Anal fissure pathophysiology: Difference between revisions
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*Although constipation or anal trauma was supposed to instigate the fissure,the exact pathogenesis of anal fissure is not fully understood.<ref name="pmid22379402">{{cite journal |vauthors=Zaghiyan KN, Fleshner P |title=Anal fissure |journal=Clin Colon Rectal Surg |volume=24 |issue=1 |pages=22–30 |year=2011 |pmid=22379402 |pmc=3140330 |doi=10.1055/s-0031-1272820 |url=}}</ref> | *Although constipation or anal trauma was supposed to instigate the fissure,the exact pathogenesis of anal fissure is not fully understood.<ref name="pmid22379402">{{cite journal |vauthors=Zaghiyan KN, Fleshner P |title=Anal fissure |journal=Clin Colon Rectal Surg |volume=24 |issue=1 |pages=22–30 |year=2011 |pmid=22379402 |pmc=3140330 |doi=10.1055/s-0031-1272820 |url=}}</ref> | ||
*It is understood that anal fissure is the result of either anal trauma (by hard stools/diarrhea), perfusion defects with ischemia caused due to increased anal pressures and decreased blood flow or increased anal sphincter tone. | *It is understood that anal fissure is the result of either anal trauma (by hard stools/diarrhea), perfusion defects with ischemia caused due to increased anal pressures and decreased blood flow or increased anal sphincter tone. | ||
*In 90% of the patients, anal fissures are found in posterior midline. A small tear is seen that extends from dentate line to anal verge.<ref name="DaviesBailey2017">{{cite journal|last1=Davies|first1=Danielle|last2=Bailey|first2=Justin|title=Diagnosis and Management of Anorectal Disorders in the Primary Care Setting|journal=Primary Care: Clinics in Office Practice|volume=44|issue=4|year=2017|pages=709–720|issn=00954543|doi=10.1016/j.pop.2017.07.012}}</ref> | *In 90% of the patients, anal fissures are found in posterior midline. A small tear is seen that extends from dentate line to anal verge.<ref name="DaviesBailey2017">{{cite journal|last1=Davies|first1=Danielle|last2=Bailey|first2=Justin|title=Diagnosis and Management of Anorectal Disorders in the Primary Care Setting|journal=Primary Care: Clinics in Office Practice|volume=44|issue=4|year=2017|pages=709–720|issn=00954543|doi=10.1016/j.pop.2017.07.012}}</ref>This is believed due to ischemia/poor perfusion of the area by inferior rectal artery.(during increased sphincter tone).<ref name="pmid2910660">{{cite journal |vauthors=Klosterhalfen B, Vogel P, Rixen H, Mittermayer C |title=Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure |journal=Dis. Colon Rectum |volume=32 |issue=1 |pages=43–52 |year=1989 |pmid=2910660 |doi= |url=}}</ref><ref name="pmid8653368">{{cite journal |vauthors=Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ |title=Ischaemic nature of anal fissure |journal=Br J Surg |volume=83 |issue=1 |pages=63–5 |year=1996 |pmid=8653368 |doi= |url=}}</ref><ref name="WrayIjaz2008">{{cite journal|last1=Wray|first1=D|last2=Ijaz|first2=S|last3=Lidder|first3=S|title=Anal fissure: a review|journal=British Journal of Hospital Medicine|volume=69|issue=8|year=2008|pages=455–458|issn=1750-8460|doi=10.12968/hmed.2008.69.8.30742}}</ref><ref>https://www.scopus.com/record/display.uri?eid=2-s2.0-84902519715&origin=inward&txGid=bc936e1b0b6831da3edcca60b04ca14a</ref> | ||
* Some studies in 1970-80 have suggested the increased tone of intenal spihincter as the basis of anal fissure genesis.<ref name="pmid4847701">{{cite journal| author=Nothmann BJ, Schuster MM| title=Internal anal sphincter derangement with anal fissures. | journal=Gastroenterology | year= 1974 | volume= 67 | issue= 2 | pages= 216-20 | pmid=4847701 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4847701 }} </ref><ref name="pmid890253">{{cite journal| author=Hancock BD| title=The internal sphincter and anal fissure. | journal=Br J Surg | year= 1977 | volume= 64 | issue= 2 | pages= 92-5 | pmid=890253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=890253 }} </ref> | |||
==Associated Conditions== | ==Associated Conditions== | ||
Revision as of 19:35, 24 January 2018
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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
The exact pathogenesis of anal fissure is not fully understood. It is thought that anal fissure is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
anal fissure arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to anal fissure usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Pathophysiology
An anal fissure is a linear tear or superficial ulcer of the anal canal, extending from just below the dentate line to the anal margin.
Pathogenesis
- Although constipation or anal trauma was supposed to instigate the fissure,the exact pathogenesis of anal fissure is not fully understood.[2]
- It is understood that anal fissure is the result of either anal trauma (by hard stools/diarrhea), perfusion defects with ischemia caused due to increased anal pressures and decreased blood flow or increased anal sphincter tone.
- In 90% of the patients, anal fissures are found in posterior midline. A small tear is seen that extends from dentate line to anal verge.[3]This is believed due to ischemia/poor perfusion of the area by inferior rectal artery.(during increased sphincter tone).[4][5][6][7]
- Some studies in 1970-80 have suggested the increased tone of intenal spihincter as the basis of anal fissure genesis.[8][9]
Associated Conditions
- Crohn's disease
- Syphilis
- HIV/AIDS
- Previous anal surgery
- Anal cancer
- Tuberculosis
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of anal fissure.
Microscopic Pathology
- On microscopic histopathological analysis, the following are characteristic findings of anal fissure:
- Prescence of fibrosis at the base of the fissure when compared to normal internal anal sphincter.[10]
References
- ↑ Source=http://www.surgwiki.com/wiki/File:Ch31-fig1.jpg
- ↑ Zaghiyan KN, Fleshner P (2011). "Anal fissure". Clin Colon Rectal Surg. 24 (1): 22–30. doi:10.1055/s-0031-1272820. PMC 3140330. PMID 22379402.
- ↑ Davies, Danielle; Bailey, Justin (2017). "Diagnosis and Management of Anorectal Disorders in the Primary Care Setting". Primary Care: Clinics in Office Practice. 44 (4): 709–720. doi:10.1016/j.pop.2017.07.012. ISSN 0095-4543.
- ↑ Klosterhalfen B, Vogel P, Rixen H, Mittermayer C (1989). "Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure". Dis. Colon Rectum. 32 (1): 43–52. PMID 2910660.
- ↑ Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ (1996). "Ischaemic nature of anal fissure". Br J Surg. 83 (1): 63–5. PMID 8653368.
- ↑ Wray, D; Ijaz, S; Lidder, S (2008). "Anal fissure: a review". British Journal of Hospital Medicine. 69 (8): 455–458. doi:10.12968/hmed.2008.69.8.30742. ISSN 1750-8460.
- ↑ https://www.scopus.com/record/display.uri?eid=2-s2.0-84902519715&origin=inward&txGid=bc936e1b0b6831da3edcca60b04ca14a
- ↑ Nothmann BJ, Schuster MM (1974). "Internal anal sphincter derangement with anal fissures". Gastroenterology. 67 (2): 216–20. PMID 4847701.
- ↑ Hancock BD (1977). "The internal sphincter and anal fissure". Br J Surg. 64 (2): 92–5. PMID 890253.
- ↑ Brown AC, Sumfest JM, Rozwadowski JV (1989). "Histopathology of the internal anal sphincter in chronic anal fissure". Dis. Colon Rectum. 32 (8): 680–3. PMID 2752854.
