1. Diseases of the rectum

2. Epidemiology:
Approximately 11 people have rectal diseases among population/
But, after primary medical examination in 25% people are determinated rectal diseases

3. History:
Firstly, the rectal diseases had been started learning in ancient India, Egypt and Mongoly
The anorectal fistula hab be en described in 430 year before our era by Sokrat
There was used sclerotherapy for treating hemorroidal veins in 1869

4. Anatomy of rectum

5. Anatomy of rectum 1 - Gear Line; 2 - perianal skin;
3 - Anal-cutaneous line;
4 - lower rectal venous plexus;
5 - Bundle of Parks;
6 - Superior rectal venous plexus;
7 - Circular layer of muscular coat
rectum;
8 - Longitudinal layer
muscle membrane of the rectum.

6. Surgical anatomy of the rectum
Cross-section of lower part of rectum

7. Surgical anatomy of the rectum
Locking the muscles of the rectum (bottom view)

8. Anatomy of the rectum
1) pars subcutanea, 2) pars sliperfici.'ilis, 3) pars proflilida, 4) in. puborectalis
1) Pars slibcutanea, 2) pars sliperfici.'ilis, 3) pars profniulii, 4) тп. puborectalis

9. Arteries of rectum

10. The lymphatic network of the rectum
Veins of rectum (VCI = vena cava inferior = postcava)
The lymphatic network of the rectum

11. Cavity around the rectum, filled with fatty tissue: 1) spatium ischiorectale, 2) spatium pelvirectale, 3) spatium perianale

12. Physiology of the rectum
Evacuation
Tank ( )
Absorptive

13. Diseases of the rectum Congenital anomalies of the rectum
Non-tumoral diseases of the rectum
Tumors of the rectum

14. Congenital anomalies of the rectum
Disease of Hirschsprung (aganglionar megacolon)
Congenital atresias of the anus and rectum

15. Congenital atresias of the anus and rectum
Anomalies of the anus and rectum is known to occur in 0,2 ° / oo of all newborns. Among the most frequent: anal stenosis, anal atresia, atresia, the anus and rectum and rectal atresia

16. Classification and diagnosis
Depending on whether over or under pubococcygeal line blockage is located, distinguish deep (aproctia) or high-obstruction (atresia, the anus and rectum). Under the new nomenclature adopted in Melbourne in 1970, and still produce an intermediate form.

17. Congenital anomalies of the rectum
Congenital anomalies of the rectum: a) stenosis anus, b) atresia anus, and c) atresia anus and rectum, r) atresia of the rectum

18. Diagnostics
To estimate the height of the obstruction is a lateral X-ray radiography in the baby's head is down (in Wangen-steen-Rice). From the distance the air, filling the blind pocket on a metal plate glued in place the anus, conclude about the height of obstruction

19. Treatment

20. Congenital atresias of the anus and rectum
Operation in atresia of the anus and rectum through abdomen-surface access and Rehbein Siepliens. To access between the sacral bone and intestine, ureter directly to form a tunnel (a), through which extend a plastic tube (b), which through the hole in the bottom of the blind pocket stretch in the abdominal cavity (в)

21. Non-tumoral diseases of the rectum
Hemorrhoids
Anal fissure, papillary hypertrophy
Anorectal abscess and anal fistula
Archoptosis and the failure of the sphincter

22. Hemorrhoids
Hemorrhoids - expansion of the cavernous cells of the rectum, the most common colo Proctoscope pathology. Hemorrhoid suffers approximately out of 100, and its share in the overall structure of diseases of the rectum is 40%. The disease occurs almost equally common among men and women aged years.

23. Hemorrhoid node
The formation of hemorrhoids contribute constant constipation, persistent diarrhea, prolonged cough, vomiting, prolonged and excessive stress on your abdominal muscles (in certain sports), narrowing the space of the processes in the pelvis (tumor, pregnancy), portal hypertension.

24. Anatomy of hemorroid nodes
The three positions:
Left lateral
Right rear
Right front

25. Hemorrhoid nodes
internal
external

26. Clinic stages
In the first stage internal hemorrhoid can be felt as a swelling, it can be seen in proctoscope.
In the second stage of internal hemorrhoid straining falls through the anus, but after straining restored spontaneously to its place.
In the third stage of the disease internal hemorrhoids fall through the anus and spontaneously restored. Only under pressure from the outside, they return to their place.
At the fourth stage of internal hemorrhoid is always outside the anus is not deposited even under pressure from the outside.

