studentRevisionCourseBenignAnalAndColonicDisease-1

studentRevisionCourseBenignAnalAndColonicDisease-1 - Benign...

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Oxford Colorectal Benign Anal and Colonic Disorders Bruce George John Radcliffe Hospital 16-6-04
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Oxford Colorectal Anatomy revision
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Oxford Colorectal Factors contributing to normal bowel function Colonic transit Ability to evacuate Mechanical barrier Sensation CNS co- ordination
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Oxford Colorectal Symptoms of anal pathology Anal pain Bleeding Discharge Swelling Itching Leakage Urgency
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Oxford Colorectal Examination Examination General Abdominal Inspection at restsoiling, excoriation, scars, patulous, guttering squeeze straining perineal descent Rectal examination Proctoscopy and sigmoidoscopy
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Oxford Colorectal Investigations Investigations Anal canal pressures Sensation Pudendal nerve latency Endoanal ultrasound Rarely: MRI anorectum MRI spine ambulatory pressures
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Oxford Colorectal Causes of Anal Pain FISSURE ABSCESS PILES (thrombosed)
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Oxford Colorectal ANAL FISSURE
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Oxford Colorectal Anal fissure Linear ulcer below dentate line midline (if multiple/lateral think of Crohn’s disease) Anal pain During + after defaecation Bleeding Bright red/spotting
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Oxford Colorectal Management Most acute fissures heal spontaneously Assisted by bulking laxatives Non-constipating analgaesica ?lignocaine gel Chronic fissures associated with internal sphincter hypertonia Above + reduction in IAS tone
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Oxford Colorectal Methods of reducing IAS tone Surgical Anal stretch Internal sphincterotomy Pharmacological GTN botulinum
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Oxford Colorectal Anal abscess and fistula Acute and chronic manifestations of the same disease proess ACUTE = ABSCESS CHRONIC = FISTULA
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Oxford Colorectal Perianal abscess acute infection originating in anal gland
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Oxford Colorectal Natural history of perianal abscess Drainage via anal gland resolution Drainage via abnormal route Resolution of abscess Creation of fistula Intersphincteric Trans-sphincteric others
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Oxford Colorectal
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Oxford Colorectal
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Oxford Colorectal Symptoms Abscess severe anal pain Fistula recurrent discharge cycles of pain/discharge
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Oxford Colorectal
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Oxford Colorectal not
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Oxford Colorectal Traditional treatment of anal fistula
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Oxford Colorectal
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Oxford Colorectal
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Oxford Colorectal
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Oxford Colorectal
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Oxford Colorectal
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Oxford Colorectal piles Swollen or fragile anal cushions
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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studentRevisionCourseBenignAnalAndColonicDisease-1 - Benign...

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