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Anal Problems

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First 15cm on rigid sigmoidoscopy Levator ani Internal sphincter (autonomic) External sphincter (voluntary) Vascular cushions Anal Problems Anal Canal Upper Superior ... – PowerPoint PPT presentation

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Title: Anal Problems


1
Anal Problems
  • First 15cm on rigid sigmoidoscopy
  • Levator ani
  • Internal sphincter
  • (autonomic)
  • External sphincter
  • (voluntary)
  • Vascular cushions

2
Anal Canal
  • Upper
  • Superior rectal av
  • (inf. mesenteric)
  • Inf. mesenteric lymph.
  • autonomic
  • Lower
  • Inferior rectal av
  • (internal iliac)
  • Superf. inguinal lymph.
  • somatic

3
Ano-rectal pain and bleeding
PAIN
Fissure-in-ano
Haemorrhoids
Perianal haematoma
Perianal abscess
Tumour of the anal margin
BLEEDING (bright red)
Haemorrhoids
Fissure-in-ano
Colon and rectal ca.
Diverticular disease
Ulcerative colitis
4
Haemorrhoids
  • Symptoms and Signs
  • Bright red rectal bleeding,
  • prolapse, mucus, pruritis ani,
  • pain on thrombosis, anaemia
  • Management
  • Exclude other causes of bleeding
  • Conservative, Sclerotherapy, Banding,
    Haemorrhoidectomy

5
Fistula in Ano
  • Symptoms and Signs
  • Initial abscess with discharge
  • recurrent perianal infection
  • and persistent discharge
  • Management
  • Examination under anaesthetic
  • Superficial and low-level fistulae laid open
  • High fistulae low part laid open, upper part
    tied with seton

6
Perianal Haematoma
  • Symptoms and Sign
  • Tense, smooth, dark blue, cherry-sized lump at
    anal margin
  • Acute onset, sudden pain
  • Management
  • Drainage under local anaesthetic
  • Hot baths

7
Perianal Abscess
  • Symptoms and Signs
  • Painful, tender perianal swelling
  • with discharge
  • Management
  • Examination under anaesthetic, MRI, US
  • Surgical incision and drainage
  • Antibiotics

8
Perianal Warts
  • Symptoms and Signs
  • Cornified epithelial lesions
  • often in clusters
  • Discomfort, pain, pruritis ani
  • Management
  • Most resolve spontaneously (2 years)
  • Silver nitrate / podophyllin
  • Curettage

9
Anal Carcinoma
  • Symptoms and Signs
  • Anal verge palpable mass,
  • pain, bleeding, discharge,
  • pruritis ani
  • Anal sphincter incontinence
  • Management
  • EUA, sigmoidoscopy, biopsy
  • Early radiotherapy (inc. inguinal lymphatics)
  • Late surgery, colostomy

10
Rectal Prolapse
  • Symptoms and Signs
  • Discomfort, bleeding and mucus on defecation,
    tenesmus, incontinence, protrusion
  • Management
  • Conservative
  • Surgical

11
Problems in Childhood
  • Imperforate anus (with fistulation)
  • 1/5000 new-born infants, especially males
  • Partial rectal prolapse
  • Confined to the mucosa, self-curing
  • Congenital megacolon /Hirschprung disease
  • Absent distal autonomic ganglion cells in
    myenteric plexus

12
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