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 Q:management of anal fissure  

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A 35-year-old Hispanic male presents w/ excruciating pain during defecation for the past week. The pain is so severe that he avoids using the toilet. He also noticed bright red blood in his stool. The caliber of his stool has not changed. Past medical history is significant for chronic constipation. Rectal exam shows a posterior mucosal tears of the anus. Which of the following is the most appropriate step in the management?
A Colonoscopy
B Local anesthetic and stool softener
C Lateral sphincterotomy
D Gradual dilation of the sphicter
E Nitroglycerin ointment

Please explain when you try to answer.


A colonoscopy is warranted in all cases of bleeding from the anus to r/o more sinister causes. Eventually he may neeed a lateral sphincterotomy.


This case is very clear for anal fissure so i go with B


kaplan has stressed of ruling out cancer----prescribing proctosigmoidoscopy

most appropriate step in m/m asked here----B


It is anal fissure.first treat it as in option B.


while it is true that in any anorectal case we should rule out cancer, for anal fissure the initial management is to examine patient under local anesthesia. in this case the patient was already examined where a mucosal tear was seen.other modes of treatment are stool softeners,topical nitroglycerine,local botulin injection..if it gets to surgery,the operation of choice is lateral internal sphincterotomy.

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