Teaching Plan 7

versailles

Anus and Rectum Anus and Rectum ExamExam

Anal canalAnal canal

2.5-4cm long2.5-4cm long Surrounded by two concentric Surrounded by two concentric

striated muscles:striated muscles:

External sphincter--voluntaryExternal sphincter--voluntary

Internal sphincter--involuntaryInternal sphincter--involuntary

rectumrectum

Terminal 12cm of colonTerminal 12cm of colon Rectosigmoid junction →rectal ampulla →entracRectosigmoid junction →rectal ampulla →entrac

e to the anal canale to the anal canal Three semilular transverse fold—valves of HoustThree semilular transverse fold—valves of Houst

onon Upper two-thirds:covered by peritoneumUpper two-thirds:covered by peritoneum Anterior peritoneal reflection:Anterior peritoneal reflection: Men—rectovesical pouch: 7.5cm to anal orificeMen—rectovesical pouch: 7.5cm to anal orifice Women—rectouterine pouch: 5.5 cm to anal orifiWomen—rectouterine pouch: 5.5 cm to anal orifi

cece

Examination of anus and Examination of anus and rectumrectum

Examine positionExamine position..\..\..\..\教学相关图片教学相关图片\\常用检查体位常用检查体位..rmrm

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

Knee-chest or knee-elbow Knee-chest or knee-elbow positionposition

Left lateral prone (Sims)Left lateral prone (Sims)

Lithotomy positionLithotomy position

Bent-over-table positionBent-over-table position

♣♣ Patient position and preparationPatient position and preparation Left lateral decubitus position Left lateral decubitus position Assistant or patient spreads glutei Assistant or patient spreads glutei ♠ Findings on Inspection♠ Findings on Inspection Anal FissureAnal Fissuress 肛裂

Anal fistula Anal fistula 瘘 Perianal dermatitis Perianal dermatitis Anal mass Anal mass External HemorrhoidExternal Hemorrhoid 外痔

Condyloma Condyloma 湿疣…… ....

inspection..\..\教学相关图片\肛门视诊.rm

Anal palpationAnal palpation..\..\..\..\教学相关图片教学相关图片\\肛门触诊肛门触诊..rmrm

First step:First step: Gloving booth handsGloving booth hands Palpate for:Palpate for: Perineum around orifice of sinuses anPerineum around orifice of sinuses an

d fistula →subcutaneous cords → direcd fistula →subcutaneous cords → direction of trackstion of tracks

Bulges in perineal tissueBulges in perineal tissue Fluctuant or tender abscessFluctuant or tender abscess

Anal palpationAnal palpation

Secondly:Secondly: Lubricate gloved examining finger Lubricate gloved examining finger Place pad on anal sphincter Place pad on anal sphincter Exert gentle pressure, direct inward and Exert gentle pressure, direct inward and

somewhat anteriorly, until sphincter relsomewhat anteriorly, until sphincter relaxes, admitting the pad followed by the taxes, admitting the pad followed by the tip of fingerip of finger

Gradually insert finger as far as possibleGradually insert finger as far as possible

Anal palpationAnal palpation

attentionattention

The anal canal slants anteriorly, so reThe anal canal slants anteriorly, so remember, when inserting a finger or inmember, when inserting a finger or instrument, the axis of entry sould point strument, the axis of entry sould point toward the umbilicustoward the umbilicus

Proper examination-not painfulProper examination-not painful To feel abscess causing a fistula:use biTo feel abscess causing a fistula:use bi

digital palpation between index finger digital palpation between index finger in canal and thumb on the skin of periin canal and thumb on the skin of perineumneum

Rectal palpationRectal palpation

Continuation of palpation of the anal caContinuation of palpation of the anal canalnal

malemale: rectoanal junction → ampulla →: rectoanal junction → ampulla →anterior wall (prostate gland, seminal vanterior wall (prostate gland, seminal vesicles, rectovesical pouch) →poterior esicles, rectovesical pouch) →poterior wall (sacrum and coccyx) →lateral wallswall (sacrum and coccyx) →lateral walls

FemaleFemale: rectoanal junction → ampulla : rectoanal junction → ampulla →anterior wall (uterine cervix, uterine f→anterior wall (uterine cervix, uterine fundus, rectouterine pouch) →poterior undus, rectouterine pouch) →poterior wall (sacrum and coccyx) →lateral wallswall (sacrum and coccyx) →lateral walls

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

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

ANAL FISSUREANAL FISSURE

ANAL FISSUREANAL FISSURE

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

How is it diagnosed?How is it diagnosed?

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

What Are Hemorrhoids What Are Hemorrhoids 痔 ? ?

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

Inflammatory Inflammatory hemorrhoidshemorrhoids

Thrombotic Thrombotic hemorrhoidshemorrhoids

Mixed Mixed hemorrhoidshemorrhoids

Incarcerated mixed Incarcerated mixed hemorrhoidshemorrhoids

What Are the What Are the Symptoms of Symptoms of

Hemorrhoids?Hemorrhoids?

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

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

Sometimes, Sometimes, internal hemorrhoidsinternal hemorrhoids will co will come through the anal opening when strainime through the anal opening when straining to move your bowels. This is called a prng to move your bowels. This is called a prolapsedolapsed 脱垂 internal hemorrhoid; it is oftinternal hemorrhoid; it is often difficult to ease back into the rectum, aen difficult to ease back into the rectum, and is usually quite painful. nd is usually quite painful.

Symptoms of Symptoms of external hemoexternal hemorrhoidsrrhoids may include painful may include painful swelling or a hard lump aroswelling or a hard lump around the anus that results wund the anus that results when a blood clot forms. This hen a blood clot forms. This condition is known as a throcondition is known as a thrombosed external hemorrhoimbosed external hemorrhoid. d.

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

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

When a blood clot forms inside an exteWhen a blood clot forms inside an external hemorrhoid, it often causes Severrnal hemorrhoid, it often causes Severe pain. Thise pain. This thrombosed external hemthrombosed external hemorrhoid can be felt as a firm, tender morrhoid can be felt as a firm, tender mass in the anal area, about the size of a ass in the anal area, about the size of a pea. pea.

Fistula in AnoFistula in Ano Arise from abscess in the anal crypts aArise from abscess in the anal crypts a

nd track to the perianal skinnd track to the perianal skin Internal orifices of the track—above thInternal orifices of the track—above th

e pectinate linee pectinate line Can be probed Can be probed palpation--subcutaneous cordpalpation--subcutaneous cord Multiple fistulas suggest Crohn diseaseMultiple fistulas suggest Crohn disease

Fistula in AnoFistula in Ano

endoscopeendoscope

endoscopeendoscope

endoscopeendoscope

Operation of anal fistulaOperation of anal fistula

Operation of anal fistulaOperation of anal fistula

Operation of anal fistulaOperation of anal fistula

Caneration of fistulaCaneration of fistula

Rectal prolapseRectal prolapse Mucosa evert below sphincter ( wMucosa evert below sphincter ( w

hen defecate)hen defecate) To demonstate: squat and strain in To demonstate: squat and strain in

the position for defecationthe position for defecation

Rectal prolapse of child Rectal prolapse of child

Rectal prolapseRectal prolapse

Rectal prolapseRectal prolapse

Perianal abscessPerianal abscess

Cancer of anal canalCancer of anal canal