Anal Fissura Ppt.pptx

ANAL FISSURA

DEFINITION

Anal fissure is a tear in the anoderm distal to the dentate line. It can be categorized as acute or chronic.Acute fissures present with anal pain, spasm, and/or bleeding with defecation

EPIDEMIOLOGY

 The incidence of fissura anal is 1 in 350 people.  The frequency of occurrence of fissure ani is similar between men and women.

 Fissura ani is more likely to occur at a younger and middle age.

ETIOLOGY • A Hemorrhoidal Condition • • • • • • •

Irritation Due To Diarrhea Partus Injury Crohn Disease Constipation Inflammatory Bowel Diseases Sexually Transmitted Diseases Anal Cancer

Symptoms  Signs and symptoms of an anal fissure include:

 Pain, sometimes severe, during bowel movements  Pain after bowel movements that can last up to several hours  Bright red blood on the stool or toilet paper after a bowel movement  Itching or irritation around the anus

 A visible crack in the skin around the anus  A small lump or skin tag on the skin near the anal fissure

Pathophysiology • Keighley Divides the ani fissures into: 1. Fissura ani primer • Acute • -Chronic 2. Fissura ani secondary. Fissura ani primer tampak sbg suatu superficial ulcer pd mukosa anal di bawah linea dentata, apabila letaknya lebih ke proksimal hampir dpt dipastikan merupakan fissura ani sekunder akibat penyakit lain.

If the hard stool passes through the anal canal will be going stretching & tearing the anal mucosa. Fissura usually occurs on the anterior & posterior Allegedly this area is a weak area when the stool passes through the anal canal, the mass will be channeled to the anterior & posterior parts due to the presence of muscles in the lateral part.

 In acute fissura ani → ulcers appear firmly bound, there is no induration, odema or cavitation.  In chronic fissura ani → visible edge of the ulcer induration & if the process the ulcer continues to expand and the outside looks odematous because of lymphatic obstruction, skin tags & anal papilla hypertropy can be found under the circumstances fissura ani chronic.

DIAGNOSIS1 1. Anamnesis  Pain in the rectal region, usually described as burning, feeling cut, or torn like a feeling. The pain is in line with intestinal contractions; anal spasm should be suspected of fissura ani.  Constipation due to fear of pain.  Feces hard  Bleeding red bloody red on the surface of the stool. Blood usually does not mix with feces.  Mucoid discharge  Pruritus

2. Physical examination • Inspeksi On inspection often found skin tags, fissures, and papilla hypertrophy The examination is doing by slowly pulling both buttocks to see if there are skin tags, discharges or blood. • Palpation The margins of fissura can be palpable irregular, tenderness (+). The direct examination on fissura is very painful • Proctoscopy / Sigmoidoscopy The use of adult protoscop in acute circumstances is usually indispensable probably done because of very pain. Usually using infant sigmoidoscopy Llyod-Davies can be seen abnormalities in the rectal & anal mucosa canal.

3. supporting examination

blood count and blood culture

Diferensial diagnosis Crohn's Disease Ulcerative Colitis Tuberculous Anal Fissures Syphlitic Fissures Intersphincteric Abscess Malignancy Ani Pruritus AIDS Proctalgia Fugax

MANAGEMENT  Advise the patient to increase dietary fibre and fluid intake to keep bowel motions soft  The importance of correct anal hygiene and the need to keep the anal area dry should be emphasised.  Regular sitz baths (sitting in warm water up to the hips) can help to relax the sphincter.

 The patient should also be advised to avoid undue straining during bowel movements.  If lifestyle and dietary interventions are insufficient, or if the fissure is severe, a stool softener, e.g. oral docusate sodium, and mild local analgesia, e.g. lidocaine (not subsidised), may be prescribed.

 If the fissure fails to heal within three to six weeks, topical nitrates or topical calcium channel blockers should be used. All topical treatments for anal fissures should be applied for at least six weeks to allow re-epithelialisation of the fissure  If the fissure has not healed after six to eight weeks of topical treatment and dietary changes secondary care to assess the appropriateness of other treatments, usually botulinum toxin or surgery.  Surgical techniques commonly used for anal fissures which aim to relax the internal sphincter include; open lateral sphincterotomy, closed lateral sphincterotomy and posterior midline sphincterotomy.