19922021 Case Study Fistulectomy Ppt

7/27/2019 19922021 Case Study Fistulectomy Ppt

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Case Study:FistulectomyGroup 6:Bulatao, Lesley Charmaine C.Cabudoc, Maricar G.Comilang, Janielle Lyn M.Constante, Quolette M.Dela Cruz, Rhealyn N.

Ebuenga, Allyssa O.Espanueva, Gaylen C.Fabon, Yvette Stephanie Nichol B.Franco, Ma. Eliza Joy L.Fuentes, Raquel F.


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Introduction


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An anal fistula is an abnormal connection

between the epithelialised surface of the analcanal and (usually) the perianal skin. Analfistulae originate from the anal glands, whichare located between the two layers of the

anal sphincters and which drain into the analcanal. If the outlet of these glands becomesblocked, an abscess can form which caneventually point to the skin surface. The tractformed by this process is the fistula.


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Abscesses can recur if the fistula sealsover, allowing the accumulation of pus. It then

points to the surface again, and the processrepeats. Anal fistulas do not generally harmand they often do not hurt, but they can beirritating because of the pus-drain (and, it isnot unknown for formed stools to be passedthrough the fistula); additionally, recurrentabscesses may lead to significant short termmorbidity from pain, and create nudes forsystemic spread of infection. A fistula is a

tiny channel or tract that develops in thepresence of inflammation and infection. Itmay or may not be associated with an abscess,but like abscesses, certain illnesses such as

Crohns disease can cause fistulas to develop.


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The channel usually runs from the rectumto an opening in the skin around the anus.However, sometimes the fistula openingdevelops elsewhere. For example, in womenwith Crohns disease or obstetric injuries, thefistula could open into the vagina or bladder.

Since fistulas are infected channels, there isusually some drainage. Often a draining fistulais not painful, but it can irritate the skinaround it. An abscess and fistula often occur

together. If the opening of the fistula sealsover before the fistula is cured, an abscessmay develop behind it.


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An anal fistula is almost always the result of aprevious abscess. Just inside the anus are smallglands. When these glands get clogged, they may

become infected and an abscess can develop. Afistula is a small tunnel that forms under the skinand connects a previously infected anal gland tothe skin on the buttocks outside the anus. After

an abscess has been drained; a tunnel may persistconnecting the anal gland from which the abscessarose to the skin. If this occurs, persistentdrainage from the outside opening may indicatethe persistence of this tunnel. If the outside

opening of the tunnel heals, recurrent abscessmay develop. Symptoms related to the fistulainclude irritation of skin around the anus,drainage of pus (which often relieves the pain),

fever, and feeling poorly in general.


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Surgery is necessary to cure an analfistula. Although fistula surgery is usually

relatively straightforward, the potential forcomplication exists, and is preferablyperformed by a specialist in colon and rectalsurgery. It may be performed at the same

time as the abscess surgery, although fistulasoften develop four to six weeks after anabscess is drained, sometimes even months oryears later.


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Fistula surgery usually involves opening upthe fistula tunnel. Often this will require

cutting a small portion of the anal sphincter,the muscle that helps to control bowelmovements. Joining the external and internalopenings of the tunnel and con-verging it to a

groove will then allow it to heal from theinside out. Most of the time, fistula surgerycan be performed on an outpatient basis.Treatment of a deep or extensive fistula mayrequire a short hospital stay. Discomfortafter fistula surgery can be mild to moderatefor the first week and can be controlled with

pain pills.


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CASEABSTRACT


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This is the case of Patient X, a 34 year oldmale who was admitted last September 3,

2009, under the service of Dr. R. Lopez ofValuecare. He came to the hospital with achief complaint of hematochezia and painfulbowel elimination.

Three weeks prior to admission, Patient Xexperienced hematochezia. He noted painfuldefecation, however describes having

constipation or diarrhea. He decided to seekconsult and was admitted to undergoproctosigmoidoscopy.


