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Rectum and anus diseases

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  • 1. UNIVERSIDAD DE GUADALAJARA Centro Universitario de Ciencias de la Salud Carrillo Cordero Brenda Elizabeth Profesor: Dr. Hector Virgen Guadalajara, Jalisco 26/OCT/2011 RECTUM AND ANUS - Anal fissure -Anorectal sepsis and fistula in ano -Hemorrhoids -Pilonidal disease
  • 2. ANAL FISSURE
    • Is a tear in the anoderm distal to the dentate line.
    • 90% Posterior midline
    • 10% Anterior midline
    • <1% off midline
    Goligher Schwartz's principles of surgery 8th ed.
  • 3. http://www.proctologa.com.mx/fisuras_anales.html http://www.proctologiacr.com/fisura.htm
  • 4. http://www.nlm.nih.gov/medlineplus/spanish/ency/esp_presentations/100154_1.htm
  • 5. ETHIOLOGY
    • Previous anorectal surgery
    • Related to trauma
    • Passage of hard stool
    • Prolonged diarrhea
    • Spasm of the internal
    • anal sphincter
  • 6. Surgery. Treatment & diagnosis, Doherty G. SPASM WOUND PAIN
  • 7. CHRONIC FISSURE
    • Ulceration
    • External skin tag
    • Hypertrophied anal papilla
    http://gsdl.bvs.sld.cu/greenstone/collect/cirugia/index/assoc/HASH01dc.dir/fig10.8g.png
  • 8. SYMPTOMS AND FINDINGS
    • Tearing pain
    • Hematochezia
    • Constipation Examination
    • under anesthesia.
    • anoscopy,
    • sigmoidoscopy
    Physical examination
  • 9. DIFFERENTIAL DIAGNOSIS
    • Lateral location of a chronic anal fissure
    • Crohn
    • HIV
    • Syphilis
    • TB
    • CMV
    http://medicosdeelsalvador.com
  • 10. TREATMENT
    • Stool softeners
    • Warm sitz baths
    • 2% Lidocaine jelly
    • 0.2% Nitroglycerin (causes severe headaches)
    • 0.3% Nifedipine
    • Botulinum toxin
  • 11. SURGICAL THERAPY
    • Lateral internal SPHINCTEROTOMY
    • open or closed
    • technique
    Schwartz's principles of surgery 8th ed.
  • 12. ANORECTAL SEPSIS AND FISTULA IN ANO
  • 13. ANORECTAL SEPSIS FISTULA IN ANO
    • Infection of the anal glands (cryptoglandular infection)
    • Drainage of an anorectal abscess
    • 50% results in cure
    • 50% develop a persistent fistula in ano
  • 14. Surgery. Treatment & diagnosis, Doherty G.
  • 15.  
  • 16. DIAGNOSIS
    • Severe anal pain
    • A palpable mass
    • Fever
    • Urinary retention
    • Sepsis
    http://www.endoinflamatoria.com/3_2.html
  • 17. Complex or atypical presentations CT MRI http://www.endoinflamatoria.com/3_2.html
  • 18. TREATMENT
    • Drainage
    • Examination under anesthesia
    • Antibiotics alone are ineffective
  • 19.  
  • 20. FISTULA IN ANO
    • Cryptoglandular
    • Trauma, Crohn's disease, malignancy, radiation, unusual infections (TB, chlamydia, actinomicosis)
  • 21. Goodsall's rule Schwartz's principles of surgery 8th ed.
  • 22. TREATMENT OF FISTULA IN ANO
    • Fistulotomy
    • Sphincterotomy
    • Seton placement
    http://fitsweb.uchc.edu/student/selectives/Luzietti/Painful_anus_fistula_in_ano.htm
  • 23. HEMORRHOIDS
    • Hemorrhoids are a normal part of anorectal anatomy
    • Increase of intraabdominal pressure
    • - obesity
    • - pregnancy
    • - standing
    • - efforts during defecation
  • 24.  
  • 25.
    • EXTERNAL HEMORRHOIDS
    • Located distal to the
    • dentate line.
    • Covered with anoderm.
    • Thrombosis.
    • INTERNAL HEMORRHOIDS
    • Located proximal to the
    • dentate line.
    • Covered with anorectal
    • mucosa.
    • Prolapse or bleeding.
    Combined internal and external hemorrhoids
  • 26.  
  • 27. INTERNAL HEMORRHOIDS
    • Graded according to the extent of prolapse
    • 1º degree - bleeding
    • 2º degree - prolapse (but reduce spontaneously)
    • 3º degree - prolapse through the anal canal (manual reduction)
    • 4º degree - cannot be reduced, are at risk for strangulation
  • 28. VIDEO
  • 29. CLINICAL MANIFESTATIONS
    • INTERNAL : bright red bleeding, rerely become painful
    • EXTERNAL : trombones may cause significant pain, a skin tag,
    •  
    • They rarely cause anemia
    •  
    Barium enema Colonoscopy Physical examination
  • 30. TREATMENT
    • Medical therapy . dietary fiber, stool softeners, increased fluid intake
    • Surgical treatment.
  • 31. Surgical treatment. Rubber Band Ligation Sclerotherapy
  • 32. Surgical treatment. Stapled Hemorrhoidectomy http://cccrs.tripod.com/PPH.html
  • 33. Surgical treatment. Excisional Hemorrhoidectomy http://colorectal.surgery.ucsf.edu/conditions--procedures/hemorrhoidectomy.aspx
  • 34. PILONIDAL DISEASE
  • 35. PILONIDAL DISEASE
    • Pilonidal disease (cyst, infection) consists of a hair-containing sinus or abscess occurring in the intergluteal cleft.
    • Etiology unknown
    • Ingrown hairs become infected
    • Recurrence is common
  • 36. CLINICAL MANIFESTATIONS
    • Dimples in the medial line.
    • Abscess near the sacrum and coccyx
    • Hirsute and heavy men with profuse sweating
    •  
    • Diagnosis :
    • Physical examination
  • 37. TREATMENT
    • Acute abscess: should be incised and drained
    • Surgical trearment
    http://www.mednet.cl http://www.davidclark.net
  • 38. ¡THANK YOU!

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