Documente Academic
Documente Profesional
Documente Cultură
OF THE
LARGE
COLON,
RECTUM
AND ANAL
CANAL
Large intestine
consists of
1. Cecum
2. Appendix
3. Ascending colon
4. Transverse colon
5. Descending
colon
6. Sigmoid colon
7. Rectum
8. Anal canal
External feature of large intestine
• Total length of large intestine = 150cm
• Larger internal diameter
Parts of large intestine Diameter (cm) Length ( cm )
Cecum 7.5-8.0 6
Ascending colon 6.0-6.5 15
Transverse colon 5.0-6.5 50
Descending colon 6.0-7.0 20
Sigmoid colon 4.0-7.5 40
• Upper 2/3 of ascending colon is supplied by right colic branch of superior mesenteric artery
• Right 2/3 of transverse colon is supplied by middle colic branch of superior mesenteric
artery
• Left 1/3 of transverse colon and descending colon are supplied by left colic branch of inferior
mesenteric artery
Anal canal Embryo. origin Epithelium Arterial Lymphatic Innervation Touch, pain,
supply drainage tempera., stretch
Above dentate line Endoderm Simple columnar Superior Internal iliac Visceral (sympa: inf NOT sensitive,
(Internal/ true) rectal ar LN mesenteric plexus, para: inf painLESS!!
hypogastric plexus, pelvic
splanchnic n)
Below dentate line Ectoderm (Anoderm) Stratified Inferior Superficial Somatic (inferior rectal nerve) Sensitive, PAIN!!
(External/ nonkeratinized rectal ar inguinal LN
false) squamous (anal
pecten)
EXAMINATION
• Abdominal examination of perineal and rectal area -
presence of external hemorrhoids or prolapse of internal
hemorrhoids may be obvious
• Digital rectal examination - can detect masses, tenderness,
and fluctuance, but internal hemorrhoids are less likely to be
palpable unless they are large , thrombosed or prolapsed.
INVESTIGATION
• Anoscopy - to visualize internal hemorrhoids that look like
purplish bulges through the anoscope
• Proctoscopy – piles prolapse into lumen as cherry red
masses. External haemorrhoid appears bluish
• Flexible sigmoidoscopy and colonoscopy – To rule out
colorectal carcinoma
• Complete blood count – To detect anemia ( if present ,
should raise suspicious for other diagnosis ) as anemia is rare
• Coagulation profile – To rule out bleeding diasthesis
MANAGEMENT ( only for symptomatic patient )
Grading Management
Grade 1 , 2 and external LIFESTYLE MODIFICATION DIETARY MODIFICATION
• warm water (sitz) baths • high-fiber diet (25 to 35 g per day)
• stool softeners • fiber supplementation
• having regular exercise • increased water intake
• Reduce to an ideal weight if obese • reducing consumption of fat
• improving anal hygiene • avoiding medication that causes
• abstaining from both straining ( > 5 min ) constipation or diarrhea
• Evacuating when natural desires arises
• Adopt a defecatory position to minimize
straining
Symptomatic despite Rubber band ligation
conservative treatment Sclerotherapy
and Grade 3 Infrared coagulation
Grade 3 and Grade 4 • Arterial ligation of hemorrhoids (HAL)
• Submucosal hemorrhoidectomy
• Stapled hemorrhoidopexy
ANORECTAL ABSCESS (An anorectal abscess refers to a collection of
pus in the anal or rectal region
DRE
Anoscopy • If clinical findings unclear / Sx persist despite tx
• Possible biopsy & histo to exclude CA
Treatment • Conservative (1st line)
Dietary improvement (fibre, water), stool softener (docusate), 2% lidocaine
jelly, Sitz bath, topical vasodilator therapy (nifedipine gel)
If persist despite >8wks conservative endoscope TRO IBD Defintive
surgical tx
• Outpatient: Botulinum toxin A (BTX) injection into internal anal sphincter
• Surgical
Risk of fecal incontinence (High/Low)
Anal fissure