THE ULTIMATE IN PROCTOLOGY - PRACTITIONERS.pdf

INSPIRING AND ASPIRING
COLO RECTAL SUPER SPECIALTY CENTRE

www.chiragglobalhospitals.com
OUR VISION
• To be a leader and a tertiary care referral center for the treatment of various
proctology disorders
• Innovate through a deep research to achieve the best medical practices in the field
of proctology
• Introduce super specialty educational courses in the field of proctology

CHIPRO TEAM

PT WITH
SYMPTOMS P/R
? TREAT
PAIN, BLEEDING, MASS
P/R
? STAGE – MEDICAL Rx
? REFER
WHEN?
HOW?
WHERE?
DETAILED
HISTORY
ROLE OF A PHYSICIAN

v ENQUIRE:- History in detail
v EXAMINE:- Proctoscopy and VRS to make a diagnosis
v EXPLAIN:- Pros & cons with safety of treatment
v EDUCATE:- Yourself & patient.
v EXPERT TREATMENT:- Refer with complete history
ROLE OF A PHYSICIAN

Thorough history of the patient itself gives the
idea of the probable diagnosis
§ Bleeding
§ Pain
§ Mass
§ Discharge
§ Abdominal symptoms
MEDICAL MANAGEMENT
§ Constipation / Diarrhoea
§ Itching
DIAGNOSIS SHOULD CO-RELATE WITH THE PATIENT’S MAIN COMPLAINT
SYMPTOMS

2. DURATION
3. CONTINUOUS
4. SEVERITY
5. NATURE
6. INCREASES ON
SITTING/ TRAVELLING
1. DEFECATORY
PAIN – DETAILED HISTORY

CONTINUOUS
ASSOCIATED WITH FEVER &
CHILLS
INCREASES ON SITTING/
TRAVELLING
THROBBING PAIN
WITH DEFECATION
BURNING / PRICKING PAIN
REFER FOR
VIDEO ANDROSCOPY &
FURTHER EVALUATION
?ABSCESS/ SINUS
THROMBOSED PILE
? ACUTE FISSURE
TREAT – MEDICAL
MANAGEMENT
STOOL SOFTENERS, PAIN
KILLERS, TOPICAL –
LIGNOCAINE, + NIFEDIPINE
ETC
INCREASES OR RECURS
IMMEDIATELY
PAIN
< 3 WEEKS DURATION
> 3 WEEKS DURATION
PILES DONOT CAUSE PAIN, UNLESS THROMBOSED
MANAGEMENT OF PAIN P/R

COLOUR
BRIGHT RED
DARK RED
BLACK
RELATION
WITH STOOLS
MIXED WITH
STOOLS
ON SURFACE
OF STOOLS
WITH MUCOUS
AND ALTERED
BLOOD
NATURE
DROPS/JET
LIKE
BLOOD
STREAK
WITH STOOLS/
SPONTANEOUS
BLEEDING - HISTORY

Bleeding
<a week > a week
spontaneous
Stool softener,
tranexamic acid
Suspected piles:
MPFF
Malignancy
Ulcers
Polyps
Rectal pathology
Refer for
Video
androscopy &
Further
evaluation
Altered blood/
mixed with stools
Infective
Bacterial/
amoebic
Stool exam.
Occult blood
Refer for
Video androscopy &
Further evaluation
With defecation
Treat – antibiotic
& anti amoebic
Immediately
Immediately
Rx

6) DURATION
5) WITH PAIN/
WITHOUT PAIN
4) ALWAYS
3) INTERMITTENT
2) RELATION WITH
DEFECATION
1) ORIGIN: ACUTE/CHRONIC
MASS/SWELLING - HISTORY

MUCUS & PUS
DISCHARGE
PRURITUS ANI
FEVER
ABDOMINAL PAIN
LOSS OF WEIGHT
OTHER SYMPTOMS:

