Documente Academic
Documente Profesional
Documente Cultură
DISEASES
Group members
E.P.C.Priyadarshani
L.A.A.C.Subhashini
H.W.K.T.Karunarathna
Parts of Guda
Guda wali
Pravahini - placed
1 angula
above
Visarjani is indicative
of the
Inferior
Houstons value or the rectal ampulla.
Visarjini - placed
1 angula
above
samvarani is indicative of the anorectal
ring.
Samvarani - placed 1 anugla above the
Gudoshta can be correlated to the zone of
sphincter muscles especially the area of
external sphincter.
Anorectal ring
This is a muscular ring present at the
anorectal junction.
It is formed by the fusion of the
puborectalis, deep external sphincter
and the internal sphincter.
It is easily felt by a finger in the anal
canal.
Surgical division of this ring, results in
rectal incontinence.
Venous drainage
Superior haemorrhoidal vein.
Middle and inferior haemorrhoidal veins
Lympatic drainage
Above the pectinate line, drain with internal illiac nodes.
Below the pectinate line, drain with superficial inguinal nodes.
Nerve supply
o Above the pectinate line, is supplied by the
autonomic nerves both sympathetic (inferior
hypogastric
plexus,
L1,
L2)
and
parasympathetic (pelvic splanchnic, S2, S3,
S4). Insensitive to pain.
o Below the pectinate line, is supplied by the
somatic nerves.(inferior rectal, S2, S3, S4).
There fore, sensitive to pain.
o Sphincters the internal sphincter is caused to
contract by sympathetic nerves and is relaxed
by parasympathetic nerves. The external
sphincter is supplied by the inferior rectal nerve
and by the perineal branch of 4th sacral nerve.
Physiology of Defecation
Anorectal diseases
1. Haemorrhoids/piles (wYia)
2. Fissure in ano (mrsl;sld)
3. Fistula in ano (N.kaor)
4. Rectal prolapse ^.=o N%xY)
5. Fistulous boils ( N.kaor msvld)
6. Anal stricture (ikaksreoaO .=o)
7. Anal boils/Perianal abscess ( .=o )
8. Napkin rashes ( wysmQ;kd)
9. Proctitis ( .=o mdl)
10.Pruritus in anus ( .=o lKavq)
11.Anal warts ( pu l,)
12.Rectal cancers ( wnqo)
Arshas
Etymology
Arsha
Ru(root) + Asun
Definition
wrsj;a m%dKsfkda udxi l,;d Iika;s h;a
wYdxis ;iaudpHkaf;a .=o ud. ksfrdaO;d#
w.yD.ks.7
Arshas is a muscular projection(mans keel), which
troubles the patient like an enemy.
wrsjwi%ekHia;s b;s wY#
Arshas is like an enemy, that destroys the blood
in the body.
Synonyms
Durnama, Guda kila, Gudnkura, Payu
roga,
Mula vyadi, Anamaka, Gudaja
Classifications of Arshas
First Classification
mD:la fodaffI iuiaff;Yap fYdaKs;dka
iycdksp
wYdxis im%ldrdKs oHd;a .=o j,s;%fh
1. Vata
2. Kapha
3. Pitta
4. Sannipatha
5. Rakthaj
6. Sahaj
Second Classification
1. Bahira (External) Arshas
2. Abyantara (Internal) Arshas
Third Classification
3. Sahaja
4. Janmoththaraj 7 (Vata, Kapha, Pitta,
Kaphavatha, Kaphapitta, Vatapitta,
Sannipatha)
Fourth Classification
1. Shushka Arshas (Vataj, Kaphaj)
2. Sravi Arshas ( Pittaj, Rakthaj)
Fifth Classification
3. Bheshaja sadya
4. Kshara sadya
5. Shashtra sadya
6. Agni sadya
Nidana of Arshas
All reasons can be divided into 2 groups
named as Sahaja and Janmoththaraj.
