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Fissure in ano
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Introduction Pathogenesis
A linear ulcer (tear) of the lower half of the anal canal Pathogenesis Exact cause is unknown Probably due to mucosal ischaemia secondary to muscle spasm Large, hard stool 5% associated with chronic intersphinteric abscess
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#CLINICAL FEATURES --Features of chronicity: Pain on defecation,
bright red bleeding pruritus ani --Features of chronicity: Symptoms for more than 6 weeks Papilla Undermined edges Visible internal sphincter
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# diagnosis DRE Proctoscopy contraindicated
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MANAGEMENT a)medical management
Stool softeners, bulking agents, sitz baths, topical local anesthesia Topical nitroglycerin (0.2% GTN) or nifedipine Botulinum toxin
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b)surgical management
Lateral sphincterotomy Lord’s dilatation (anal stretch procedure) Fissurectomy & local advancement flap
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Acute anal fissure
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