ANAL FISTULA

1. CHIEF COMPLAINT
•Anal fistula

2. HPI

3. ROS

4. SYMPTOMS
•Pain
•Discharge - either bloody or purulent
•Pruritus ani - itching

5. HISTORY
•FAMILY HISTORY
•SOCIAL HISTORY
•PASTMEDICAL HISTORY
•SURGICAL HISTORY
•CHRONIC CONDITIONS

6. ALLERGIES

7. PHYSICAL EXAMINATION
•The area painful on examination

8. SPECIFIC DATA LIKE GRADING ETC

9. TESTS TO BE ORDERED
•CBP
•USG
•Anoscopy

10.ASSESSMENT /PLAN

11.EDUCATION
•Doing nothing - drainage section can be left in place long-term to
prevent problems. This is the safest option although it does not
definitively cure the fistula.
•Lay-open of fistula-in-ano - this option involves an operation to cut
the fistula open. Once the fistula has been layed open it will be
packed on a daily basis for a short period of time to ensure that the
wound heals from the inside out. This option leaves behind a scar,
and depending on the position of the fistula in relation to the
sphincter muscle, can cause problems with incontinence.
•Cutting seton - if the fistula is in a high position and it passes
through a significant portion of the sphincter muscle, a cutting
section may be used. This involves inserting a thin tube through the
fistula tract and tying the ends together outside of the body. The
seton is tightened over time, gradually cutting through the sphincter
muscle and healing as it goes. This option minimizes scarring but
can cause incontinence in a small number of cases, mainly of flatus
(wind). Once the fistula tract is in a low enough position it may be
layed open to speed up the process, or the seton can remain in
place until the fistula is completely cured.
•Fibrin glue injection
•Endorectal advancement flap

12.MEDICATION
•Amikacin
•Gentamicin
•Kanamycin
•Cefixime
•Cefdinir
•Naproxen
•Ibuprofen
•Cefditoren
•Aspirin

13. FOLLOW-UP