Teaching Plan 7

versailles

Anus and Rectum Exam

Anal canal  

2.5-4cm long Surrounded by two concentric striated muscles: External sphincter--voluntary Internal sphincter--involuntary

rectum  

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Terminal 12cm of colon Rectosigmoid junction →rectal ampulla →entrace to the anal canal Three semilular transverse fold—valves of Houston Upper two-thirds:covered by peritoneum Anterior peritoneal reflection: Men—rectovesical pouch: 7.5cm to anal orifice Women—rectouterine pouch: 5.5 cm to

Examination of anus and rectum

Examine position..\..\ 教学相关 图片 \常用检查 体位 .rm

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Left lateral prone (Sims) Bent-over-table position Lithotomy position Knee-chest or knee-elbow position

Knee-chest or knee-elbow position

Left lateral prone (Sims)

Lithotomy position

Bent-over-table position

inspection..\..\教学相 关图片 \肛门 视诊 .rm ♣ Patient position and preparation Left lateral decubitus position Assistant or patient spreads glutei ♠ Findings on Inspection

肛裂 瘘

Anal Fissures

Anal fistula Perianal dermatitis Anal mass

External Hemorrhoid Condyloma … ..

湿疣

外痔

Anal palpation..\..\教学相 关图片 \ 肛门触 诊 .rm

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First step: Gloving booth hands Palpate for: Perineum around orifice of sinuses and fistula →subcutaneous cords → direction of tracks Bulges in perineal tissue Fluctuant or tender abscess

Anal palpation    

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Secondly: Lubricate gloved examining finger Place pad on anal sphincter Exert gentle pressure, direct inward and somewhat anteriorly, until sphincter relaxes, admitting the pad followed by the tip of finger Gradually insert finger as far as possible

Anal palpation

attention 

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The anal canal slants anteriorly, so remember, when inserting a finger or instrument, the axis of entry sould point toward the umbilicus Proper examination-not painful To feel abscess causing a fistula:use bidigital palpation between index finger in canal and thumb on the skin of perineum

Rectal palpation  

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Continuation of palpation of the anal canal male: rectoanal junction → ampulla →anterior wall (prostate gland, seminal vesicles, rectovesical pouch) →poterior wall (sacrum and coccyx) →lateral walls Female: rectoanal junction → ampulla →anterior wall (uterine cervix, uterine fundus, rectouterine pouch) →poterior wall (sacrum and coccyx)

WHAT IS AN ANAL FISSURE? An anal fissure is a small tear or cut in the skin lining the anus which can cause pain and/or bleeding.

A thin slit-like tear in the anal tissue, an anal fissure is likely to cause itching, pain, and bleeding during a bowel movement.

ANAL FISSURE

ANAL FISSURE

The typical symptoms of an anal fissure are extreme pain during defecation and red blood streaking the stool. Patients may try to avoid defecation because of the pain.

How is it diagnosed? The diagnosis of an anal fissure is made by examination of the anus and anal canal. The tear usually is easy to see, although occasionally a small viewing instrument, called an anoscope, may be used in the evaluation.

What Are Hemorrhoids 痔?

The term hemorrhoids refers to a condition in which the veins around the anus or lower rectum are swollen and inflamed. Hemorrhoids may result from straining to move stool. Other contributing factors include pregnancy, aging, chronic constipation or diarrhea, and anal intercourse. Hemorrhoids are either inside the anus (internal) or under the skin around the anus (external).

Inflammatory hemorrhoids

Thrombotic hemorrhoids

Mixed hemorrhoids

Incarcerated mixed hemorrhoids

What Are the Symptoms of Hemorrhoids?

Although many people have hemorrhoids, not all experience symptoms. The most common symptom of internal hemorrhoids is bright red blood covering the stool, on toilet paper, or in the toilet bowl. However, an internal hemorrhoid may protrude through the anus outside the body, becoming irritated and painful. This is known as a protruding hemorrhoid.

Internal hemorrhoids occur higher up in the anal canal, out of sight. Bleeding is the most common symptom of internal hemorrhoids, and often the only one in mild cases.

Sometimes, internal hemorrhoids will come through the anal opening when straining to move your bowels. This is called a prolapsed 脱垂 internal hemorrhoid; it is often difficult to ease back into the rectum, and is

Symptoms of external hemorrhoids may include painful swelling or a hard lump around the anus that results when a blood clot forms. This condition is known as a thrombosed external hemorrhoid.

In addition, excessive straining, rubbing, or cleaning around the anus may cause irritation with bleeding and/or itching, which may produce a vicious cycle of symptoms. Draining mucus may also cause itching.

External hemorrhoids are visibleoccurring out side the anus. They are basically skin-covered veins that have ballooned and appear blue. Usually they appear without any symptoms. When inflamed, however,

When a blood clot forms inside an external hemorrhoid, it often causes Severe pain. This thrombosed external hemorrhoid can be felt as a firm, tender mass in the anal area,

Fistula in Ano 

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Arise from abscess in the anal crypts and track to the perianal skin Internal orifices of the track—above the pectinate line Can be probed palpation--subcutaneous cord Multiple fistulas suggest Crohn disease

Fistula in Ano

endoscope

endoscope

endoscope

Operation of anal fistula

Operation of anal fistula

Operation of anal fistula

Caneration of fistula

Rectal prolapse Mucosa evert below sphincter ( when defecate)  To demonstate: squat and strain in the position for defecation 

Rectal prolapse of child

Rectal prolapse

Rectal prolapse

Perianal abscess

Cancer of anal canal