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At the Recovery Room, Patient X wasinserted with a Foley Catheter for urine

collection and was transferred to room. Hewas hooked to a liter of D5NM + Ketorolac 60mg to run for 6 hours and was placed on dietas tolerated. A few hours later, the foleycatheter was removed and he was able to voidfreely. The sack on the surgical site wasremoved later on.

On September 5, 2009 at 5:40 a.m. theIVF was discontinued upon request and onSeptember 6, 2009, Patient X was dischargedambulatory.


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Physical

Assessment


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GENERAL DATA

1. General Information

Name: D.Y. Age: 34 y/o

Gender: Male

Chief complaint: Hematochezia

Admitting diagnosis: ProctosigmoidoscopyFistulectomy


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2. Vital Signs Temperature: 36.4 Pulse Rate: 62

Respiratory rate: 16 Blood Pressure: 100/70


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3. General Survey

3.1 Anthropometric Measurement Height: 55 Weight: 72kg

3.2 General AppearanceThe patient shows sign of distress,

conscious and coherent. He is oriented to the place,person, and time. He is well-developed, looksaccording to his age. Well- nourished and calm.


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4. Skin The patients skin is brown, smooth and fair,

without any abnormalities found. He has goodskin turgor and is warm to touch.

5. Head The patients head size is proportion to the size

of his body and with a normocephalic shape. Thehairs are evenly distributed. There is nopresence of dandruff or scar. The face issymmetrical and with negative facial musculture.The patients eyes are symmetrical. Eyebrows

and eyelashes are evenly distributed. Paleconjunctiva. Anicteric sclera. The cornea and lensare clear. Pupil sizes are equal. The visual acquityis good (20/20).


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6. Ears The ears of the patient are symmetrical, soft

and pliable, and at the level of the outer cantus

of the eye. There is no presence of discharges onthe ear canal. Able to hear sounds on both ears.

7. Nose Patients nose is smooth, nasolobial fold is

symmetrical, septum is located in the midline, nopresence of nasal discharge seen. Patent nostrils.

8. Mouth and Pharynx The lips are pinkish in color and moist, no

presence of cracks or lesions. Tongue is found at

the midline and can move freely. Complete teethwithout presence of cavity. Gums and buccalmucosa are pinkish in color, smooth and moist.Uvula is on the midline. There is no presence ofinflammation of tonsils.


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9. Neck Patients neck moves freely. Trachea is located in

the midline. Cervical lymph nodes are non-palpable. There is no presence of masses.

10. Chest and Lungs Patients chest is cylindrical with regular

breathing pattern. Lung expansion is symmetricaland no retractions.

11. Heart

The precordium is flat. Apical pulse is located atthe fifth intercostal space left mid-clavicularline. Heart rhythm is regular.


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12. Abdomen

Patients abdomen appears globular and withoutpresence of scars/lesions, with a presence oftenderness upon palpation.

13. Genitals

Not assessed, the patient refused to.14. Anus and rectum Not assessed, the patient refused to.

15. Back and Extremities Nail and nail beds are pinkish with no sign ofinflammation. Decreased ROM upon surgery.Spine is on the midline. Coordinated gait.


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Anatomy & Physiology:Digestive Functions


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TheDig

estive

Sys

tem


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Digestive functions

Ingestionoccurs when foods enter thedigestive tract through mouth.

Mechanical processingis the physicalmanipulation of solid foods, first by the

tongue and the teeth and then by swirlingand mixing motions of the digestive tract. Digestionrefers to the chemical breakdown

of food into small organic fragments that

can be absorbed by the digestive epithelium. Secretionaids digestion through the releaseof water, acids, enzymes and buffers by thedigestive tract and accessory organs.


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Absorptionis the movement of small organicmolecules, electrolytes, vitamins, and wateracross the digestive tract.

Excretionis the elimination of waste

products from the body. Within thedigestive tract, these waste products arecompacted and discharge through theprocess of defecation


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Hist

ological

Features


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1. Mucosa Inner lining.

An example of a mucous membrane. Consist of an epithelial surface moistenedby glandular layer of loose connectivetissue, the lamina propria.

