IBS + Rectal Prolapse, Hemorrhoids + Abscesses

Question 1

What is IBS?

Answer 1

Chronic relapsing remitting disorder of lower GI tract with no discernable structural/ biochemical cause

Question 2

S+S of IBS

Answer 2

Abdo pain associated with change in stool form and/or frequency
Bloating

Question 3

When is a diagnosis of IBS made?

Answer 3

Abdo pain related to defecation or change in bowel habit AND:
Other conditions excluded
Passage of rectal mucus
Symptoms worse on eating
Abdo bloating, distension or hardness
Altered stool passage (straining, urgency, incomplete evacuation)

Question 4

Investigations for IBS

Answer 4

FBC, ESR, CRP, celiac serology

Question 5

Management of IBS

Answer 5

Manage stress + anxiety
Healthy diet with fibre 
OTC probiotics for 4 weeks 
Foods high in soluble fibre 
Bulk forming laxatives for constipation 
Loperamide for diarrhea 
Antispasmodics 
TCA for refractory abdo pain, then SSRI

Question 6

What are the is rectal procidentia vs intussusception?

Answer 6

Rectal procidentia = rectal prolapse

Intussusception = occult rectal prolapse

Question 7

S+S of rectal procidentia

Answer 7

Abdo discomfort, incomplete bowel evacuation, rectal mass, mucus or stool discharge, altered bowel habits
Full thickness protrusion of rectum through anus

Question 8

What are the differentials for rectal prolapse?

Answer 8

Prolapsing internal hemorrhoids, partial (mucosal) rectal prolapse, occult rectal prolapse (intussusception), and solitary rectal ulcer syndrome

Question 9

Associated conditions with rectal prolapse

Answer 9

Cystocele, enterocele or vaginal vault prolapse

Question 10

What are haemorrhoids?

Answer 10

Abnormally swollen vascular mucosal cushions present in anal canal

Question 11

Classification of haemorrhoids

Answer 11

External = originate below dentate line, covered in modified squamous epithelium (anoderm)
Internal - above dentate line, covered in columnar epitheliam
Internal are further divided into:
1st degree = project into lumen of anal canal, don’t prolapse
2nd degree = prolapse on straining
3rd degree = prolapse on straining + require manual reduction
4th degree = cannot be reduced

Question 12

Difference between internal + external haemorrhoid S+S

Answer 12

External are painful + itchy, internal have no pain fibres

Question 13

RF for development of haemorrhoids

Answer 13

o	Constipation.
o	Straining while trying to pass stools.
o	Ageing.
o	Heavy lifting.
o	Chronic cough.
o	Conditions that cause raised intra-abdominal pressure (such as pregnancy and childbirth).

Question 14

Complications of hemorrhoids

Answer 14

Ulceration; skin tags; maceration of the perianal skin; ischaemia, thrombosis, or gangrene; and rarely, perianal sepsis and anaemia from bleeding.

Question 15

S+S of haemorrhoids

Answer 15

Bright red, painless bleeding

Itching/ irritation, discomfort, feeling of rectal fullness, soiling, incomplete evacuation

Question 16

Management of hemorrhoids

Answer 16

Laxatives if needed
Minimise straining 
Topical hemorrhoid preparations 
Rubber band ligation, injection sclerotherapy, infrared coagulation, bipolar diathermy, direct current electrotherapy 
Surgery

Question 17

Management of pilonidal abscess

Answer 17

Same day incision and drainage
Paracetamol +/- NSAID
Abx if cellulitis is present

Question 18

How to prevent abscess in future

Answer 18

Good hygiene

Buttock hair removal techniques

Question 19

What are the classifications of anal fissures?

Answer 19

Acute - less than 6 weeks
Chronic - over 6 weeks
Primary - no clear underlying cause
Secondary - has clear underlying cause such as constipation, IBD, STD, cancer

Question 20

S+S of anal fissure

Answer 20

Anal pain with defecation, bright red rectal bleeding, anal spasm

Question 21

Where do anal fissures usually occur?

Answer 21

In posterior midline
10% in anterior
Secondary = lateral

Question 22

Management of anal fissures

Answer 22

High fibre diet + fluids
Pain relief
GTN ointment
Review after 6-8 weeks - surgery if not healed

Question 23

Pathology of perianal haematoma

Answer 23

Pool of blood collecting in tissue around anus

Usually caused by ruptured/ bleeding vein

Question 24

Management of perianal hematoma

Answer 24

Cool compress, sitz bath, donut pillow
High fibre diet
Drainage

Question 25

Classification of anorectal fistula

Answer 25

Superficial, intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric fistulas

Question 26

Pathology of anorectal fistula

Answer 26

Usually originate from infected anal crypt gland

In Crohns, they develop from penetrating inflammation

Question 27

Presentation of anorectal fistula

Answer 27

Nonhealing abscess after drainage

Chronic pustulent drainage

Question 28

Management of anorectal fistula

Answer 28

Surgery