Anal lesions surgical

The diagnosis of anal and perianal lesions (which are incidental disorders) can be usually clinical story only. And include the usual symptoms caused by these pests include:
· Bleeding bright red.
Pain Anal.
· Pollution underwear.
· Itching or burning sensation around the anus.
· Protrusion blocks from the mouth of the anus.
Lesions that cause symptoms "anal:
And include:
1. Hemorrhoids: transverse full of blood stand out from the mouth of the anus.
And symptoms include:
· Hemorrhage: is the most common "and happens when you stand beneath the pillows vascular lining the upper anal canal, this bag because of the pressure Tanguen fiber mill anal internal medicine. Result in additional congestion and irritation during the passage of stool bleeding to these pads, and often," What this is bleeding heavily. "chronic congestion also leads" to the magnitude of these pads. And once it returns to these vascular cushions within the anal canal (as happens with the arrest of muscle fibers and flexible under normal mucosa), stop the bleeding.
· Swellings, which stand out from inside the anal canal: it is the second presentation of the most common for hemorrhoids and classified to the degree usually 1 or 2 or 3.
· Swelling outer curd: He is one of the most common acute manifestations "in the piles, resulting from a thrombosis in one venous saccules of State in the outer part of the anal canal. Sometimes called the" (and incorrectly) Designation of hematoma around the anus. This causes the thrombosis to the emergence of tough bluish tender swelling go away automatically "within 10 days or more. Caused by the unknown.
2. Anal fissures: A crack in the skin anal extends from the dentate line to the outside, and often "associated with pagan skin edematous on the edge of Foreign Affairs (notch Guardian.) In patients with anal fissures chronic can see sometimes" circular fibers of the section bottom of the winepress anal Medicine in the depth of the slit. Anal fissures occur in the midline, and usually in the back. And that seen in another place, you may not be real anal fissure, anal ulcer, but. Is usually severely painful anal fissure during defecation and for a period of 1-2 hours later. Sometimes "mild pain may be" relatively "during the passage of stool, but occurs after severe and lasts for more than two hours (often" due to spasm winepress).
3. Multiple or chronic ulcers side effects: Less common, "and see patients with Crohn's disease and tuberculosis. And are sometimes painful ulcers Alhadma" I started demonstrations for syphilis (especially in gay males).
4. Abscesses and fistulas: perianal abscesses are usually extremely painful and can not be diagnosed only after 2-3 days into the pain because the pus be slow "in the creation of its way to the skin. Abscess usually begins with inflammation in one of the anal glands that open into the anal canal above the dentate line directly. start glands infected with sepsis usually within the winepress anal, but it may make their way between the winepress Medicine and the phenomenon. causes the pain caused by the abscess to cause spasm in the muscle mill so that the pus makes his way to the top and bottom. sometimes, "can pus caused abscess behind the line for the medium to find his way around the anal orifice, and thus becomes an abscess or a single two-sided (a horseshoe). Fistula resulting from outlying areas became Linz outside with the survival of his contact with the anal gland origin. And this is usually above the point of origin of anal adhere to, leading to the creation by Linz and contaminated permanently.
5. Inflammation of the skin around the anus: The injury of the skin around the anus perineal sepsis or inflammation leads to a sense of itching or burning. And predisposing factors include both the "From:
· Long-term contamination with fecal matter (poor communities healthy. ")
· Sensitivity of the skin (often "associated with skin lesions elsewhere in the body).
· Trauma caused by constant scratching.
Applying vehicles high sensitivity (especially topical drugs).
· Escort anal lesion, such as hemorrhoids or anal fissures or anal fistula.
6. Malignancies: can low-rectal carcinoma to grow down to infect the anus, and are usually few symptoms until the advanced stage of disease.
Include other less common malignancies, "both" of squamous cell carcinoma and malignant melanoma of the anus. Are usually squamous cell carcinoma in the painful early stage and may be confused diagnosed with hemorrhoids or anal fissure. Therefore, cases of chronic anal pain when the elderly should require an examination under general anesthesia with biopsy.
7. Worms: Tapeworms are most of the parasites that give the symptoms "anal, especially itching.
8. Anal warts (Alalghemoma acuminata) caused by viruses Ahalimomcih. The anal warts are usually transmitted through contact Asamimi (not necessarily at the same-sex).