MASS PER RECTUM
SWELLING IN PERIANAL REGION
DISCHARGING SINUS/WOUND
LOSS OF WEIGHT/ APPETITE
ABDOMINAL SYMPTOMS
REFER FOR FURTHER
EVALUATION

v Should be done with proper protocol
v Symptomatic treatment – only if
emergency and should be in a written form
v Insist that all cases are to be examined and
the diagnosis to be made even if the
symptoms subside
ONLINE CONSULTATIONS

EXPLAIN TO THE PATIENT:
§ What you are suspecting?
§ Why are you referring?
§ Why to this particular specialist?
§ What do you expect from the referral?
§ What role you play once you understand the disease?
§ ? Malignancies – earlier the better
STRESS THE IMPORTANCE OF EARLY DIAGNOSIS
Preferably discuss with the concerned specialist before sending
the patient
Become part of the treatment team by visiting the patient in
the hospital after surgery
HOW TO REFER?

The concerned specialist / centre
v Must have expertise in the field
v Must be approachable
v Genuine interest in the patient
v Necessary infrastructure / equipment
WHERE TO REFER?

ANATOMY: it is only 7 x 7 x 7cm organ where partly
ectodermal and endodermal. Dentate line,
Hiltons line and anorectal ring. Vascular cushions.
PHYSIOLOGY: highly sophisticated sphincter mechanism which calibrates and expels gas, liquids or
solids efficiently
PHARMACALOGY: MPFF, Calcium Dobesilate, Botox, stool softeners, bulking agents, Ayurvedic
preparations etc.
PATHOLOGY: Fissure, Fistula, Haemorrhoids.
MICROBIOLOGY: it’s a host to plethora of micro-organisms( aerobic/anaerobic bacteria/ fungus/
worms/ viruses)
HOME REMEDIES
ROLE OF DIET AND PHYSICAL ACTIVITIES
INFLUENCE OF COMORBIDITIES ON DISEASE AND TREATMENT
PECULIARITIES OF RECTUM AND ANAL CANAL –
A PROCTOLOGIST SHOULD BE WELL VERSED WITH

v Piles and fissures are curable.
v All piles do not require surgery.
v Earlier the stage, better the results.
v Most surgeries are day care procedures
v Minimal anesthesia risk –local anesthesia/Saddle block.
v High end safe procedures are available
v Proper treatment is more important than “Freebies /
offers”
v Medical services require trust between doctor and
patient and should not be outsourced to aggregators who
are neither interested in patient welfare nor answerable
for complications.
TELL YOUR PATIENTS THAT:-

1. Piles is not a symptom, it is a diagnosis.
2. ‘Heat’ is a concept, not an etiology.
3. Don’t continue symptomatic treatment for >48
hours.
4. All that bleeds are not piles.
5. Don’t encourage patients taking treatment from
‘quacks’. Educate them
6. Explain to the patients about cost effectiveness by
early and precise treatment
7. Educate the patient to leave the decision of what
sort of procedure / surgery to the surgeon instead of
demanding lasers / stappled procedures etc
LISTEN, BUT DON’T ASSUME BASED ON WHAT THE PATIENT SAYS

GOALS FOR THE FUTURE
THE ULTIMATE IN PROCTOLOGY

v There is exponential increase in the number of people suffering from ano-rectal diseases, thanks
to our modern lifestyle.
v Equally there is an exponential growth in technological solutions for the same
v In business connotation it’s a “huge opportunity for health care sector “
v Medical professionals should not think it as an opportunity for earning, but an opportunity for
learning to prevent these problems crippling the society.
v Implementing never ending newer technologies alone will yield no benefits for the community,
but only fill the coffers of the technology giants, most of them from abroad.
v The knowledge in the pathology and treatment in each disease is expanding by day and much
more is in store for the future.
v So proctology as a speciality and a proctologist dealing with all the diseases will not be ideal.
v Now there is a need to consider the department of PROCTOLOGY as a “super- speciality”, with
multiple branches dealing with each disease by a specially trained surgeon and all of them
forming a team of proctologists.
v Imbibing the knowledge from AYUSH and Naturopathy and age old home remedies should also be
a part of the ultimate in proctology.
THE ULTIMATE IN PROCTOLOGY

