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Common anorectal conditions

Common anorectal conditions. Dr/Fatma AL-thubaity Surgical consultant Assisstant professor. Haemorrhoides. A venous plexus draining into the superior haemorrhoidal vein & a small branch of the superior rectal artery surrounded by areolar tissue. Cushion of vascular tissue. Position Sex

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Common anorectal conditions

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  1. Common anorectal conditions Dr/Fatma AL-thubaity Surgical consultant Assisstant professor

  2. Haemorrhoides • A venous plexus draining into the superior haemorrhoidal vein & a small branch of the superior rectal artery surrounded by areolar tissue. • Cushion of vascular tissue .

  3. Position • Sex • Internal & external piles. • degrees

  4. Left lateral,right anteriolateral & posterolateral positions.

  5. Classification of internal hemorrides • 1-bulge into the lumen with or without painless bleeding. • 2-protrude with bowel movement & reduce spontaneously. • 3-protrude spontaneously (manual replacement). • 4-permanently prolapse and irreducible.

  6. Venous congestion ==increase in venous pressure : Straining at stool. Alteration in haemodynamics during pregnancy.

  7. Heridity. • Erect posture. • Absence of valves within the hemorrhoidal sinusoides. • Aging (deterioration of anal supporting tissues). • Internal sphincter abnormalities.

  8. Clinical features • Itching & perianal irritation. • Bleading. • Prolapse.

  9. treatment • Increase diatery fibers. • Bulk laxative. • Injections of phenol in almond oil. • Ligation with rubber band (Barron s bands). • Cryoprobe. • Lord s procedure. • Haemorrhoidectomy.

  10. Milligan-Morgan haemorrhoidectomy.

  11. Complications • Bleading. • Anal stenosis.

  12. RECTAL PROLAPSE • rectal intussception &poor sphincter tone.

  13. Clinical features • Mucus discharge. • Bleading. • Incontinence.

  14. Treatment • Rectopexy. • Ripstein operation (the mobilized rectum is supported in the hollow of the sacrum with a Teflon sling. • De Loirmes operation.

  15. Perianal haematoma

  16. Anal Fissure • A longitudinal tear in the mucosa of the anal canal due to local trauma sustained while evacuating a constipated stool.

  17. Inflammatory bowel disease. • Tuberculosis. • Syphilis. • AIDS.

  18. Midline posteriorly. • Sentinel pile.

  19. Internal anal sphincter • Thickining of the circular smooth muscle in the lower part of the rectum.

  20. External anal sphincter • Skeletal muscle(subcutaneous,superficial &deep).

  21. Treatment • Lateral internal sphictretomy.

  22. Perianal infections • Infections start in the anal glands which lie between internal & external sphincters. • Glands normally drain into the anal canal at the level of anal valves.

  23. Perianal abcess • A painful inflamed lump adjacent to the anal margin.

  24. Causes of perianal abcess/fistula • Crhon s disease. • Carcinoma of anus & rectum. • Tuberculosis. • HIV. • Actinomycosis. • Radiation. • Trauma. • Foreign body.

  25. Ischiorectal abcess

  26. Pararectal abcess

  27. Pilinoidal abcess

  28. Perianal warts • Condyloma acuminatum. • HPV

  29. Fistula-in-ano • Perianal abcesses which discharge spontaneously into the anal canal or are inadequately drained.

  30. AETIOLOGY • Non specific infections. • Inflammatory bowel disease. • Tuberculosis.

  31. Goodsall s rule • External opening posterior to a transverse line that bisects the anus will connect to posterior midline crypt. • External opening anterior to this line will communicate to an anterior crypt by a short direct tract.

  32. Treatment • Fistulotomy. • A seton.

  33. Pilinoidal sinus • Nest of hairs . • Upper end of the natal cleft. • Hirsute men.

  34. THANK YOU

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