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Perianal pathology

Clinical Discipline(s)/Organ System(s)
Digestive System, General Surgery, General Practice, Gastroenterology & Hepatology
Progress Test Topic(s)
Digestive
Description
A 27 year old Chinese/Samoan man presents to the General Surgical Clinic with bleeding from his anus and pain on passing a bowel motion. He has noticed this for the past 6 months and has had occasional constipation. He has never experienced faecal incontinence. The referral letter from his GP also indicates some fatigue and weight loss.
Applied Science for Medicine 
   - Anatomy of the rectum, anal canal, perineum and anus
   - Physiology of faecal continence
   - Fistula pathogenesis
   - Differentiate pathology of Crohn's disease from ulcerative colitis
   - Microbiology of human papilloma virus (HPV)
   - Pharmacology of glyceryl trinitrate (GTN) ointment, metronidazole, fluoroquinolones
Clinical and Communication Skills 
   - History from a patient with rectal bleeding; seek information relevant to inflammatory bowel disease
   - Take a sexual history in a sensitive manner
   - Perform examination of abdomen, perineum and anus including rectal examination
   - Differential diagnosis of perianal pathology
   - Indications for colonoscopy, rigid sigmoidoscopy, CT and MRI
   - Interpret relevant investigations including full blood count, coagulation screen, electrolytes, creatinine, liver function tests, CRP
   - Management of fistulae, fissures, perianal abscess, anal prolapse, haemorrhoids, faecal incontinence, ano-genital warts
   - Psychological and social impact of incontinence
   - Management of inflammatory bowel disease and its complications
   - Role of the inflammatory bowel disease/colorectal nurse specialist, dietitian
Personal and Professional Skills 
   - Consent for intimate examination and use of chaperone
   - Managing embarrassment when taking sexual history regarding anal symptoms
Population Health 
   - Epidemiology of perianal disease
Conditions to be considered relating to this scenario
Common
anal fissure, haemorrhoids, constipation, fistula-in-ano, anal prolapse, pilonidal sinus, perianal abscess, human papilloma virus
Less common but 'important not to miss'
Crohn's disease, HIV, anal squamous cell carcinoma
Uncommon
anal trauma