1. ANUS & ANAL CANAL DISEASES

2. 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

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

4. 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

5. 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

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

7. 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

8. 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

9. 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 )

10. ANAL CUSHIONS

11. 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

12. HAEMORRHOIDS
*definition
*types

13. -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

14. -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

15. DEGREES OF HAEMORRHOIDES

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

20. Fibroepithelial polyp

21. PERIANAL HAEMATOMA

22. #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

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

24. ^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

25. 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

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