Basic care of colorectal disease Diseases of Colon

Basic care of colorectal disease 嘉義長庚醫院 大腸直腸外科 葉重宏

Diseases of Colon and Rectum • • • Hemorrhoid Anal abscess and fistula Colorecral cancer Colon inertia Others

Hemorrhoid • Hemorrhoid : Vascular cushion of anus • Position: • Pathogenesis : still controversial Destruction of the anchoring connective tissue with the down ward displacement or prolapse of the anal cushions

Hemorrhoid (2) • Type : Internal hemorrhoid External hemorrhoid Mixed hemorrhoid • Grade : Grade III Grade IV

Hemorrhoid (3) • Treatment Sclerotherapy Rubber ring ligation Cryosurgery Infrared coagulation Bipolar diathermy Lord’s dilatation Surgical treatment

Anal abscess and Anal fistula • Etiology Non-specific : cryptoglandular origin Specific : Crohn’s disease, CUC, TB, Actinomycosis, foreign body, Carcinoma, pelvic inflammation, Trauma, Radiation, Leukemia

Anal abscess and Anal fistula (2) • Pathogenesis : Infection of anal gland • Abscess is the acute manifestation • Fistula is the chronic manifestation

Anal abscess and Anal fistula (3) • Classification of anorectal abscess Perianal 43 % Ischiorectal 23 % Intersphincter 21 % Supralevator ( pelvirectal ) 7% Submucosal 6%

Anal abscess and Anal fistula (4) • Classification Intersphincteric Transsphincteric Suprasphincteric Extrasphincteric • Goodsall’s rules

Anal abscess and Anal fistula (5) • Treatment Incision and drainage Fistulotomy Fistulectomy Seton application

Colorectal Cancer • • • Anatomy Location Blood supply Venous drainage Lymphatic drainage

Chemotherapy Indication : Stage of Duke’s C ( C 1~ C 3 ) -- 9102 -A Stage of Duke’s D / C 2 ( LN > 4 ) -- 9505 Stage of Duke’s B 2 -- ? Dose: According to the body surface

Endoscopic Examination • • Anoscopy Proctoscopy Sigmoidscopy Colonoscopy

Prepare for colonoscopy • On clear liquid diet -- the day before exam • On full diet -- the meal before exam • Dulcolax 3 # p. o. s. t. 3 PM the day before exam • Fleet enema 2 PC s. t. or Cleansing enema before exam