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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.
Progress Test-Type Questions: Question 1 | Question 2Applied 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
- 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
- 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
- Consent for intimate examination and use of chaperone
- Managing embarrassment when taking sexual history regarding anal symptoms
Population Health
- Epidemiology of perianal disease
- 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
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
Crohn's disease, HIV, anal squamous cell carcinoma
Uncommon
anal trauma
anal trauma
