Anal fissure physical examination: Difference between revisions
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{{CMG}}; {{AE}}{{ADS}} | {{CMG}}; {{AE}}{{ADS}} | ||
==Overview== | ==Overview== | ||
Patients with | Patients with anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with anal fissure is usually remarkable for | *Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. | ||
===Appearance of the patient=== | ===Appearance of the patient=== | ||
| Line 20: | Line 12: | ||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Tachycardia]] with regular pulse (in pain). | |||
* | ===Skin=== | ||
*Skin examination of patients with anal fissure: | |||
**Perianal skin can be inflamed. | |||
===HEENT=== | ===HEENT=== | ||
| Line 36: | Line 31: | ||
===Abdomen=== | ===Abdomen=== | ||
Abdominal examination of patients with anal fissure is usually normal. | * Abdominal examination of patients with anal fissure is usually normal. | ||
===Back=== | ===Back=== | ||
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|[[File:Anal fissure.jpg|thumb|250px|By Jonathanlund - Own work, Public Domain<ref>https://commons.wikimedia.org/w/index.php?curid=5148617</ref>]] | |[[File:Anal fissure.jpg|thumb|250px|By Jonathanlund - Own work, Public Domain<ref>https://commons.wikimedia.org/w/index.php?curid=5148617</ref>]] | ||
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The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain. [[Anoscopy]]/[[proctoscopy]] can be done with topical anesthesia with [[lidocaine]] | *The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.<ref name="pmid15812586">{{cite journal |vauthors=Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ |title=Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable |journal=Dis. Colon Rectum |volume=48 |issue=2 |pages=349–52 |year=2005 |pmid=15812586 |doi=10.1007/s10350-004-0753-2 |url=}}</ref> | ||
*[[Anoscopy]]/[[proctoscopy]] can be done with topical anesthesia with [[lidocaine]] gel to examine, and rule out internal [[hemorrhoids]].<ref name="pmid29132530">{{cite journal |vauthors=Davies D, Bailey J |title=Diagnosis and Management of Anorectal Disorders in the Primary Care Setting |journal=Prim. Care |volume=44 |issue=4 |pages=709–720 |year=2017 |pmid=29132530 |doi=10.1016/j.pop.2017.07.012 |url=}}</ref><ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref> | |||
====Inspection==== | ====Inspection==== | ||
*On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline. | *On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline. | ||
* Chronic anal fissures may have a skin tag also. | *Acute anal fissures appear as fresh laceration while chronic have raised margins.<ref name="pmid27041801" /> | ||
*Chronic anal fissures may have a skin tag also. | |||
====Palpation==== | ====Palpation==== | ||
Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine. | *Anal fissures are usually exquisitely [[Tenderness (medicine)|tender]] and the patient is scared to touch them or let physician examine. | ||
*Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the [[buttocks]]).<ref>{{cite book | last = Bope | first = Edward | title = Conn's current therapy 2018 | publisher = Elsevier | location = Philadelphia | year = 2018 | isbn = 978-0323527699 }}</ref> | |||
===Neuromuscular=== | ===Neuromuscular=== | ||
| Line 60: | Line 59: | ||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with anal fissure is usually normal.<br> | * Extremities examination of patients with anal fissure is usually normal.<br> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
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[[Category: | [[Category:Medicine]] | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
Latest revision as of 20:24, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2]
Overview
Patients with anal fissure usually appear in pain. Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure. A tear is usually seen in the posterior part of anal canal (90)% and in anterior or middle part (10%). Patient usually resists use of anoscope due to the pain. Acute anal fissures appear as fresh laceration while chronic have raised margins.
Physical Examination
- Physical examination of patients with anal fissure is usually remarkable for painful skin laceration, skin tags in the chronic anal fissure.
Appearance of the patient
- Patients with anal fissure usually appear in pain.
Vital Signs
- Tachycardia with regular pulse (in pain).
Skin
- Skin examination of patients with anal fissure:
- Perianal skin can be inflamed.
HEENT
- HEENT examination of patients with anal fissure is usually normal.
Neck
- Neck examination of patients with anal fissure is usually normal.
Lungs
- Pulmonary examination of patients with anal fissure is usually normal.
Heart
- Cardiovascular examination of patients with anal fissure is usually normal.
Abdomen
- Abdominal examination of patients with anal fissure is usually normal.
Back
- Back examination of patients with anal fissure is usually normal.
Genitourinary
- Genitourinary examination of patients with anal fissure is usually normal.
Local/anal examination
 |
 |
- The examination should be done when the patient is lying in the lateral position. The digital rectal examination is contraindicated in many patients considering the amount of pain.[3]
- Anoscopy/proctoscopy can be done with topical anesthesia with lidocaine gel to examine, and rule out internal hemorrhoids.[4][5]
Inspection
- On inspection, there is a breach in the skin. A laceration can be seen usually in the posterior midline in 90% of patients while in the remaining 10% of patients in the anterior midline.
- Acute anal fissures appear as fresh laceration while chronic have raised margins.[5]
- Chronic anal fissures may have a skin tag also.
Palpation
- Anal fissures are usually exquisitely tender and the patient is scared to touch them or let physician examine.
- Palpation shows tear in the anoderm with exposed internal sphincter (with retraction of the buttocks).[6]
Neuromuscular
- Neuromuscular examination of patients with anal fissure is usually normal.
Extremities
- Extremities examination of patients with anal fissure is usually normal.
References
- ↑ https://commons.wikimedia.org/w/index.php?curid=8885756
- ↑ https://commons.wikimedia.org/w/index.php?curid=5148617
- ↑ Jones OM, Ramalingam T, Lindsey I, Cunningham C, George BD, Mortensen NJ (2005). "Digital rectal examination of sphincter pressures in chronic anal fissure is unreliable". Dis. Colon Rectum. 48 (2): 349–52. doi:10.1007/s10350-004-0753-2. PMID 15812586.
- ↑ Davies D, Bailey J (2017). "Diagnosis and Management of Anorectal Disorders in the Primary Care Setting". Prim. Care. 44 (4): 709–720. doi:10.1016/j.pop.2017.07.012. PMID 29132530.
- ↑ 5.0 5.1 Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
- ↑ Bope, Edward (2018). Conn's current therapy 2018. Philadelphia: Elsevier. ISBN 978-0323527699.