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Anal fissure (Diagnosis (Investigations (Bloods
FBC, CRP, U+E, LFT (nil)
…
Anal fissure
Diagnosis
Examination
Abdo: nil
PR: visible ulcer/fissure, generally DON'T PR as painful
Investigations
Bloods
FBC, CRP, U+E, LFT (nil)
Infection screen (if STI suspected e.g. HIV, syphilis)
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-
Imaging
Generally not needed unless IBD/CRC suspected,
then a colonoscopy may be warranted
History
PC/HPC: anal pain, PR blood
PMH: constipation, IBD, STIs, surgery
DH: opiates etc
FH: IBD, cancer
SH: diet, smoking
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Management
Medical
Analgesia
Indication: pain
E.g. paracetamol, NSAIDs, topical anaesthetic/rectal GTN
if severe; avoid opiates as exacerbate constipation
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Surgical
Lateral partial internal sphincterotomy
Indication: failure of medical management
MOA: excision of chronic ulcer
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Pathophysiology
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Cause
Primary
No clear cause
?ischemic ulcers caused by spasm of anal sphincter,
reduced blood flow and ischemia, tearing and poor healing
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Aetiology
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Secondary
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Infection
STIs (HIV, HSV, syphilis)
Pruritus ani
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Drugs
Opiates, nicorandil, chemotherapy
Clinical
presentation
Pain
Site: around anus
Onset: acute, suddent
Character: sharp, stinging
Radiation: nil
Assoc: PR bleed
Timing: intermittent
Exac/relief: exac: passing stool
Severity: variable
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Differentials
Rectal
Vascular: haemorrhoid
Infection: HIV, HSV, syphilis
Trauma: constipation, fistula
Autoimmune: IBD
Neoplastic: rectal ca
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Definition
A tear or ulcer in the lining of the anal canal, immediately within the anal margin