Hi Just No.4,5,6 eminar 9: Common Anorectal diseases (Fissure, Haemorrhoids, Fis

Question

Hi Just No.4,5,6 eminar 9: Common Anorectal diseases (Fissure, Haemorrhoids, Fistula, Abscess By the end of this seminar, the student should be able to: Revisit the anatomy of the anus and pelvic floor muscles and its physiological applications. 1. p 2. Conduct a clinically oriented history and physical examination of perianal diseases. 3. Enlist differential diagnosis. Describe and define the commonbenign anorectal diseases) (Haemorrhoids, Fissures, Fistulas, abscesses and Pilonidal disease). Order clinically oriented investigations to reach the final diagnosis. Describe briefly the line of management of each different type of benign anorectal diseases. Suggested Reading: Baily & Love Short Practice of Surgery 26th Ed. 5. 6.

Explanation / Answer

4.Hemorrrhoids:THey are swollen veins in the lowest part of the rectum and anus.Sometimes the walls of these blood vessels stretch so thin that the veins bulge and get irritated,especially during poop.Swollen hemorrhoids are also called as Piles.They are one of the most common causes of rectal bleeding.

Fissure:An anal fissure is a small tear in the thin,moist tissue that lines the anus.An anal fissure may occur when passing hard or large stools during a bowel movement.Anal fissures typically cause pain and bleeding with bowel movements.

Fistula: It is an abnormal connection between two hollow spaces such as blood vessels,intestines or other hollow organs.Fistulas are usually caused by injury or surgery,but they can also result from an infection or inflammation.Fistula is generally a disease condition but they may be surgically created for therapeutic reasons.

An anal abscess is a painful condition in which a collection of pus develops near the anus.Most of the anal abscess are a result of infection from small anal glands.Most common type of abscess is perianal abscess.It is located in deeper tissues are less common and may be less visible.

Pilonidal disease is achronic skin in the crease of the buttocks near the coccyx.It is more common in men than women often occurs between puberty and age 40.Obesity and thick,stiff body hair make people prone to pilonidal disease.

5.Physical examination,Digital rectal examination,anoscopy or proctoscopy,imaging studies like fistulography ,MRI,Histopathological examinations,clinical pathology and microbiology examinations to be done for the diagnosis of anorectal diseases.

6.A patient with a perirectal abscess should be admitted to the surgical service unless other medical conditions or complications from the abscess necessitate a primary medical admission, with the surgeon acting as a consultant. Consider admitting a patient with a perirectal abscess to a medical service with the surgeon as a consultant should be considered if the patient is elderly, febrile, hypotensive, or immunocompromised or has significant comorbidities.

The main contraindication to surgery for an anal fissure is impaired fecal continence, a state that could be exacerbated by surgery. This contraindication mostly applies to patients with minor incontinence (occasional seeping). Patients with gross fecal incontinence (solid material) rarely develop fissures; however, those with irritable bowel syndrome and incontinence to liquid stool can develop fissures if they become constipated. These patients are at the most risk for surgical treatment of an anal fissure

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