Anal fistula overview: Difference between revisions
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===Physical Examination=== | ===Physical Examination=== | ||
Patients with [[anal fistula]] usually appear in [[distress]] due to throbbing [[rectal pain]]. Patient presents with anal fistula is having normal vital signs but if [[anal fistula]] gets [[infected]], it will lead to the formation of an [[abscess]]. Patient with an [[abscess]] presents with unstable vitals like High-grade [[fever]], [[ | Patients with [[anal fistula]] usually appear in [[distress]] due to throbbing [[rectal pain]]. Patient presents with anal fistula is having normal vital signs but if [[anal fistula]] gets [[infected]], it will lead to the formation of an [[abscess]]. Patient with an [[abscess]] presents with unstable vitals like High-grade [[fever]], [[tachycardia]], [[tachypnea]], low [[blood pressure|blood pressure]]. On rectal examination, there is redness, tenderness and discharge is seen. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Revision as of 19:13, 1 February 2018
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Anal fistula Microchapters |
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Anal fistula overview On the Web |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
An anal fistula is an abnormal connection between the epithelialised surface of the anal canal and (usually) the perianal skin. (See definition of a fistula).
Anal fistulae originate from the anal glands, which are located between the two layers of the anal sphincters and which drain into the anal canal. If the outlet of these glands becomes blocked, an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.
Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It then points to the surface again, and the process repeats.
Anal fistulas per se do not generally harm and they often do not hurt, but they can be irritating because of the pus-drain; additionally, recurrent abscesses may lead to significant short term morbidity from pain, and create a nidus for systemic spread of infection.
Surgery is considered essential in the decompression of acute abscesses; repair of the fistula itself is considered an elective procedure which many patients elect to undertake due to the discomfort and inconvenience associated with a draining tract.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Anal fistula overview from Other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Natural History
Complications
Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
The hallmark of anal fistula is rectal pain during defecation, sitting and cough. A positive history of Crohns disease, Rectal abscess, Obstetric injury and prior anorectal injury is suggestive of anal fistula. Common symptoms are intermittent rectal pain during defecation, sitting and any activity, pain is throbbing in quality and sometimes occur throughout the day and resolved by opening the track, recurrent perianal malodourous discharge, perianal bloody discharge, perianal pruritis. Less common symptoms of anal fistula are fever and pain referred to thighs, low back, or buttocks.
Physical Examination
Patients with anal fistula usually appear in distress due to throbbing rectal pain. Patient presents with anal fistula is having normal vital signs but if anal fistula gets infected, it will lead to the formation of an abscess. Patient with an abscess presents with unstable vitals like High-grade fever, tachycardia, tachypnea, low blood pressure. On rectal examination, there is redness, tenderness and discharge is seen.
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Pharmacotherapy used in anal fistula depends upon the location and symptoms of patient. Antibiotics are used in patient with comorbities like immunosuppression, diabetes, extensive cellulitis, prosthetic devices and high risk cardiac patients. Antipyretics and analgesic for symptomatic relief of pain and fever. Treatment of underlying causes is important to treat recurrent anal fistulas.
Surgery
The mainstay of treatment of anal fistula is surgical treatment.The principles for the management of anal fistula are described by the acronym SNAP, which stands for sepsis, nutrition, anatomy, and procedure according to British Medical Journal. Various methods of surgery are Fistulotomy and Seton. Sphincter-saving methods are Fibrin glue, Endorectal advancement flap, LIFT procedure, BioLIFT, Stem cells and Defunctioning.