Anal fistula pathophysiology: Difference between revisions
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==Microscopic Pathology== | ==Microscopic Pathology== | ||
On microscopic histopathological analysis, following features are found:<ref name="urlanal fistula - Humpath.com - Human pathology">{{cite web |url=https://www.humpath.com/spip.php?article18351 |title=anal fistula - Humpath.com - Human pathology |format= |work= |accessdate=}}</ref> | |||
*There is the central core of active and chronic inflammation with granulation tissue, foreign body giant cells, and surrounded by scar. | |||
*Granulomas are seen occasionally. | |||
*There is squamous cell extend into the fistula track which is partially epithelialized. | |||
==References== | ==References== | ||
Revision as of 20:14, 31 January 2018
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Anal fistula Microchapters |
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Diagnosis |
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Treatment |
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Anal fistula pathophysiology On the Web |
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American Roentgen Ray Society Images of Anal fistula pathophysiology |
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Risk calculators and risk factors for Anal fistula pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2]
Overview
Pathophysiology
Anatomy
- The anal canal is a 2 to 4cm in length, starts at the anorectal junction to the end of anal verge.[1]
- It is divided into an upper and a lower part by transition zone that is seen at the dentate line or pectinate line which is surrounded by longitudinal mucosal folds, called columns of Morgagni.[1]
- Each of this fold contains anal crypts, each of which contains 3 to 12 anal glands, the distribution of these glands is not uniform with most of the glands present anterior to the position of the anal canal and fewer in the posterior position.
Pathogenesis
- Anal fistula develops from infection of anal crypts gland.
There are following steps in the formation of anal fistula:
- The initial infection occurs in the ducts of the anal glands and the spread of infection results in the formation of the abscess, .[2]
- The crytoglandular theory states that obstruction of anal gland duct results in a infection and due to the presence of these glands deep in relation to the anal canal and sphincter, the infection follows the path of least resistance resulting in abscess formation at the termination of the gland.[3][4]
- If the abscess is ruptured, a fistula is formed.
Associated Conditions
Anal fistulas are associated with following conditions:[5]
- Diverticulitis
- Foreign-body reactions
- Actinomycosis
- Chlamydia
- lymphogranuloma venereum (LGV)
- Syphilis
- Tuberculosis
- Radiation exposure
- HIV disease
- Crohn’s disease
- Pilonidal disease
- Hidradenitis suppurativa
- Trauma
- Previous surgery (including ileoanal pouch surgery)
- Presacral dermoid cysts
- Sacrococcygeal teratoma
- Rectal duplication
Gross Pathology
- On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
Microscopic Pathology
On microscopic histopathological analysis, following features are found:[6]
- There is the central core of active and chronic inflammation with granulation tissue, foreign body giant cells, and surrounded by scar.
- Granulomas are seen occasionally.
- There is squamous cell extend into the fistula track which is partially epithelialized.
References
- ↑ 1.0 1.1 "Anatomy and Embryology - Springer".
- ↑ Rickard MJ (2005). "Anal abscesses and fistulas". ANZ J Surg. 75 (1–2): 64–72. doi:10.1111/j.1445-2197.2005.03280.x. PMID 15740520.
- ↑ PARKS AG (1961). "Pathogenesis and treatment of fistuila-in-ano". Br Med J. 1 (5224): 463–9. PMC 1953161. PMID 13732880.
- ↑ Coremans G, Dockx S, Wyndaele J, Hendrickx A (2003). "Do anal fistulas in Crohn's disease behave differently and defy Goodsall's rule more frequently than fistulas that are cryptoglandular in origin?". Am J Gastroenterol. 98 (12): 2732–5. doi:10.1111/j.1572-0241.2003.08716.x. PMID 14687825.
- ↑ "Management of anal fistula | The BMJ".
- ↑ "anal fistula - Humpath.com - Human pathology".