Increase the surface area available forabsorption

Four Major Layers of DigestiveTract


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Permit expansion after a large meal. Forms fingerlike projections, called villi. Outer portion of the mucosa contains a

narrow band of smooth muscle and

elastic fibers Muscularis mucosae, move the mucosal

folds and villi.


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2.Submucosa

Second layer of loose connective tissuethat surrounds the muscularis mucosae.

Contains large blood vessels andlymphatics as well as network of nerve

fibers, sensory neurons andparasympathetic motor neurons.

This neural tissue submucosal plexushelps control and coordinate thecontractions of smooth muscle layer andalso helps regulate the secretion of thedigestive glands.


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3. Muscularis externa Collection of smooth muscle cells arranged

in an inner circular layer and an outerlongitudinal layer.

Contractions of these layers in various

combinations agitate or propel materialsalong the digestive tract. These are autonomic reflex movements

controlled primarily by a network of nerve,

the myenteric plexus, sandwiched betweenthe inner and outer smooth muscle layers.


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4. Serosa A serous membrane

Covers the muscularis externa along mostportions of the digestive tract inside theperitoneal cavity

The parietal and visceral peritoneum that linesthe inner surfaces of the body wall. The parietal and visceral peritoneum are

connected by double sheets of serous

membrane called mesenteries, loose connectivetissue sandwiched between epithelia providesan access route for the passage of bloodvessels, nerves and lymphatics servicing the

digestive tract.


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TheMovemen

tofDige

stive

Materia

ls


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Peristalsis and Segmentation

Peristalsis Waves of muscular contractions that move along

the length of the digestive tract.

During a peristaltic movement, the circularmuscles first contract behind the digestivecontents. Then longitudinal muscles contract,shortening adjacent segments. A wave ofcontraction in the circular muscles then forcesthe materials in the desired direction.


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Segmentation Movements that churn and fragment

digestive materials. This action results in a thorough mixing

of the contents with intestinalsecretions. Because they do not follow aset pattern, segmentation movements donot propel materials in a particulardirection.


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The agitation of ingested materials withgastric juices secreted by the glands of the

stomach produces a viscous, soupy mixturecalled chyme. The principal anatomical landmark of the

stomach is a muscular organ with the shape

of an expanded J. The esophagus connects to the stomach at

the cardia. The bulge of the stomach superior to the

cardia is the fundus of the stomach. The large area between the fundus and the

curve of the J is the gastric body.


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Pylorus the curve of the J connects thestomach with the small intestine.

A muscular pyloric sphincter regulates theflow of the chyme between the stomach andthe small intestine.

The stomach resembles a muscular tube withnarrow and constricted lumen. When full, itcan expand to contain 1-1.5 liters.

This degree of expansion is possible because

the stomach wall contains a number ofprominent ridges and folds called rugae.


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The visceral peritoneum covering the outersurface of the stomach is continuous with apair of mesenteries. The greater omentumextends below that hangovers and protectsabdominal viscera. The much smaller lesser

omentum extends from the lesser curvatureto the liver. Stomach is lined by an epithelium dominated

by mucous cells. These secreted mucus

produced helps protect the lining from theacids, enzymes, and abrasive materials itcontains.


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Gastric pits shallow depressions andopen onto the gastric surface. Eachgastric pit communicates with thegastric glands that extends deep intothe underlying lamina propria. These

glands are dominated by two types ofsecretory cells: parietal cells andchief cells. Together these cellssecrete about 1500 ml of gastric juice

each day. Chief cells secrete pepsinogen, an

inactive form of the enzyme pepsin.


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Regulation of Gastric Activity

The cephalic phase the sight, smell, taste orthought of food initiates at the cephalicphase of gastric secretion directed by theCNS, prepares the stomach to received food.Under the control of vagus nerve,parasympathetic fibers innervate parietalcells, chief cells, and mucous cells of thestomach.

