Rectum and anus diseases

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Rectum and anus diseases

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

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