27. Treatment
Conservative (baths, medication with thrombophlebitis of hemorrhoidal veins and sclerotherapy)
Surgical

28. Sclerotherapy At first described in 1869 in stages 1 and 2, effective
30% relapse within 4 years

29. Ligation of hemorrhoids with rubber rings
2 cm proximal from the anus
Causes necrosis and scarring of the lining of the rectal wall, thus reducing the relapse
96% of asymptomatic for a month

30. Surgical treatment Operation by Milugan - Morgan Operation by Parks
Operation by Rijih

31. Operation by Milugan Morgan
All three hemorrhoidal node tied and cut off

32. Operation by Parks
Node is separated medially - anodermy from the outside - from the internal sphincter

33. Hemorrhoidectomy by Rizhih

34. Rectal anal fissure
Among all the diseases of the rectum anal fissure is the frequency of the third place (11.7%) after colitis and hemorrhoids. Fissures are more common in women (60%) aged 30 to 50 years. Usually, the crack has a length of 2 cm, width 2-3 mm. Most often anal fissure is located in the posterior commissure anus, due to traumatization of the zone during defecation. Maybe a few cracks in this case, the most common localization of - anterior and posterior commissure ("mirror" the crack). The direction of the longitudinal cracks.

35. Anal fissure, pectenoz, papillary hypertrophy
Anal fissure with caruncle and hypertrophied anal warts

36. Anal fissure, pectenoz, papillary hypertrophy
About anal fissure say if the boundary of chronic ulcers anus, more or less deep penetration into the anal canal. With a long-term deep fissures, accompanied by a chronic inflammatory process, there is strong, prone to wrinkle, scar tissue, which increasingly constricts the anal canal. This is called pectenoziz.

37. Anal fissure, pectenoz, papillary hypertrophy
Internal sphincterotomy. a) Dissection of the crack and the internal sphincter, and b) the same schematic, c) a small external wound after the removal of Tongue

38. Anal fissure, pectenoz, papillary hypertrophy
The operation is performed under local anesthesia or intra-trachea anesthesia, the patient is in position for lithotomy. In the radial direction, bordering the cut in one piece is removed hypertrophied papilla, crack and caruncle.

39. Paraproctal abscess and paraproctal fistulas
Stages
Acute-abscess
Chronic paraproktal fistula

40. Paraproctal abscess Paraproctal abscesses: a) perianal,
B) ishiorektal,
c) pelviorektal,
d) submucosal

41. Clinic of the acute paraproctitis (abscess)
Pain
Redness
Edema
Increased body temperature
Increased ESR

42. Paraproctitis (abscess)
Opening perianal and ishiorectal abscesses

43. Paraproctitis (abscess)
Opening of ischiorectal and pelviorectal fistulas

44. Anorectal fistula
In the first described by Hippocrates in 430g. BC
Swelling, pain, separation, or slimy stools.
A history of acute or inflammatory paraproctitis and cancers of the colon

45. Anorectal fistula
According to the rule Qoodsati, anorectal fistulas are different depending on their location relative to the perpendicular lines drawn through the anus

46. Classification of anal fistulas.

47. Diagnostic а в
The introduction of dyes for determination of the (a) or holding a thin wire (a).

48. Anorectal fistula
Excision of posterior anorectal fistula by the method of Parks, outer part of the fistulous excised from the skin in the form of a cylinder

49. Archoptosis Loss of part or all of the rectal wall to the anus.
Accompanied with fecal incontinence and constipation
Rare bleeding
No pain
Loss of rectum

50. Archoptosis and the failure of the sphincter
Distinguish partial loss - or loss of mucosal and total precipitation (protsidention), when all the layers of the rectal wall torn out through the anus.
Loss of mucous is easily recognized by passing radially inverted pleats on the mucous

51. Failure of the sphincter
The simplest method for the treatment - infiltration of the tissues around the colon causing inflammation of the drug.

52. Failure of the sphincter.
Fixing fallen rectum "assemblies" and "reverse intussusception"

53. The failure of the sphincter
Plastic tender muscles in the way Pickreil

54. Tactics of GP
In admittion of patient with rectum disease general practitioner must perform followings:
Careful picking of anamnesis;
To perform rectoromanoscopy;
To perform colonoscopy;
Taking in laboratory methods of research;
As appropriate direct the patient in surgery in-patient department.