Nidana of Sahaja Arshas
Mithya ahar and vihar of mother and
father
Poorvajanma karma
VISHESHA HETHU
1. Vataja arshas
1. Pittaja arshas
Kashaya
Katu
Tiktha
Ruksha
Sheeta
Laghu rasa ahara
Pramitha/alpa
bojana
Teekshana madya
Anaashana
Athi-maithuna
Athi-vyayama
Athi-upavasa
Athi-vata sparsha
Athi-athapa
sparsha
Shoka
Sheeta
desha
sevana
Sheeta
kala
sevena
Lavana
Amla
Katu
Ushna
Vidahi
Tikshna rasa ahara
Ushna jala
Athi-vyayama
Atapa sevana
Agni sevana
Ushna desha,kala
Krodha
Dwesha
1.Kaphaja
arshas
Madhura
Snigdha
Sheeta
Lavana
Amla rasa
ahara
Guru
ahara
Avyayam
a
Diva
swapna
Aasan
shook
Achintam
Praag
vata
sevana
Sheeta
Samprapthi of Arshas
Nidana
Agni mandaya
Arshas(VYAKTHI)
Vataja pittaja
Roopa of Arshas
Pittaja Arshas
Pile masses are blue at their tip, thin,
spreding, yellowish or similar to liver,
resembles the tongue of the parrot in their
shape, bulged in the middle like barley or
the mouth of leech and exudating fluid
The patient suffering; expel liquid faecess
mixed with blood, fever, burning sensation,
severe thirst and fainting
His skin, nails, teeth, mouth, urine and
faeces all become yellow.
Kaphaja Arshas
Pile masses are white in colour, deep,
rooted, stable, round, unctuous, pale,
resembles karira, panasaasthi or
gosthana, do not exudate fluids and
have severe itching.
The person has diarrhoea, with
faecess mixed with kapha, large in
quantity, resembling mutton wash,
swelling, cold fever, loss of taste,
indigestion and heavyness of head
His skin, nails, teeth, mouth, urine
Rakthaja Arshas
Pile masses are same like pittaja
arshas
Colur is same as vata praroha, gunja
and vidruma
The patient expels hard stool with
lots of blood
Due to loss of bala, varna/ojoshaya
and blood, he suffering from anaemic
diseases.
Sannipataja arshas
Piles produced by all the three doshas
together, will have symptoms of all the doshas
simultaneously. (Su.Ni. 2/24)
Sahaja arshas
Sahaja is due to vitiation of blood and semen.
Pile masses are difficult to see, dark brown in
colour, troublesome and bent inward. Afflicted
by this the person is emaciated, eats very little
food, network of veins visible prominently all
over the body, has less children and semen,
has feeble voice and is always angry, has poor
digestion. (Su.Ni. 2/25)
Complications of Arshas
Baddagudodara, udawartha, vamana,
aruchi, vibanda, athisara, shawasa,
jwara, shosha, moha, pada shotha, guda,
nabhi and medra shotha
Examination of Arshas
General examination
Local examination
General-per rectal examination
Special instrumental-Proctoscope
Treatment of Arshas
Chikithsa sutra
iafkay
iafjod;ajfhd
jdf;
ms;af;aIq
frpkdoh!#
lfM jdka;HdofhdYia fY% Y% m%;sls
%hd#
ms;a;j;a rla;fc ldhh m%;sldfrdYxis O
%ej
- fhda. r;akdlrh-
1. Beshaja/medicines
Arshas
-Which are newly occurred
-Having less dosha-dushya
-Symptoms are not fully developed
-Without complications
2. Kshara applications
Arshas
-Of soft consistency
-Which are widely spread
-Deeply situated
-Protruded out
3. Shashtra/surgery
Arshas
Which are thin rooted
Which mucous discharge
Projected out
4. Agni/thermal cauterization
Arshas
Having rough surface
Having fixed base
Which are thickened
Which are harder in consistency
Kashaya/decoction
Yaf; uQ, YAj mQ;kd rfidak id; - lIdh ix.
%yhidrK uq,a" h<s b.=re" wr" iqKq
rla;dmdud. c,o lajdf:d rla;dY ixys;
mqgmdlx m,dfvdIag yIHdYidx yf;a
Y;djr f.damlkHd
fldys, w," r;= Kq" uqx weg" Wn,lv" f.dgq ovq
lIdh
r ,aj mqkkjd lIdh
uqia;d lrxc uQ, ;ajla
OdkH mxplh
Peya
OdkH mxpl fmahdj
mxpflda, fmahdj
Ivx. mdkh
Arishta
wNhdrsIagh
msmam,HdoHdijh
;l%drsIag
dlaIdrsIag
YdrsndoHdijh
WYsrdijh
Pkaokdijh
Churna/powders
Od;% pQKh
udksN pQKh
NdIalr,jK pQKh
wm;a;slr pQKh
Alepa/pastes
fnfy;a wfkdaod fld< we,a osfhka wUrd .Eu
oe;a;" ;sriaijd" m,audkslal m%f,amh
frdayfka ldIa yd ij Idos f;,a Y% lr .Eu
l=lals,a tkafka m%f,amh
cd;Hdos ff;,h fyda uQIsldos ff;,h
;sla; jegfld yd ly wUrd .Eu
Sweda/sitz bath
mxp j,al, lIdh
wdvf;davd" jrd" fn,s" trvq fld< ;nd wj>dykh
.xiQrsh fld< yd fmd;= iu. fldfydU fld< yd fmd;=
wj>dykh
Pradana karma
This is indicated for II Grade internal piles. The patient is in lithotomy
position and kshar is applied to the dilated pile pedicles with the help of
Jambaushatha shalaka under the guidence of proctoscope (Arsho
darshan yantra) having slit on its side.
