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 I Grade II 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 ( C1~ C3 ) -- 9102-A Stage of Duke’s D / C2 ( LN > 4 ) -- 9505 Stage of Duke’s B2 -- ? 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