skin or may end blindly in perianal soft tissue (most commonly ischiorectal fossae)
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Most common causes are Crohn's disease (complex fistulae with irregular edges), infections (tuberculosis [lung disease usually present] and lymphogranuloma venereum) and rectal foreign bodies
Signs and symptoms
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pus, serous fluid and/or (rarely) feces discharge — can be bloody or purulent
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Causes
Just inside your anus are several glands that make fluid. Sometimes, they get blocked or clogged. When that happens, a bacteria buildup can create a swollen pocket of infected tissue and liquid. Doctors call this an abscess.
If you don’t treat the abscess, it’ll grow. Eventually, it’ll make its way to the outside and punch a hole in the skin somewhere near your anus so the gunk inside it can drain. The fistula is the tunnel that connects the gland to that opening.
Most of the time, an abscess causes a fistula. It’s rare, but they can also come from conditions like tuberculosis, sexually transmitted diseases, or an ongoing illness that affects your bowels.
Diagnosis
If the doctor thinks you have an anal fistula, she’ll ask about your medical history and give you a physical exam.
Some fistulas are easy to spot. Others aren’t. Sometimes they close on their own, then open back up. Your doctor will look for signs of oozing fluid or bleeding. She might stick a finger into your anus during the exam.
She’ll probably send you to a specialist in colon and rectal problems for more exams or imaging tests like X-rays or a CT scan. You might even need a colonoscopy. For this test, the doctor will put a tube with a camera on the end into your anus to look at the inside of your bowels. You’ll be asleep when this happens.
Health education
Education should focus on maintaining anal and personal hygiene, avoiding constipation by maintaining a high-fibre diet, increased fluid intake (2-3 litres a day) and prevention of recurrences.
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Anal abscesses
defination
An anal abscess is a painful condition in which a collection of pus develops near the anus. Most anal abscesses are a result of infection from small anal glands.
Causes
An anal fissure, a tear in the anal canal, that becomes infected
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Symptoms and signs
Pain, which is usually constant, throbbing, and worse when sitting down
Skin irritation around the anus, including swelling, redness, and tenderness
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Diagnosis
Usually, a clinical evaluation -- including a digital rectal exam -- is sufficient to diagnose an anal abscess. But some patients may require additional tests to screen for:
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Pathophysiology
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Abscess may extend into adjacent perirectal spaces possible fistula formation , bacteremia and sepsis
Nursing Management
Nursing interventions for anal disorders mainly focus on improving the patient's comfort by giving analgesics and local topical applications as ordered for pain, sitz baths to promote comfort, relieve pain, support cleanliness, and reduce oedema around the anal area.
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