Gastro: Anal Fissures: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Anal Fissures🎧 A clear, high-yield breakdown of this painful anorectal condition causing bleeding withdefecation – perfect for exam prep andreal-life clinical scenarios. 🧠 Key Learning Points📌 Definition•A small linear tear in the anal canal mucosa, often located at the posteriormidline, causing pain and bleeding during or after defecation.📌 Causes & Risk Factors•Trauma from hard or large stools•Chronic constipation•Chronic diarrhoea•Inflammatory bowel disease (e.g. Crohn’s)•Childbirth (due to perineal trauma)•Straining during defecationMnemonic: “CRISP”– Constipation, Repeated irritation, IBD, Straining, Postpartum📌 Pathophysiology•Trauma to anal mucosa → local inflammation•Increased internal anal sphincter tone → reduced blood flow (ischaemia)•Poor healing due to reduced perfusion → chronic fissure formation•Vicious cycle of pain → spasm → ischaemia → non-healing📌 Symptoms•Sharp, stinging pain during defecation•Bright red bleeding on toilet paper•Post-defecation pain lasting hours•Possible perianal itching or discomfortMnemonic: “PainfulBLEED” – Bright red, Linear tear, Excruciating, External tag (sentinel pile),Defecation-related📌 Differential Diagnosis•Haemorrhoids (especially thrombosed)•Perianal abscess•Crohn’s disease•Anal cancer•Proctitis•Proctalgia fugax📌 Diagnosis•Clinical history and visual inspection•Avoid DRE initially due to pain•Look for linear tear (posterior midline), sentinel pile if chronic•Further investigations (e.g. endoanal ultrasound, manometry) only if refractoryor atypical📌 Management•Initial:High-fibre diet, increased fluidsSitz bathsTopical anaesthetics (e.g. lidocaine) • Topical treatments:Glyceryl trinitrate (GTN) 0.2% ointmentDiltiazem 2% creamNifedipine (off-label) • Advanced options:Botulinum toxin injectionsSurgery: Lateral internal sphincterotomy (LIS) for chronic or refractory cases • Avoid digital rectal exam in acute stage unless necessary • Refer if symptoms persist >6–8 weeks despite treatment📌 Complications•Chronic fissures•Sentinel piles•Anal fistula or abscess•Rarely, anal stenosis📌 Prognosis•Excellent for acute fissures with conservative treatment•Up to 50% respond well to non-surgical treatment•Surgery highly effective but small risk of incontinence•Recurrence possible – long-term lifestyle changes important 📎 More MSRA Resources for AnalFissures📝 Revision Notes: https://www.passthemsra.com/topic/anal-fissures-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/anal-fissures-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/anal-fissures-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/anal-fissures-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards#MSRAQandANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment#MSRAOnlineRevision #MSRARevisionWebsite #AnalFissures