HTHSCI 1DT3 Lecture 17: anatomy sur-63-70
26 Dec 2020
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Document Summary
Tear of squamous epithelial lining in lower anal canal. Mostly trauma 2o to the passage of hard stool. Spasm of internal anal sphincter contributes to pain and ischaemia + poor healing. Rarer causes, often multiple lateral fissures. May be a mucosal tag sentinel pile. Groin lns suggest complicating factor: e. g. hiv. If fissure recurrent, chronic or difficult to rx the patient requires eua. Division of internal anal sphincter @ 3 o"clock. Lord"s operation (anal dilatation under anaesthesia) is no longer used due to high rates of incontinence. Abnormal connection between ano-rectal canal and the skin. High: cross sphincter muscles above dentate line. Low: don"t cross sphincter muscles above dentate line. Fistula anterior to anus track in a straight line (radial) Fistula posterior to anus always have internal opening at the 6 o"clock position curved track. May visualise external opening: may be pus. Extent of fistula must first be delineated by probing the fistula @ eua.
