ANUS & ANAL CANAL DISEASES

Anal Canal The anal canal is about 3.8 cm long begins at level of anorectal junction as a continuation of the rectum passes downwards & backwards opens at anal orifice in the perineum  Pecularities Anterior wall of canal is shorter than Posterior wall Surrounded by Sphincter ani muscles, the tone of which keeps canal closed except during daefecation

Internal Apperance Divided into 3 parts Upper part = 15 mm Middle part = 15 mm Lower part = 8 mm

Upper Part of Anal Canal lined by mucous membrane (columnar epithelium) mucosa thrown into vertical folds called anal columns joined at their lower ends by small semilunar folds called anal valves The anal valves together form a transverse line that runs all round anal canal called pectinate line

Middle Part The upper part is separated from the lower part by the pectinate line Lined by Mucous membrane (stratified squamous epithelium but no sweat & sebaceous gland) anal columns are absent Bluishish in Colour due to deep venous plexus The lower limit of this zone is whitish in appearance so it is referred as white line of Hilton

Lowest part Cutaneous – lined by skin containing sweat & sebaceous gland

Sphincters Internal anal sphincter Formed by circular muscle fibres of the rectum Extends from upper end to white line of Hilton involuntary External anal sphincter Formed by of striated muscle Surrounds whole length of canal voluntary consist of 3 parts- deep part, superficial part, subcutaneous part

Subcutaneous part Lies below the level of internal sphincter & surrounds lower part of anal canal Is in form of flat band about 15 mm broad  Superficial part Surrounds lower part of internal sphincter  Deep part Surrounds upper part of internal sphincter

Blood Supply, Venous Drainage, Lymphatic Drainage & Nerve Supply Above Pectinate Line Lower Pectinate Line Arterial Supply superior rectal artery inferior rectal artery Venous Drainage superior rectal vein inferior rectal vein Nerve Supply Sympathetic (L1 & L2) Parasympathetic S2, S3 & S4) somatic supply via (S2, S3, S4 )

ANAL CUSHIONS

DISEASES OF ANAL CANAL -congenital abnormalities -imperforate hymen -post-nidal dimple -pilonidal sinus -Anal incontinence -Anal fissure -haemorrhoides -Anorectal abscess -Fistula-in-ano -Pruritis ani

HAEMORRHOIDS *definition *types

-local----------anorectal deformity,hypotonic anal sphincter #CLASSIFICATION 1)PRIMARY------AT ORIGINAL SITE 2)SECONDARY-----OCCURS B/W THE PRIMARY SITES AND AS A RESULT OF SOME SPECIFIC CONDITIONS e.g -colorectal ca -local----------anorectal deformity,hypotonic anal sphincter -abdominal----ascitis -pelvic-----gravid uterus,uterine ca,bladder ca -nerological causes

-current view -portal HTN and varicose veins -other vascular causes #THEORIES OF DEVELOPMENT. -portal HTN and varicose veins -other vascular causes -infections -Diet and stool consistency -anal hypertonia -ageing -current view

DEGREES OF HAEMORRHOIDES

#SYPMTOMOLOGY Bleeding Prolapse Pain Itching Defaecatory derangement and tenesmes #EXAMINATION Other causes of prolapse History and anoscope Rectoscopy/rigid sigmoidoscopy

Fibroepithelial polyp

PERIANAL HAEMATOMA

#COMPLICATIONS 1-STRANGULATION AND THROMBOSIS 2-ULCERATION 3-GANGRENE -RECTAL PROLAPSE -RECTAL CA #COMPLICATIONS 1-STRANGULATION AND THROMBOSIS 2-ULCERATION 3-GANGRENE 4-PORTAL PYEMIA 5-FIBROSIS 6-SUPPURATION-----------PERIANAL ABSCESS

#MANAGEMENT. Fibrous diet Sitz bath A)GENERAL Fibrous diet Sitz bath Local application to reduce pain and edema Antibiotics Laxatives Anti-inflammatory drugs

^RUBBER-BAND LIGATION ^INFRA-RED PHOTOCOAGULATION ^BIPOLAR DIATHERMY B)INTERVENTIONAL ^SCLEROTHERAPY ^CRYOTHERAPY ^RUBBER-BAND LIGATION ^INFRA-RED PHOTOCOAGULATION ^BIPOLAR DIATHERMY ^LASER THERAPY ^HAEMORRHOIDECTOMY-------- *OPEN(MILLIGAN-MORGAN) *CLOSED

INDICATIONS ^POST-OPERATIVE CARE 1-3RD AND 4TH DEGREE HAEMORRHOIDES 2-2ND DEGREE UNRESPONSIVE 3-FIBROSED HAEMORRHOIDS 4-INTERO-EXTERNAL HAEMORRHOIDS ^TREATMENT OF COMPLICATIONS. ^POST-OPERATIVE CARE

#POST-OPERATIVE COMPLICATIONS ^ACUTE *PAIN *ACUTE URINARY RETENTION *REACTIONARY HAEMORRHAGE ^LATE *SECONDARY HAEMORRHAGE *ANAL STRICTURE *ANAL FISSURES AND ABSCESS *INCONTINENCE