fongch
Forum Elite
Topics: 71
Posts: 316
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A 1 year old girl is brought to the physician by her grandmother because of a 1 week history of crying immediately before and during bowel movements. She is otherwise asymptomatic. Examination shows no abnormalities except foran anal fissure. Which of the following is the most appropriate initial step in management?
A) Notification of child protective services.
B) Stool softener therapy.
C) Anal dilatation in the office
D) Excision of the fissure.
E) Sphinterectomy.
I pick B, but some people choose A. Is anal fissure indicative of sexual abuse?
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| Justice
Forum Fanatic
Topics: 100
Posts: 1,900
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These are the most frequent causes if the anal fissures:
* Passage of hard stool
* Chronic diarrhea
* Habitual use of cathartics
* Anal trauma (can occur with anal intercourse or a rectal examination using a speculum or digit)
Nothing in the Q (mom's boyfriend, uncle, brother, etc...) suggests that the child was abused
I would go with (B)
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Don't live in a town where there are no doctors
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