The gastric phase begins with the arrival of

food in the stomach. Stimulation of stretchreceptors in the stomach wall andchemoreceptors in the mucosa triggers therelease of a hormone, gastrin, into the

circulatory system.


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3. The intestinal phase begins when chyme

starts to enter the small intestine. Thepurpose of this phase is to control rate ofgastric emptying and ensure that thesecretory, digestive, and absorptivefunctions of the small intestine can proceedefficiently.


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Digestion in the stomach

The stomach performs preliminarydigestion of proteins by pepsin and, for avariable period, permits the digestion ofcarbohydrates by salivary amylase.

This enzyme remains active until pHthroughout the material in the stomachfalls below 4.5, usually within 1-2 hoursafter a meal. As the stomach contents

become more fluid and the pH approaches2.0, pepsin activity increases and proteindisassembly begins.


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Protein digestion is not completed in thestomach, but there is usually enough timefor pepsin to breakdown complex proteinsinto smaller peptide and polypeptide

chains before the chyme enters the smallintestine.


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The Small Intestine

About 6 meters (20 ft) long and has adiameter ranging from 4 cm at the stomachto about 2.5 cm at the junction with thelarge intestine. It has three subdivisions:

the duodenum, the jejunum, and the ileum. The duodenum is the 25 cm (1 ft) closest tothe stomach. This portion receives chymefrom the stomach and exocrine secretionsfrom the pancreas and liver.

Thejejunum, which is supported by a sheetof mesentery, is about 2.5 meters (8 ft) inlength. The bulk of chemical digestion andnutrient absorption occurs in the jejunum.


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The jejunum leads us to the third segment,the ileum. The ileum ends at the sphincter,the ileocecal valve, which controls the flowof chyme from the ileum into the cecum ofthe large intestine.

Plicae intestinal lining bears a series oftransverse folds.

Villi lining of the intestine is also thrown intoseries of fingerlike projections. Small intestine were a simple tube with

smooth walls, it have a total absorptive area

around 3300 square centimeters, or roughly3.6 square feet. Lacteal refers to the pale, cloudy

appearance of the lymph in these channels.


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Intestinal Movements

Two examples are thegastroenteric reflex and thegastroileal reflex.

Gastroenteric reflex initiated by distention, whichimmediately accelerates glandular secretion and

peristaltic activity in all segments. Gastroileal reflex is a response to circulating levels

of hormone gastrin. Intestinal juice moistens the intestinal contents,

assists in buffering acids, and dissolves bothdigestive enzymes provided by the pancreas and theproducts of digestion.

I i l h


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Intestinal hormones Secretin is released when the pH falls in the

duodenum, occurs when acid chyme arrives fromthe stomach. The effect is to increase thesecretion of water and buffers by the pancreasand liver

Cholecystokenin is secreted when chyme arrive

in the duodenum, especially when it containslipids and partially digested proteins, targetsthe pancreas and liver, accelerates theproduction and secretion of all types of

digestive enzymes. Gastric inhibitory peptide is released whenfats and glucose enter the small intestine. Thispeptide hormone inhibits gastric activity andcauses the release of insulin from pancreaticislets.


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The Large Intestine

The horseshoe-shaped large intestine beginsat the end of the ileum and ends at the anus. Lies below the stomach and liver. The principal functions of large intestine

include reabsorption of water andcompaction of feces, the absorption ofimportant vitamins liberated by bilateralaction, and the storing of fecal materialprior to defecation.

The large intestine often called the largebowel.


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It has an average length of approximately 1.5meters (5 ft) and a width of 7.5 cm (3 in).

It is divided into three major regions: the pouchlike cecum, the first portion of the large intestine;the colon, the largest portion of the large intestine;and the rectumthe last 15 cm (6 in) of the largeintestine and the end of the digestive tract.

Large intestine absorbs a variety of othersubstances from the chyme Vitamins (2) bilirubinproducts bile salts toxins

Movement from the transverse colon through therest of the large intestine results from thepowerful peristaltic contractions, called massmovement.


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The Cecum

Material arriving from the ileum first entersan expanded chamber called cecum.