9. Landing and do not adhere to: When patients with severe degree of hemorrhoids (piles degree 3), can fall in the mucous membrane that gives the scene "like" land full thickness rectal (prociedentia). But in hemorrhoids hanging, the examiner can not enter his finger between the landing between the mill and anal.
The decline is real common, "relatively" in childhood and is usually associated with constipation. And usually requires little treatment and tends to fall away on its own as soon as constipation. The decline is considered rectal common "in the elderly and often" is associated with lack of devotion. Sagging is caused in part by "the weakness of the winepress, and in part" for relaxation of lateral support of the fabric straight.
Can leak through the anus and do not adhere to that caused by the muscle of the anus or the winepress Tasebha who may suffer damage or because of illness. And is not to adhere to continuous since childhood is usually due to "the scourge of defects. The infant direct anal relatively rare," but may be due to overlap of Surgeons (inappropriate treatment of non-perforation of the anus / episiotomy during childbirth / left fistula anal deep open "or treatment violent hemorrhoidal disease through the expansion of the hand of the anus). The neurological disorders that cause lack of devotion to include demyelinating disease Nkhaaan and do not adhere to an unknown reason in the elderly.
Assessment of anal symptoms:
1. Medical history: The underlying cause of the difficulties that accompany the diagnosis of anal lesions is a shame in the patients described their symptoms in detail. Doctor should not accept the patient's description of his complaint as projections spherical, but must have a precise description of symptoms, as the bleeding anal may often "caused by hemorrhoids, but it may also be a" sign "to neoplasia Kasi in the large intestine.
Patients complain of internal hemorrhoids they see blood, "bright red fall after leading natural undyed blood. And stop bleeding as soon as the return to prominence within the anal canal and anal shrinking winepress.
The bleeding rarely "What is falling in anal fissures and are usually associated with the subject of severe pain during defecation. And the blood is also" bright red, but it usually appears only on the tissue paper. And rarely "What is happening in anal fissures pain spontaneously." Even if the pain persists for about 1-2 hours, but it does not come back only when the following defecation.
2. Clinical manifestations: The careful clinical examination with adequate lighting is "necessary." And only the existence of good lighting with the abduction of the two mechanisms can be warned not to assess the presence of inflammation of the skin around the anus or the presence of internal fistula opening. And meditation is a division with caution to the skin of the anus best way to assess the presence of anal fissure.
Probing the skin of the perineum assist in the evaluation of external hemorrhoid coagulated, and placed in the area of ​​maximum tenderness perianal abscess, fistula, and the direction of trajectory. The finger is surrounded by good Bmzelq more sensitive than the finger dry.
Tapeworms can be seen on the surface of the stool to talk, and can be easily seen on the surface of the stool in the rectum during endoscopy Seine. And eggs can be distinguished tissue "in a sample of stool.
3. Theory: It includes:
· Anoscopy (proctoscopy) and uses the tool length of 4 cm with the source of light and open-ended, this end can be straight (to reflect the diagnostic channel anal) or curved (which allows for part of the anal canal the top that hangs to the end of the tool ). And this device is useful "in the treatment of internal hemorrhoids by injection or coagulation of photosynthesis.
· Rectal endoscopy (colonoscopy Seine) and uses the tool length of 25 cm with a solid source of light and a window for air intake at the end, with a few of the larger picture. Used in the rectum so that the inflatable is used telescope in the fecal material and the anal valves.
· Seine flexible endoscopy (colonoscopy colon) is not commonly used in the diagnosis of anal and perineal lesions, but should be resorted to as long as there is a complaint rectal bleeding. Sometimes "be limited to the Seine and rectal endoscopy in the diagnosis is" practical ", but keep in mind that the cancer-rays can be associated with anal or rectal lesion.
4. Other surveys: There are quality surveys are required when Zake Symptoms include anal or not adhere to or landing. These include surveys and measurements of pressure in the anal sphincter (and which are measured using the winepress anal inner tube open end, or a small balloon). And there is increasing use of ultrasound imaging through the anus and pelvic MRI to determine the extent and depth of the tumors and the spread of forest septic foci.
