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Disease of Rectum
Disease of Rectum
REFERATH
TALAL
MOHAMMAD
Group No 52
Teacher in charge
М.И.КУГАЕВ
Vitebsk 2021
Anal fissure
An anal fissure is a painful linear tear or crack in the distal anal canal,
which, in the short term, usually involves only the epithelium and, in the
long term, involves the full thickness of the anal mucosa.
Anal fissures develop with equal frequency in both sexes; they tend to
occur in younger and middle-aged persons.
Anatomy
The exact etiology of anal fissures is unknown, but the initiating factor
is thought to be trauma from the passage of a particularly hard or
painful bowel movement.
Low-fiber diets (eg, those lacking in raw fruits and vegetables) are
associated with the development of anal fissures.
No occupations are associated with a higher risk for the development of
anal fissures.
Prior anal surgery is a predisposing factor because scarring from the
surgery may cause either stenosis or tethering of the anal canal, which
makes it more susceptible to trauma from hard stool.
Initial minor tears in the anal mucosa due to a hard bowel movement
probably occur often.
In most people, these heal rapidly without long-term sequelae.
In patients with underlying abnormalities of the internal sphincter,
however, these injuries progress to acute and chronic anal fissures.
Studies of the internal anal sphincter and of anal canal physiology have
been performed with varied results, but at least one abnormality is
likely present in the internal anal sphincter of many anal fissure
patients.
The most commonly observed abnormalities are hypertonicity and
hypertrophy of the internal anal sphincter, leading to elevated anal
canal and sphincter resting pressures.
The internal sphincter maintains the resting pressure of the anal canal;
anal-rectal manometry can be used to measure this pressure.
Most patients with anal fissures have an elevated resting pressure,
which returns to normal levels after surgical sphincterotomy.
The posterior anal commissure is the most poorly perfused part of the
anal canal.
Occasionally, a few drops may fall in the toilet bowl, but significant
bleeding does not usually occur with an anal fissure.
Physical Examination
Initially, the fissure is just a tear in the anal mucosa and is defined as an
acute anal fissure. If the fissure persists over time, it progresses to a
chronic fissure that can be distinguished by its classic features.
The fibers of the internal anal sphincter are visible in the base of the
chronic fissure, and often, an enlarged anal skin tag is present distal to
the fissure and hypertrophied anal papillae are present in the anal canal
proximal to the fissure. (See the images below.)
Laboratory Studies
Diagnostic Procedures
Treatment
Medical Therapy
First-line medical therapy consists of therapy with stool-bulking agents,
such as fiber supplementation and stool softeners.
Laxatives are used as needed to maintain regular bowel movements.
Mineral oil may be added to facilitate passage of stool without as much
stretching or abrasion of the anal mucosa, but it is not recommended
for indefinite use.
Sitz baths after bowel movements and as needed provide significant
symptomatic relief because they relieve some of the painful internal
sphincter muscle spasm.
Recurrence rates are in the range of 30-70% if the high-fiber diet is
abandoned after the fissure is healed. This range can be reduced to 15-
20% if patients remain on a high-fiber diet.
Hemmoroids
Hemorrhoids also called piles, are swollen veins in your anus and lower
rectum, similar to varicose veins. Hemorrhoids can develop inside the
rectum (internal hemorrhoids) or under the skin around the anus
(external hemorrhoids).
Nearly three out of four adults will have hemorrhoids from time to time.
Hemorrhoids have a number of causes, but often the cause is unknown.
External hemorrhoids
These are under the skin around your anus. Signs and symptoms might
include:
Internal hemorrhoids lie inside the rectum. You usually can't see or feel
them, and they rarely cause discomfort. But straining or irritation when
passing stool can cause:
Severe pain
Swelling
Inflammation
A hard lump near your anus
When to see a doctor
Causes
The veins around your anus tend to stretch under pressure and may
bulge or swell. Hemorrhoids can develop from increased pressure in the
lower rectum due to:
The best way to prevent hemorrhoids is to keep your stools soft, so they
pass easily. To prevent hemorrhoids and reduce symptoms of
hemorrhoids, follow these tips:
Diagnosis
Home remedies
You can often relieve the mild pain, swelling and inflammation of
hemorrhoids with home treatments.
Medications
Paraproctitis
Paraproctitis is a purulent inflammation of the
cellular tissues surrounding the rectum. The most frequent cause is
penetration of bacterial flora from the rectum into the surrounding
cellular tissues, which may occur through an anal fissure. The
inflammation is sometimes limited to the formation of an anorectal
abscess, and in some cases it spreads for a considerable distance and
may be complicated by sepsis.
The symptoms are acute pain in the rectal region, tenderness
during defecation, elevated body temperature, and the appearance of
an infiltrate in the anal region or on the buttocks. An unlanced abscess
may burst and a fistula form. The disease becomes chronic after
recurrences. Treatment includes administration of antibiotics and anti-
inflammatory agents and, in the suppurative stage, surgical lancing of
any anorectal abscess.
Reference List
https://www.google.by/search?
hl=en&sxsrf=ALeKk021rsqrtI38L_NVOtotzNSfd9-ZwA
%3A1614620820069&source=hp&ei=lCg9YMTaAcG5kwWO9aegCw&ifl
sig=AINFCbYAAAAAYD02pLJePWfgDDhS4HlwAWekGakPY66-
&q=paraproctitis&oq=pa&gs_lcp=Cgdnd3Mtd2l6EAEYADIECCMQJzIECC
MQJzIECCMQJzIECAAQQzIECAAQQzICCAAyCAguEMcBEKMCMgIIADICC
AAyCAguEMcBEKMCOgcIIxDqAhAnOgcILhDqAhAnUIMHWLMIYIYdaAB
wAHgBgAGxDIgBwx2SAQc2LTEuMS4xmAEAoAEBqgEHZ3dzLXdperABCg
&sclient=gws-wiz
https://en.wikipedia.org/wiki/Paraproctitis#:~:text=Paraproctitis%20is
%20a%20purulent%20inflammation,occur%20through%20an%20anal
%20fissure.
https://www.mayoclinic.org/diseases-
conditions/hemorrhoids/symptoms-causes/syc-20360268