When the colour of arshas aree appeared like a colour of pakwa-jambu,
kshara is washed out by amla dravya.
Kshara application is repeated till the pakwa-jambu colour is not appear.
Each pile pedicle is treated differently at the interval of one week.
This may cause fibrosis of the tissues which prevents the pile pedicle
from protrusion.
Paschat karma
The paste of yashtimadhu and ghruta is applied to the arshas.
APPLICATION OF KSHARA-SUTRA
THERAPY.
In this process hemorrhoids are tied off
at its base (pedicle) by Kshara-sutra or
specially
processed
thread
with
medicines. By the principle of pressure
necrosis, it prevents blood supply to
the respective pile mass immediately.
Eventually hemorrhoids shrink, shrivel
up, die and ultimately fall off within 10
days, leaving some scar tissue which
supports the corresponding veins in
that area, preventing them to distend or
Pathyapathya
Dos
Drink Plenty of fluids
Do take adequate fibers in the diet
Exercise regularly. Walking is the one of the best
things
Train yourself for regular food intake of lunch and
dinner
Lose weight, if you are overweight
Chew your food properly which enable digestion
Take buttermilk, onion, leafy vegetables and green
gram
You should not eat any food which is hard to digest
Donts
Dont sit too much on a hard surface because it can
restrict blood flow around the anal area
Dont sit in the toilet for long periods. This position
causes extra pressure on the anal area
Dont drink coffee or alcohol
Hurry, worry and curry is absolutely not advisable for
a piles patient
Dont lift heavy objects. Even if you lift anything
heavy exhale and dont hold your breath
Dont use laxatives regularly as it may become a
habit and cause the bowels to lose its ability to
function normally
Dont consume any medication directly; this can be
harmful for your stomach as well as diseases
HAEMORROIDS/PILES
Latin word - PILE pila(a ball)
Greek word - HAEMA - blood
RHOOS - flowing HAEMORRHOID
Definition
Dilated plexus of superior haemorroidal
veins, in relation to anal canal.
Classification
1. Primary/Idiopathic Hemorrhoids
Causes
Standing position of human being
Anatomical factors
Familial or genetic
Constipation causes excessive straining
2. Secondary Haemorrhoids
Causes
Carcinoma of rectum
Portal hypertension
Pregnancy
both
varieties
together
Location
Classically situated in the 3, 7, 11 0
clock positions.
Clinical features
Painless bleeding fresh bleeding
occurs after defecation. (Flash in the
pan).
Constipation
Discharge of mucous
Irritation of peril anal skin
Pruritus
Permanently prolapsed pile outside
patient complains of pain and
discomfort
Investigations
Per rectal examination
Proctoscopy
Sigmoidoscopy
Complications
Chronic anaemia
Strangulation if the treatments are not
given
in
right
time,
may
cause
suppuration,
ulceration,
thrombosis,
fibrosis, gangrene or pyaemia.
Ulceration and secondary infection
Thrombosis and fibrosis
Treatments of piles
Lords dilatation
- Under general anesthesia, the internal
sphincter it widely stretched which is supposed
to relieve the venous congestion and improve
the piles. This is indicated in grade 1 piles.
Injection of sclerosant
- 5% of phenol in almond oil is injected into sub
mucosa above the dentate line. Hence it is
painless. It produces aseptic thrombosis of pile
mass and is indicated in grade 1.
Post-operative complications
Retention of urine
Secondary haemorrhage
Anal stenosis
Wound infection
According to Ayurveda,Haemorrhoids
originated due to apathya ahara and
vihara.
There fore, the first step of the
treatment is nidana parivarjana.
According to acharya Sushruta, there
are 4 kinds of treatment methods in the
management of Haemorrhoids.
1. Bheshaja
2. Kshara
3. Shashtra
4. Agni
Discussion
Ayurveda, the born of life is the basis of long and healthy life in
India from the ancient period.