Treatment
The treatment primarily on the diagnosis, but also "depends on the symptoms.
1. Hemorrhoids: treatment include:
· Medical treatment: including ways to control the tension during bowel movements. Patients should address the factors that increase the size of the stool and toilet, such as vegetables and fruit, and can support the facilitator to add salt to prevent excessive dehydration in the stool. Well advised not to postpone defecation when needed, and not to resort to pulling back during defecation and try to pass the last piece of feces. These tips can control the symptoms in more than 50% of patients in the early stages of hemorrhoids.
The topical use of the baths are widely spread, whether "by doctors or by the patient himself. And many patients contend that these uses have led to the healing of topical hemorrhoids have, but it is very difficult to" understand the pharmacological mechanism for this to happen. And is the primary use is to have a moisturizing internal hemorrhoids or falling folds of skin, and thus prevent pain while walking.
· Conservative treatment: The conservative treatment of internal hemorrhoids the basic install (hardener) hemorrhoidal vascular tissue within the anal canal to prevent him from landing through the anus, or to prevent the falling of the drop-down the mucous and congestion Alanakal the wheels inward anal long.
And study:
1. Install the mucous: The interstitial injection of phenol extended oil is easy and painless if the injection within the base of the hemorrhoid with certainty. And must use a special needle to avoid the risk of injection depth is a plus, especially for the front where they can be infected prostate or vagina.
Can be installed mucous also "by pulling the mucous at the base of the hemorrhoid using a bundle of flexible rubber or by sabotage by a bundle subversive or coagulation or freezing of degrees - 80 degrees Celsius. And is the use of tie rubber most effective way and the most useful in the elderly with mucous lean. But when younger patients, "can be linked to cause pain," and consequently bleeding "may occur in 1% of patients. Occurs coagulation light pain "less and does not cause bleeding following. So is the simplest way to treat hemorrhoids grade 1 and 2, especially when young, because of its speed and simplicity and freedom from complications. Can be coagulation base of all hemorrhoids basic At therapeutic First . and requires about 20% of the patients to additional treatment is usually performed after 6-8 weeks, go away as soon as the swelling caused by the initial burn.
And very important "to remember here that if the complaint is rectal bleeding and diagnosis showed the presence of internal hemorrhoids, you must re-evaluate the patient in the absence of control of bleeding, which can detect polyps or carcinoma at a higher level in the large intestine.
2. Prevent congestion: can prevent congestion pillow vascular falling (caused by the end of the lower shrinking of the mill internal) either by stretching the anus manually "(and sometimes called" inappropriate expansion of the manual), or by cutting parts of the surface of the winepress of Interior at the edge side (time 3) of the anal canal. With both cases and can result in the non-Astmsak anus.
· Radical surgical treatment: About 20% of patients who were referred to the clinic hemorrhoids surgical need for surgical interference for the eradication of hemorrhoids. Process is an effective eradication of hemorrhoids in the elderly with Masrat weak and who is to have less pain after surgery. Also recommended surgery for young patients with large hemorrhoids that continue to emerge despite the attempts of conservative treatment. And there remains the possibility here of a lack of devotion.
Process can eradicate the hemorrhoids to be open (when leaving the wound open, "to heal by granulation) or closed (when the incision skin anal and some anatomical submucosa and then suture). There are currently" supporters advocate using the laser in the destruction of hemorrhoids because of the results of the best . Brenngham In English, the results were compared with the use of laser versus traditional use in the eradication of hemorrhoids, and found to be equally effective. But it seems that the use of painful "less after surgery and the patient can be kept for one day in the hospital after surgery. And where that is cheaper than therapy Ballaser, so it is now our best option in the eradication of hemorrhoids. There is no need for linking or sewing, and the wounds dry At the end of the surgery so that there is a need for bench or dressing after surgery.
2. Anal fissures:
· Medical treatment: medical treatment do not have a lot to offer in the management of anal fissures. However, the demise of constipation in children leads to spontaneous healing. And can be used topical anesthetic creams to a short period of the disappearance of symptoms. However, continued use in chronic anal fissures, or may result in recurrent (especially for adults) to the induction of skin sensitivity and is not considered practicable, "such as surgical treatment of the province.
