nitupal.in

2. SURGICAL
CASE PRESENTATION
ON
HEMORRHOIDS AND
ANAL FISSURE

3. BIOGRAPHICAL DATA

4. PHYSICAL
EXAMINATION

5. ANATOMY AND
PHYSIOLOGY
LARANA, INC.

6. Disease condition
Disease condition

7. HEMORRHOIDS
Hemorrhoids are painful,swollen, enlarge
bulging of blood vessels in lower postion of
anus or rectum . swelling in Anal or rectal
vein cause hemorrhoids

8. Ceo Of Ingoude
Company
Ceo Of Ingoude
Company
ANAL FISSURE
Anal fissure is a tear it cut in the skin that lines the anus and rectum causing
painful linear ulcer at margin of anus

9. CAUSE AND RISK FACTORS
01
02
03
04
05
06
07
CONSTIPATION / DIARRHOEA
STRAINING DURING BOWEL MOVEMENT
LARGE AND HARD STOOL PASSING
THROUGH ANAL CANAL
ANAL SEX
CHILD BIRTH/PREGNANCY
INFLAMMATORY BOWEL
DISEASE
PROCTITIS

10. Pathophysiology
Due to etiological factors
Blood vessels swelling
Pressure on anal area
Formation of lump(Hemorrhoids )
and leads to bleeding during defecation

11. pathophysiology
Due to etiological factors
Increase pressure in anal area
Spasm of internal sphincter
Impairment of Intersphincteric blood circulation
Impaired Healing
Chronic Anal fissure

12. Clinical manifestations

13. 1.pain during and after defecation and bleeding

14. sharp burning pain during
defecation
itching and malodorous discharge

15. A visible crack in skin around the anus

16. A small lump or skin tag near the fissure

17. Red spots on toilet tissue

18. Anal ache and pain especially while sitting

19. Diagnostic Evaluation
1. History collection
2. Physical examination
3.complete blood count
4.Digital rectal examination
5.Proctoscopy
6.colonoscopy or sigmoidoscopy
7.Barium enema X ray
1.History collection physical
examination
((inspection )
2.Anal manometry
3.sigmoidoscopy and colonoscopy

20. 1. Warm sitz bath
2. Dietary changes
3. Fluid
4. Activity suggestions
5.stool softeners
6. OTC analgesic or suppository containing hydrocortisone
7.local anesthetic(2%lignocaine)
8.Nitroglycerin(0.2%)
Medical management

21. Surgical management

22. Rubber band ligation

23. Sclerotherapy

24. Infrared photocoagulation

25. Laser therapy

26. Cryotherapy ( super freezing)

27. 1.Anal Dilation
In this anal dilation process,Anal sphincter are stretched or dilated
to prevent hemorrhoid from increasing rectal pressure.As
well as reduce the need of straining to pass stool

28. 2.Stapled Hemorrhoidectomy
It is a technique of treating the Hemorrhoids by blocking
blood flow to the tissue .this technique use a special device
to internally staple and excise internal hemorrhoidal tissue

29. 3.Hemorrhoidectomy
It is the complete removal of hemorrhoid
under either spinal or general anesthesia

30. surgery : Anal fissure
1.Lateral Internal Sphincterectomy
Chronic fissure which are resistant to medical
management
usually require surgery.This is achieved by cutting
a small portion of inner muscle around
anus(Internal Sphincterectomy)

31. Nursing management

32. Nursing diagnosis:
Pre operative:
1.Acute pain related to Hemorrhoids and anal fissure as evidence by pain score is
7/10
2.Impaired perineal skin integrity related to Anal fissure as evidence by pain and
discomfort
post operative:
1.Acute pain related to Hemorrhoidectomy and lateral internal Sphincterectomy as
evidence by pain score is 7 /10
2.constipation related to surgery as evidenced by patient has not passed stool since
2 days
3.Risk for infection related to surgery as evidenced by itching

33. Health Education

34. 1.Add fibre to diet
2.Drink adequate fluid
3.Exercise regularly
4.Avoid straining during bowel movemen
5.Advice to take sitz bath