Last updated on 12 Jan 2023 at 9:30 AM (Abdo17)

Perianal pathology
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