Ileocecal valve a muscular sphincter guardsthe connection between the ileum and thececum.

It usually has the shape of a rounded sacand the slender veniform appendix attaches

to the cecum along its posteromedialsurface. Appendix is almost 9 cm( 3.5 in)


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Descending colon turns inferiorly.

The descending colon continues along theleft side until it curves and recurves as thesigmoid colon.


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The Rectum

Forms the end of the digestive tract. Anorectal canal last portion of the rectum

contains small longitudinal folds joined bythe transverse folds that mark the boundarybetween columnar epithelium of the rectumand a stratified squamous epithelium similarto that found in the oral cavity.

Anus the opening of the anorectal canal, theepidermis becomes keratinized and identicalto that on the surface of the skin.


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The circular muscle layer of themuscularis externa in this region formsthe internal anal sphincter.

The external anal sphincter guardsthe exit of the anorectal canal. Consistof muscle fibers, is under voluntary

control.


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Pathology and

Physiology


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PRESSURE IN RECTUM


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E E E

PASSAGE OF HARDENED STOOL

CAUSES FRICTION TO LINING

PREDISPOSITION TO ANAL GLAND INFECTION IN THEINTERSPHINTERIC PLANE

FORMS ABSCESS IN THE PERI-ANAL AREA

FORM A CHRONIC TRACT ( FISTULA-IN-ANO)


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WBC NEUTROPHILS

INFLAMMATORY RESPONSE DUE TO INFECTION

RELEASE OF CHEM. MEDIATORS

HISTAMINE & PROSTAGLANDIN SEROTONIN

PAIN FEVER


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Past medical history

Important points in the history that may suggesta complex fistula include the following:Inflammatory bowel disease

DiverticulitisHistory of traumaPrevious radiation therapy for prostate or

rectal cancer

TuberculosisImmune suppression-Steroid therapy, HIV

infection


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Classification of fistula in-ano

Parks classification system (all are inrelation to the sphincters)

The Parks classification system defines4 types of fistula-in-ano that resultfrom cryptoglandular infections.

1 I hi i 70%


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1.Intersphincteric-commonest-70%

Common course - Via internal sphincter to theintersphincteric space and then to the perineum.They result from perianal abscesses

2. Transsphincteric -25%

Common course - Low via internal and external

sphincters into the ischiorectal fossa and then tothe perineum. Originate from ischiorectalabscesses

3.Suprasphincteric -5%

Common course - Via intersphincteric spacesuperiorly to above puborectalis muscle intoischiorectal fossa and then to perineum. Resultfrom supralevator abscesses


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4. Extrasphincteric-1%

Bypass the anal canal and sphincter

mechanism, passing through the ischiorectalfossa and levator ani muscle, and open high inthe rectum


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Laboratory


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Drug Study


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Name ofDrug

Classification Dosage/frequency

Route Mechanism ofaction

Indication Nursingresponsibilities

Plasil Antacids,

anti-emeticagents, anti-ulcerants

1 amp x 1

dose

TIV Dopamine

antagonistthat acts byincreasingreceptorsensitivity andresponse ofupper GITtissues to

acerthylcoline.

Disturbanc

es of GImotility

Give at least

30 mins.. Beforemeals and atbedtime.Assess mentalstatus duringtreatment.Instruct pt. to

avoid hazardousactivities for atleast 2 hours.Advice pt toavoid alcohol andotherdepressant thatenhancesedatingproperties ofthis drug.


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Name ofDrug




Ranitidin

e

Antacids,

anti- emetic,anti-ulcerants

1 amp x 1

dose

TIV Completely

inhibits actionof histamineon the H2 atreceptor siteof parietalcells.Decreasinggastric acidsecretions.

selected

cases ofpersistentdyspepsia,stressulceration,& inpatientsat risk ofacidaspirationduringanesth

Assess pt. for

abdominal pain.Note forpresence ofblood in emesis,stool or gastricaspirate.May be addedto totalparenteralnutritionsolution.


