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* anal fissure
  a_antibody - 05/28/07 15:31
  A 23-year-old woman seeks help for exquisite pain with defecation and blood streaks on the outside of her stools, which she has been having for several weeks. Because of the pain, she has avoided having bowel movements, and when she finally did the stools were hard and even more painful. When seen, she has no fever or leukocytosis. Physical examination has to be done under spinal anesthesia, because the patient was so afraid of the pain that she initially refused even inspection of the area. The examination confirms the suspected diagnosis, and she is placed on stool softeners and appropriate topical agents, but without success. She is willing to undergo more aggressive treatment. Which of the following is the most appropriate next step?
A. Excision of the lesion
B. Fistulotomy
C. Incision and drainage
D. Lateral internal sphincterotomy
E. Rubber band ligation
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* Re:anal fissure
  floridaguy - 05/28/07 15:33
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* Re:anal fissure
  fmg22 - 05/28/07 16:21
  b ....and also fistulectomy.....  
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* Re:anal fissure
  a_antibody - 05/28/07 16:24
  The correct answer is
D. The clinical picture is classic for anal fissure, which is perpetuated by the fact that the anal sphincter is "too tight." Forceful dilatation under anesthesia, lateral sphincterotomy, or botulinum toxin injections are acceptable options to "break the cycle." The only one of those choices given is the sphincterotomy. Excision (choice A) used to be done for this condition, before the role of the "too tight sphincter" was elucidated. Fistulotomy (choice B) is not the answer. She has a fissure, not a fistula. Incision and drainage (choice C) is another option that addresses a wrong diagnosis. We do that for perirectal abscess, which produces severe pain with fever and leukocytosis, but without blood streaks, and drains spontaneously after several days if not diagnosed and treated. Rubber band ligation (choice E) is the answer for internal hemorrhoids. Internal hemorrhoids can bleed, but typically do not hurt. Thrombosed external hemorrhoids can hurt tremendously, but those are not amenable to rubber band ligation
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* Re:anal fissure
  darkhorse - 05/28/07 16:25
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* Re:anal fissure
  floridaguy - 05/28/07 16:33
  Oh crap, yes its D. I mixed up Fistula and Fissure. If I get it once (Fissure) I will never mix them up anymore. :)  
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* Re:anal fissure
  fmg22 - 05/28/07 16:39
  floridaguy even biased me ....hahahahhahahha  
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* Re:anal fissure
  floridaguy - 05/28/07 16:41
  I guess we all have some NEGATIVE effects on each other here. :) But I will print this and keep it as the memory of when I affected your judgment.  
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* Re:anal fissure
  fmg22 - 05/28/07 16:44
  you are a cool wacky dude.....................  
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* Re:anal fissure
  floridaguy - 05/28/07 16:49
  And you are knowledgable and in a serious mood :)  
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* Re:anal fissure
  shashank16997 - 03/10/18 08:15
  Clove contains anti-bacterial and antiviral properties. On other hands, clove is very good in the soothing nervous stomach and to prevent parasitic infections in the body. Cloves are another excellent home remedy for anal fistula because it will boost your immunity and it will work as a natural colon cleanser.

Take cloves and make a powder of it.
Then prepare ginger tea and add 1/2 tsp of clove powder int it.
Mix it well and then cover it with lid.
After 10 minutes, this ginger tea is operated with a nappy so that the anal fistula can cure.
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