Diseases of the Anus Rev#1C

8/14/2019 Diseases of the Anus Rev#1C

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LEARNING OBJECTIVESLEARNING OBJECTIVES

Enumerate the common anal diseasesEnumerate the common anal diseases

among Filipinos seen at the OPD.among Filipinos seen at the OPD.

Discuss the etiology, surgical anatomyDiscuss the etiology, surgical anatomy

and classification of these conditions.and classification of these conditions.

Discuss the signs and symptoms,Discuss the signs and symptoms,

diagnosis and treatment modalities ofdiagnosis and treatment modalities of

the common anal conditions.the common anal conditions.


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Diseases of the AnusDiseases of the Anus

COMMONCOMMON

HemorrhoidsHemorrhoids

Fistula in AnoFistula in Ano Anal FissureAnal Fissure

UNCOMMONUNCOMMON

Anal WartsAnal Warts

Anal TBAnal TB

Rectal ProlapseRectal ProlapseAnorectal TumorsAnorectal Tumors

Pilonidal SinusPilonidal Sinus

Hidradenitis SuppurativaHidradenitis Suppurativa


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Symptomatology of AnalSymptomatology of Anal

ConditionsConditions

Rectal bleedingRectal bleeding

Peri-anal dischargePeri-anal discharge

Prolapsing massProlapsing mass Pain on defecationPain on defecation

PruritusPruritus

Feeling of incomplete evacuationFeeling of incomplete evacuation


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Rectal ExaminationRectal Examination


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DIAGNOSTIC TESTSDIAGNOSTIC TESTS


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Adult and Pediatric Proctosigmoidoscope; Anoscope


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Flexible Colonoscope


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Normal

Colonoscopy


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Abnormal Colonoscopy

Polyp w/ stalk

Sessile polyp

Colon Cancer


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DIAGNOSTIC TESTSDIAGNOSTIC TESTS

Barium enemaBarium enema


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Endorectal and Endoanal Ultrasonography


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Recurrent fistula-in-ano with posteriorly

located tract and internal openning


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Recurrent Fistula in Ano with posteriorly located track

visualized after instillation of hydrogen peroxide


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HemorrhoidsHemorrhoids


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Recommended TreatmentRecommended Treatment

for Hemorrhoidal Diseasefor Hemorrhoidal Disease

Grade IGrade I - Conservative treatment- Conservative treatment

Grade IIGrade II - Conservative or- Conservative or

Rubber band ligationRubber band ligation

Grade IIIGrade III - Rubber band ligation or- Rubber band ligation or

HemorrhoidectomyHemorrhoidectomy

Grade IVGrade IV - Hemorrhoidectomy- Hemorrhoidectomy

(excision or stapled)(excision or stapled) Mostly outpatient except forMostly outpatient except for

complicated casescomplicated cases


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Banded Internal Hemorrhoid


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InfraredInfrared

PhotocoagulationPhotocoagulation


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STAPLEDSTAPLED

HEMORRHOIDECTOMYHEMORRHOIDECTOMY


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STAPLEDSTAPLED

HEMORRHOIDECTOMYHEMORRHOIDECTOMY


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hemorrhoidectomyhemorrhoidectomy

Harmonic scalpel Ultrasonic activated instrument

(Ultracision)

-Vibrates at 55,000/sec-Minimal lateral thermal injur< 1:5 mm


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Anal fissuresAnal fissures


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Recommended TreatmentRecommended Treatment


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Recommended TreatmentRecommended Treatmentforfor

Anal FissureAnal FissureAcute fissureAcute fissure - Conservative treatment- Conservative treatmentNitroglycerine ointmentNitroglycerine ointment

Chronic fissureChronic fissure - Lateral internal- Lateral internal

sphincterotomysphincterotomy

with or without excision of the analwith or without excision of the analfissurefissure


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Open sphincterotomyOpen sphincterotomy


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Closed SphinterotomyClosed Sphinterotomy

C t l d lCryptoglandular


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CryptoglandularCryptoglandular

InfectionsInfections Anal AbscessesAnal Abscesses

PerianalPerianal

Ischiorectal / Deep Post-AnalIschiorectal / Deep Post-Anal

IntersphinctericIntersphincteric

Fistula-in-AnoFistula-in-Ano


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Perianal AbscessPerianal Abscess


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Complicated AbscessComplicated Abscess


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Fourniers DiseaseFourniers Disease


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General Care forGeneral Care for


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General Care forGeneral Care for

Anorectal ConditionsAnorectal Conditions

High fiber diet or fiber supplementsHigh fiber diet or fiber supplements

Avoid constipationAvoid constipation

Perianal hygienePerianal hygiene

Warm sitz bathsWarm sitz baths Analgesics as indicatedAnalgesics as indicated

Generally no antibiotics requiredGenerally no antibiotics required

Avoid rectal exam in patients with severeAvoid rectal exam in patients with severepain!pain!

Postop Care for AnalPostop Care for Anal


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Postop Care for AnalPostop Care for Anal

ConditionsConditions High fiber diet or fiber supplementsHigh fiber diet or fiber supplements Avoidance of constipationAvoidance of constipation

Perianal hygienePerianal hygiene

Warm sitz bathsWarm sitz baths

Analgesics RTC for 2-3 days then PRN there-Analgesics RTC for 2-3 days then PRN there-afterafter

Watch for bleeding, unusual discharge, progres-Watch for bleeding, unusual discharge, progres-

sion of painsion of pain

Follow-up 1 week postop then every month tillFollow-up 1 week postop then every month tillresolution of conditionresolution of condition


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Other Anal DiseasesOther Anal Diseases


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Rectal ProlapseRectal Prolapse


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Condyloma AcuminataCondyloma Acuminata

FibroepithelialFibroepithelial


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FibroepithelialFibroepithelial

pseudopolyppseudopolyp


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Anal StrictureAnal Stricture


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Pilonidal SinusPilonidal Sinus


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Hidradenitis SuppurativaHidradenitis Suppurativa


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PerianalPerianal


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PerianalPerianal

RhabdomyosarcomaRhabdomyosarcoma


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Thank YouThank You

Diseases of the Anus Rev#1C

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