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Name ofDrug




Coamoxiclav

Antibiotic 625 mg/tab q 8hrs

x 6 doses

PO An antibiotic

that is a

combination

of a penicillin

(amoxicillin)

and a

substance

called

clavulanicacid. It kills

bacteria, by

interfering

with their

ability to

form cell

walls. The

bacteria

therefore

break up and

die.

skin & softtissue

infections,UTI, pre &post-surgicalprocedures, bone &joint

Instruct

patient to

immediately

report signs or

symptoms of

hypersensitivity

reaction, such

as rash, fever,

or chills.Monitor

patient

carefully for

signs and

symptoms of

hypersensitivityreaction.

Monitor

patients vital

signs before,

during and after

medication.

N f Cl f D / R M h f d N


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Name ofDrug




Flanaxforte

non-steroidalanti-

inflammatoryand antrheumaticproducts

550 mg/tab q 8 hrs

x 3 doses

PO Reversiblyinhibits

cyclooxygenase-1 and 2(COX-1 and 2)enzymes,which result indecreasedformation of

prostaglandinprecursors;hasantipyretic,analgesic, andanti-inflammatoryproperties

Relief of

mild to

moderatel

y severe

pain &

fever w/

or w/o

accompany

inginflammati

on eg

musculosk

eletal

trauma,

post-op

pain &

post-

dental

extraction

.

Advice the pt.to take this

medicationexactly asdirected; do notincrease dosewithoutconsultingphysician. Do

not crushtabletsInstructclient to takewith food ormilk to reduceGI distress.


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Name ofDrug




Tell pt. thatshe may

experiencedrowsiness,dizziness,lightheadedness, or headachealso, nausea,vomiting, orheartburnInstruct pt.to report DOB,chest pain, skinrash anditching.

Name ofDrug





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Drug frequency action responsibilities

Fibrosinesachets

Laxatives andpurgatives

1 sachet in 1glass ofwater TID x

2 days

PO Is a stimulantlaxative. Itacts directly

on the bowels,stimulating thebowel musclesto cause abowelmovement.

Fibersupplement to

maintainregularityof bowelmovement.

Instruct patientto report if she/he develop

nausea, vomiting,or stomach pain.Instruct patientto stop laxativeand inform nurseor physician ifshe/ heexperienced

Rectal bleedingor failure to havea bowel movementwithin 12 hoursafter use of alaxative, may be asign of a serious

condition.


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Nursing

Care

Plan


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PRE-OP

Assessment Diagnosis Planning Nursing

Interventions

Evaluation


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Interventions

Subjective:

Masakit kapagako ay

dumudumi, asverbalized by thepatient

pain in rectalregion

Objective:

a pain rating of7 on a scale of 0-10

Irritable

Confused

change in pulserate

increase and

decrease inrespiratory rate

Acute pain related

to actual tissue

damage

After 1 hour of

nursing

intervention, the

client willexperience lesser

pain.

Performed a

comprehensive

determined

whether the client isexperiencing pain

the tine of initial

interview.

assessed pain in

a client using a self

report 0-10

numerical painrating scale

assessed and

document the

intensity of pain and

discomfort.

Goal has been

partially met.

The client

experiencedlesser pain.


Interventions

Evaluation


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Interventions

asked the client

to describe

appetite, bowel

elimination andability to rest and

sleep.

obtained a

prescription to

administer by the

doctor.


Interventions

Evaluation


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Interventions

Subjective:

Nahihirapan

ako dumumi as

verbalized bythe patient

Objective:

Bright red

blood with stool

(+) flatus

Abdominal

tenderness

Constipation

related to

discomfort

duringdefecation

After 1 hour of

nursing

intervention the

client will relieffrom discomfort

of constipation

Assessed

usual pattern of

defecation

including timeof day, amount

and frequency

of stool

Assessed

history of bowel

habitsPalpated for

abdominal

distention,

percuss for

dullness and

auscultate for

bowel sounds

Goal has

been partially

met.

The client hasexperienced

lesser pain

from the

discomfort of

constipation.


