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Benign Anorectal Disease

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Benign Anorectal Disease

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    1. Benign Anorectal Disease David J. Orcutt MD Paul M. Tender MD

    2. Benign Anorectal disease Hemorrhoids Fissure-in-Ano Anorectal Abscess/Fistula-in-Ano

    3. Anorectal Anatomy

    4. Anorectal Physiology

    5. Hemorrhoids Definition Not varicosities “Vascular cushions” arterioles, venules, thick submucosa, smooth muscle, connective tissue Normal anatomy ? Continence ?

    6. Hemorrhoids Predisposing factors Change in bowel habits diarrhea or constipation Pregnancy ? hormonal

    7. Hemorrhoids

    8. Hemorrhoids Nonoperative Treatment diet eliminate straining Minor Procedures rubber band ligation Sclerotherapy phenol oil, sodium morrhuate, quinine urea Infrared Photocoagulation

    10. Three quadrant hemorrhoidectomy:

    13. Strangulated Hemorrhoids:

    15. Fissure-in-Ano Clinical features Tearing, sharp stabbing Bleeding linear ulcer/crack Post midline (90%) female ant midline (10%) Etiology Anal trauma Hard/constipating stool

    16. Fissure-in-Ano Pathogenesis Viscous Cycle crack/tear-> pain-> int anal spincter spasm-> decreased blood flow-> ischemia Treatment Acute Avoidance of constipation sitz baths +/- creams, ointments

    17. Fissure-in-Ano Treatment Acute(cont) Nitroglycerin (0.2%) Diltiazem (2.0%) Recurrence 25%-30%

    18. Fissure-in-Ano Chronic Failure of conservative treatment exposed sphincter sentinel pile hypertrophied anal papilla

    20. Anorectal Abscess/Fistula-in-Ano Pathogenesis Infected anal gland

    21. Anorectal Abscess/Fistula-in-Ano

    22. Anorectal Abscess/Fistula-in-Ano

    23. Fistula-in-Ano

    24. Fistula-in-Ano Treatment Fistulectomy/Fistulotomy Fibrin Glue Advancement Rectal Flap

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