· Surgical treatment: and include the treatment of anal spasm and / or stenosis, which is accompanied by anal fissures. Where it disappears as soon as stenosis, anal fissures heal all about. "
Is a process of stretching (expanding) the anus is usually performed under general anesthesia. Is inserted two fingers into the anal canal and are gradually Tbadehma from each other with Tdoaarhama for stretching narrowed part of the anus. And then is inserted four fingers and a gradual expansion lasts for about 2-4 minutes.
Is a biopsy of the presses, usually through a small incision either side (lateral biopsy winepress under the skin). Manasroa osteotomy based on the idea that it is more accurate than stretching the anus, but also "is more difficult and may be followed by profuse bleeding. And sometimes" occurs sepsis and abscess develops in the region around the anus.
Swallow rate of relapse after any of the two processes is less than 10%. However, the 2-3% of patients have become able to adhere to materials for liquid or solid fecal less than it should.
3. Perianal fistulas: and study:
· Crohn's disease: is usually recommended in patients with Crohn's disease that is treated conservatively anal fistulas as the surgical treatment of deep fistulas carries with it the risk of not adhere. And may be antibiotics (especially those effective against anaerobic organisms) are useful in controlling symptoms. The effectiveness of the immune inhibitor treatment in patients with perineal form of Crohn's disease is installed, but these drugs rarely "as described.
· Fistulae other than Crohn's disease: rarely "are conservative treatment successful in the treatment of fistulas, anal other is caused by Crohn's disease. Treatment aims are to find the crater interior of the fistula, and the best way to do this include the use of spectrum for the sensor gave me a special and rare," What is portray the course of the fistula is useful. "The injection of blue Almiteleyn at the exit fistula helps in determining its course and branches. The branching only important is the open part of the anal canal. and once they are treating this branch by cutting fiber surface of the mill or through a blow to defuse a flexible, Side extensions to heal spontaneously. " And the surgeon must pay attention not to damage the winepress Medicine.
4. Inflammation of the skin around the anus or anal itching: Includes the basics of treatment are to stop the use of any allergenic substances effective hygiene and topical to the anal region through frequent washing and drying well. Must also apply astringents (such as silver nitrate or potassium permanganate solution) in the case of cracking of the anus, especially if there is a secondary fungal invasion of the facilities. But these drugs cause pigmentation of acne resistant to the hands and clothing, so often "used only on patients with hospitals. If we have sensitive skin eczematous clear, may be useful to use some products hydrocortisone weak for a limited period. However, the use of such ointments in the long term can occur damage in the skin and predispose to a secondary fungal infection.
Treatment is indicated perineal lesions associated (such as internal hemorrhoids or anal fistulas) after it is to control the acute phase of inflammation of the skin.
In the case of annoying itching night, have a systemic anti-histamines (such as Albroomatakizn during the night) effect "homes" for the itching and Mnoma "in the same time.
Children, you must doubt the existence of worms stripe, and when verified treated Balbabraszen.
5. Landing and do not adhere: and includes:
· Rectal landing: the disease tends in children regress spontaneously, because "once the control of constipation (usually by giving him a diet rich in fiber), while in the elderly often setting calls" to the surgery.
That surround the anus using a string or nylon or Teflon Selasstic or wire is full of Balachtlatat and is not recommended. Even if the substance does not cause soreness cordon gradually "toward the surface, they induce fecal impaction with the increase in non-adhere. On the other hand result in the installation of the deficit on the wall of the rectum (either" through intervention of abdominal or perineal) to good results but also increases constipation facilities. And can decrease this ratio by meeting or eradication of O. Colon left the facilities.
Not to adhere to: can not adhere to the following address directly on the infant anal winepress in most patients by tailoring direct presses made. And has become such reforms currently surgical "safer" and easier through the use of preventive antibiotics. It is possible now to "avoid herniation wound through the application of a diet free of debris for a period of two weeks, until you heal. The trauma following the births in pregnant women on the winepress anal can be associated with the removal of innervation partial presses the remaining (often" because of the stretch filleting facilities), and not be the anatomical repair of the mill here, a successful "Always."