1) Inspection & palpation of the perineum 2) Per-rectal ...
Transcript of 1) Inspection & palpation of the perineum 2) Per-rectal ...
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Ano-rectal examination
1) Inspection & palpation of the perineum
2) Per-rectal examination (PR)
3) Anoscopy
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Localization &Recording
Anal verge Dentate line
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Privacy & Witness
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Instruments
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Patient’s position & Exposure
90
90-100
10cm
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Inspection & Palpationof
the perineum
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Inspection & Palpationof
the perineum
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Per Rectal Examination(PR)
Umbilicus
100
4cm
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Per Rectal Examination(PR)
Umbilicus
100
4cm
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Per Rectal Examination(PR)
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Anoscopy
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Anoscopy
4cm
100
Umbilicus
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Anoscopy
4cm
100
Umbilicus
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The most common benign anal-rectal diseases
1-Hemorrhoids(piles)
2-Anal fissure
3-Anorectal abscess and
4-Fistula-in-ano
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Hemorrhoids
• • EH: distal to dentate, covered
• by anoderm, PAIN &LUMP
• • IH: prox. to dentate, covered by
• mucosa, PAINLESS BLEEDING
• Combined hemorrhoids
• • PE: make sure to evaluate
• with straining, complete AR
• exam.
37
11
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Ext. HemorrhoidsThrombosed
Ext. Hemorrhoids
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1) Conservative management:bulking agents,NSAIDS,topical agents and
warm sitz baths
2) Less likely surgery: deroofing of the thrombosed external hemorrhoids
Treatment of External hemorrhoids
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Internal Hemorrhoids: Grade
Degrees of internal hemorrhoids1- First degree : Bleeds, but does not prolapse.2- Second degree :protrudes with straining; reduces
spontaneously.3- Third degree : Spontaneous protrusion ; need
manual reduction.4- Fourth degree : Irreducible to manual reduction
(constantly outside)
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Internal Hemorrhoids (cont.)
Diagnosis:• Painless anorectal
• bleeding is the
main complaint in the 1st.
degree
• Prolapsing mass is the
• main feature of the 2nd 3rd
• and the 4th.degrees
• P.R and proctoscopy are mandatory to exclude secondary piles due to carcinoma.
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Treatment of Internal hemorrhoids
1) –Consevative management:It is reserved for first degree in the form of bulking agents, topical agents and vasotonic agents
(diosamine).2) - Sclerotherapy (1 – 2 ml sclerosing agent in
the submucosal space proximal to the hemorrhoids)
3) – Infrared photocoagulation4 )- Banding
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Treatment of hemorrhoid (cont.)
5 )-Traditional hemorrhoidectomy:
- Open technique of Milligan.
-Closed technique of Ferguson
6 ) - Hemorrhoidectomy using Ligasure, Harmonic scapel
7 )- Stapled Circular Hemorrhoidectomy.