Anal fissure physical examination: Difference between revisions

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{{CMG}}; {{AE}}{{ADS}}
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==Overview==
==Overview==
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
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.
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].


==Physical Examination==
==Physical Examination==
*Physical examination of patients with anal fissure is usually remarkable for: painful skin laceration, skin tags in chronic anal  
*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).


*[[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>]]
|}
|}
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]] jelly to examine/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>
*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===
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===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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Latest revision as of 20:24, 29 July 2020

Anal fissure Microchapters

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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

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

By Bernardo Gui - Own work, Public Domain[1]
By Jonathanlund - Own work, Public Domain[2]
  • 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

  1. https://commons.wikimedia.org/w/index.php?curid=8885756
  2. https://commons.wikimedia.org/w/index.php?curid=5148617
  3. 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.
  4. 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. 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.
  6. Bope, Edward (2018). Conn's current therapy 2018. Philadelphia: Elsevier. ISBN 978-0323527699.

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