Ver el código de «Anal fissure»

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==Background== <!--T:1-->

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[[File:Human anus-en.png|thumb|Anatomy of the anus.]]
[[File:Gynecological diagnosis (1910) (14798113703).jpg|thumb|Anatomy of anal fissure.]]
*Superficial linear tear of anal canal from at/below dentate line to anal verge
**May be due to passage of hard stool, frequent diarrhea, or abuse
*Most common cause of painful rectal bleeding
*In >90% of cases anal fissures occur in the midline posteriorly
**Non-healing fissure or one not located in midline suggests alternative diagnosis (e.g. Crohn's, malignancy)


==Clinical Findings== <!--T:3-->

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[[File:Anal fissure 2.jpg|thumb|Close up photo of anal fissure (at red arrow).]]
*Acute sharp, cutting pain most severe during and immediately after bowel movement
**Subsides between bowel movements (distinguishes fissure from other anorectal disease)
*Bright red [[Special:MyLanguage/rectal bleeding|rectal bleeding]], small in quantity (usually noticed only on toilet paper)
*Lateral to anus often indicates associated systemic illness such as [[Special:MyLanguage/Crohn's|Crohn's]], [[Special:MyLanguage/HIV|HIV]], [[Special:MyLanguage/leukemia|leukemia]], [[Special:MyLanguage/TB|TB]], [[Special:MyLanguage/syphilis|syphilis]]


==Differential Diagnosis== <!--T:5-->

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{{Anorectal DDX}}
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{{Lower GI bleeding DDX}}
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==Evaluation== <!--T:6-->


===Workup=== <!--T:7-->

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*Typically clinical (no studies needed)


===Diagnosis=== <!--T:9-->

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*Having patient bear down may make fissure more noticable
*Sentinel pile, located at distal end of fissure, along with deep ulcer suggests chronicity
**Often misdiagnosed as an external [[Special:MyLanguage/hemorrhoid|hemorrhoid]]


==Management== <!--T:11-->

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*Warm sitz baths 15 min TID-QID and after each bowel movement
**Provides symptomatic relief by improving anal blood flow and relieves anal sphincter spasm
*Topicals
**Pain control with [[Special:MyLanguage/lidocaine|lidocaine]]
**Vasodilators such as [[Special:MyLanguage/nitroglycerin|nitroglycerin]] or [[Special:MyLanguage/nifedipine|nifedipine]] ointment
**[[Special:MyLanguage/Hydrocortisone|Hydrocortisone]] 
*High-fiber diet
**Prevents stricture formation by providing a bulky stool
*Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly
*Surgical referral indicated if healing does not occur in a reasonable amount of time


==Complications== <!--T:13-->

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*[[Special:MyLanguage/Anorectal abscess|Anorectal abscess]]


==Disposition== <!--T:15-->

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*Most patients can be managed medically and discharged with outpatient follow-up


==See Also== <!--T:17-->

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*[[Special:MyLanguage/Anorectal Disorders|Anorectal Disorders]]


==External Links== <!--T:19-->

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*[https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anal-fissure?query=anal%20fissure Merk Manual - Anal Fissure]
*[https://emottawablog.com/2019/10/the-bottom-line-hemorrhoids-and-anal-fissures-in-the-ed/ EM Ottawa - Hemorrhoids and Anal Fissures in the ED] 


==References== <!--T:21-->

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[[Category:GI]]
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