Team work – includes specialists in preventive aspects, minimal
procedures, technology development, complex surgeries, wound
healing and other post op management, research and
innovation.
v Other systems of medicine
v Newer indigenous technologies
v Prevention of the diseases by lifestyle changes
v Early and complete diagnosis and minimal treatment
v Permanent cure of the diseases by wholesome treatment
v Focussed treatments for complex problems and complicated
issues.
v These are the newer approaches to the goal of “ULTIMATE IN
PROCTOLOGY”
GOALS FOR THE FUTURE

Definite protocols for:
v History taking
v Clinical examination
v Video rectoscopy
v Necessary lab investigations
v Treatment – medical / surgical
WHAT WE DO…

• For the past 20-25 years, there are a lot of advances in
• DIAGNOSTIC- Pocket Video Rectoscopy and sphincter
assessment, MR Fistulogram, EUS, MR defecography
• CONCEPTUAL – haemorrhoidal cushions and cryptoglandular
theory. Sphincters can be cut and repaired.
• CURATIVE ASPECTS- Doppler, LASER, RF unit, Infra Red
coagulator, etc.
• ALTERNATIVE THERAPIES – AYUSH therapies – Panchakarma,
medications, Kshara sutra, Kshara karma, Agni karma
PROGRESS IN PROCTOLOGY

DIAGNOSTIC
Pocket Video Rectoscopy and
sphincter assessment
MR Fistulogram
EUS MR defecography
CONCEPTUAL – haemorrhoidal cushions and cryptoglandular theory. Sphincters
can be cut and repaired.
FOR THE PAST 20-25 YEARS, THERE ARE A LOT OF ADVANCES
PROGRESS IN PROCTOLOGY

“ANTHAR NETHRA”
(POCKET VIDEO RECTOSCOPY)
DEVELOPED AND USED AT
CHIRAG INSTITUTE OF PROCTOLOGY AND RESEARCH ORGANIZATION
DISTRIBUTED TO TRAINEE SURGEONS

VRS IMAGES

CURATIVE ASPECTS
DGHAL & RAR LASER
RF unit Infra Red coagulator
ALTERNATIVE THERAPIES – AYUSH THERAPIES
PANCHAKARMA KSHARA SUTRA
KSHARA KARMA AGNI KARMA

v“Technical revolution” in PROCTOLOGY is happening
v“Revolution in awareness” is responsibility of Primary care physicians
vEnquire, Examine, Explain & Treat or Refer
vDanger is in Delay, not in treatment
vAll procedures are safe, curative when done meticulously - DAY CARE & COST EFFECTIVE
vAnus is an exit gate for all the things dumped through the mouth and has to bear the brunt of it.
vAny mismanagement of the diseases, the patient and the treating doctor have to face the
consequences for life
IN A NUTSHELL

Any symptom
v > 3 weeks
v not responding within 72 hrs of treatment
v Unexplained bleeding P/R
v Unexplained pain
Should be immediately and thoroughly investigated for a
final diagnosis
TREAT WHAT YOU CAN, REFER WHEN IN DOUBT
TAKE HOME MESSAGE:

THANK YOU

THE ULTIMATE IN PROCTOLOGY - PRACTITIONERS.pdf

Recommended

Recommended

More Related Content

Similar to THE ULTIMATE IN PROCTOLOGY - PRACTITIONERS.pdf

Similar to THE ULTIMATE IN PROCTOLOGY - PRACTITIONERS.pdf (20)

Recently uploaded

Recently uploaded (20)

THE ULTIMATE IN PROCTOLOGY - PRACTITIONERS.pdf