The medicines are prepared from the herbal plants and their
extracts for piles treatment.
Several modern therapy like Sclerotherapy, Cryotherapy,
Rubber band ligation, Bipolar diathermy, Direct current
electrotherapy, Infrared photocoagulation, Surgical treatments
etc. areused for the curing of hemorrhoids.
The modern treatment of and surgery gives many other side
effects like burning sensation , pain, bleeding, itching etc. Postoperative complications are Retention of urine, Secondary
haemorrhage, Anal stenosis, Wound infection which cause life
time disability to the patient.
but the herbal / natural therapy and Para surgical methods
only takes slightly long time in comparison but do not shows
any type of side effect.
Drugs prepared from the plants alone and in combination
cures I IV degree of piles.
Treatment of Arbuda
Herbal poultice
(composed of Karkaruka,Erudruka,coconut,Piydla, and Castor seeds
,boiled with milk,water and clarified butter, and mixed with oil,should be applied
lukewarm (to the tumuor).As an alternative ,a poultice applied made up of boiled
meat or Vesa vara ,should be applied to It.)
Blood should be let out from the affected part ( after the systems
of patients has been cleaned (by emetics and purgatives) .
Medicinal plaster composed of the drugs which are efficacious in
correcting the doshas.
Herbal drugs pasted together with urine ,or with alkaline water
should
be applied to it.
The kalkas (pastes)of nishpdva(simbi).Pinyaka (oil-cakes of
sesamum)and Kulattha pulse,pasted with curd-dream and an
abundant quantity of flesh , should be used in plastering the
affected part so that worms and parasites may be produced in the
ulcer and flies attracted to it (and so consume the ulcer ).
A small portion of the ulcer ,left unconsumed( un eaten) by
worms and parasites ,etc, should be sacrificed and the ulcer should
then be cauterized with fire.
Western Management
The treatment of colorectal cancer can be aimed at cure or
palliation.The decision on which aim to adopt depends on various
factors, including the person's health and preferences, as well as
the stage of the tumor. When colorectal cancer is caught early,
surgery can be curative. When it is detected at later stages (for
which metastases are present), this is less likely and treatment is
often directed at palliation, to relieve symptoms caused by the
tumuor and keep the person as comfortable as possible..
Treatments
May include some combination of surgery.
Radiation therapy.
Chemotherapy.
Targeted therapy.
Oral drugs (Aspirin and other non-steroidal antiinflammatory drugs decrease the risk). Their general use
is not recommended for this purpose, however, due to
side effects.
Surgery
Surgery is the main treatment for early colorectal cancer. Often, the piece of
the colon or rectum with the tumor is removed and the ends are sewn back
together.
This can either be done by an open laparotomy or sometimes laparoscopically.
Side effects of surgery
If there are only a few metastases in the liver or lungs they may also be
removed.
Sometimes ended up with colostomy , In that case, one end is attached to the
wall of the belly so that stool can empty into a bag outside the body.
Chemotherapy
Chemotherapy
Chemotherapy (chemo) is the use of drugs to fight cancer. The drugs may
be put into a vein or given by mouth. These drugs enter the bloodstream
and travel throughout the body, making this treatment useful for cancers
that have spread to distant organs.
Side effects of chemo
While chemo kills cancer cells, it also damages some normal cells and this can
cause side effects. Theseside effects will depend on the type of drugs given, the
amount given, and how long treatment lasts. Common side effects could include:
Diarrhea
Hair loss
Mouth sores
Loss of appetite
Nausea and vomiting
Increased chance of infection (from low white blood cell counts)
Easy bleeding or bruising after minor cuts or injuries (from low levels of
platelets, which help the blood clot)
Severe tiredness (fatigue) (from low levels of red blood cells)
Some drugs can cause something calledhand-foot syndrome, where the
palms of the hands and the soles of the feet get red and irritated and
may even blister or develop open, painful sores.
Some drugs can cause nerve damage which can be painful.
Radiation treatment
Radiation treatment is the use of high-energy rays (such
as x-rays) to kill cancer cells or shrink tumors.
Treatment of Guda-Bhramsa
In traditional medicine,
paste of Brahmi which fried with tila oil
fumigation with the fumes of tortoise shell.
Are indicated in Guda bramsha.
ABDOMINAL APPROACHES
ABDOMINAL RECTOPEXY WITH POSSIBLE BOWEL
RESECTION
PERINEAL APPROACHES
PERINEAL RECTOSIGMOIDECTOMY
THANK
YOU.