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Anal fissure

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Gastrointestinal system

Pathology

Peritoneum and peritoneal cavity
Upper gastrointestinal tract disorders
Lower gastrointestinal tract disorders
Liver, gallbladder and pancreas disorders
Gastrointestinal system pathology review

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Anal fissure

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Anal fissure

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USMLE® Step 1 style questions USMLE

1 questions
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A 36-year-old man comes to the outpatient clinic because of perianal pain. The pain has persisted for five weeks and is unbearable during defecation. The perianal pain is associated with dull throbbing pain and hematochezia. On examination, his temperature is 37°C (98.6°F), pulse is 80/min, respirations are 16/min, and blood pressure is 125/78 mm Hg. He denies any difficulty urinating or previous episodes similar to what he is experiencing now. Physical examination shows a superficial tear along the posterior midline of the anus. Which of the following is the most likely diagnosis?

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Summary
An anal fissure or rectal fissure is a break or tear in the skin of the anal canal. Anal fissures may be noticed by bright red anal bleeding on toilet paper, sometimes in the toilet. If acute they may cause pain after defecation but with chronic fissures pain intensity is often less. Anal fissures usually extend from the anal opening and are usually located posteriorly in the midline, probably because of the relatively unsupported nature and poor perfusion of the anal wall in that location.