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Interventions

Evaluation

Encouraged

the client toheed defecation

warning signs

Checked for

impaction of

feces in bowel

Provide

privacy for

defecation

Administer

stool softeners

ordered by the

doctor


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POSTOP

Assessment Diagnosis Planning NursingInterventions

Evaluation


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Interventions

Subjective:

Objective:Open wound

High risk for

infection r/t

inadequateprimary

defense as

manifested by

broken skin

After 2 hoursof

nursing

interventionthe

patient willgain

knowledge in

infectioncontrol

as evidencedby

discussing the

wound care.

IndependentEstablishRapportTeach patient

to wash hands

often,

especially

before

toileting,Before andafter meals.

After 2 hours of

Nursingintervention

the patient will be

able to gain

knowledge in

infection controlas

evidenced by hisdiscussion inwound

care. Therefore,the

goal was met

Assessment Diagnosis Planning NursingInterventions

Evaluation


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Interventions

Discuss to

patient the

following signsof infection:

redness,

swelling,

increased pain,

or purulent

drainage on thesite and feverDemonstrate

and allow

return

demonstrationof wound care

N


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EVALUATIO

N

AND

DISCH

ARGE

PLAN

MEDICATION


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MEDICATION

Take Home Med. Fibrosine Sachet 1 sachet in 1 glass of water 3 times a day.

EXERCISE


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EXERCISE

Avoid heavy lifting, straining and strenuousexercise for two weeks at a minimum (i.e.,weightlifting, jogging, swimming, etc.)

TREATMENT


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TREATMENT

Fistulectomy - in a fistulectomy, the surgeon makesan incision in the fistula tract, opening it up andmerging it with the anal canal. This allows thetissues to heal from the inside out.For very smallfistulas, a fistulotomy may be performed in adoctors office, using only local anesthesia. Largerfistulas, however, require surgery under spinal orgeneral anesthesia, and are typically performed in ahospital or surgery center. Patients typicallyexperience mild or moderate discomfort or painfollowing this procedure, with a recovery time ofone to four weeks.

HEALTH TEACHING


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HEALTH TEACHING

Maintain a liquid diet for two days after theprocedure (i.e., soup, Jell-O, etc.)

Eat a high fiber diet after two days Use the bathroom once a day. A warm bath

may help your symptoms. Take over-the-counter pain medicine as

needed

Shower standing up and bathe the area withwater to soothe and keep it clean. Do not sit in the bathtub


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Do not use topical steroids or topical agentssuch as Preparation H

Expect some drainage for two to four weeksafter the procedure as the Surgisis AFPplug is incorporated and the fistula tract isclosed.

Using stool softeners and adhering to goodhygiene, such as sitz baths after everybowel movement, decreases discomfort andhelps for recovery.

OPD


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OPD For anal fissures, the WASH regimen is indicated.

For anal fistulas, outpatient follow-up with asurgeon is indicated if consultation did not takeplace at the time of presentation.

Botulinum toxin injection has been shown to be aneffective alternative to surgery for the treatment

of uncomplicated idiopathic anal fissure. Topical application of clove oil cream has

demonstrated significant benefit in patients withchronic anal fissure.

The application of topical 0.5% nifedipine ointment

has been used as a chemical sphincterotomy agent.It has been shown to offer a significant healingrate for acute anal fissure and may prevent it frombecoming a chronic fissure.

DIET


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DIET A high-fiber diet causes a large, soft, bulky stool

that passes through the bowel easily and quickly.Because of this action, some digestive tractdisorders may be avoided, halted, or even reversedsimply by following a high-fiber diet. A softer,

larger stool helps prevent constipation andstraining. This can help avoid or relievehemorrhoids. More bulk means less pressure in thecolon, which is important in the treatment ofirritable bowel syndrome and diverticulosis (defects

in the weakened walls of the colon). In addition,fiber appears to be important in treating diabetes,elevated cholesterol, colon polyps, and cancer of thecolon.

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19922021 Case Study Fistulectomy Ppt