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

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

3. 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

4. Hemorrhoid (2) Type : Internal hemorrhoid External hemorrhoid
Mixed hemorrhoid
Grade :
Grade I
Grade II
Grade III
Grade IV

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

6. 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

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

8. Anal abscess and Anal fistula (3)
Classification of anorectal abscess
Perianal %
Ischiorectal %
Intersphincter %
Supralevator ( pelvirectal ) %
Submucosal %

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

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

11. Colorectal Cancer Anatomy Location Blood supply Venous drainage
Lymphatic drainage

12. Chemotherapy Indication : Stage of Duke’s C ( C1~ C3 ) -- 9102-A
Stage of Duke’s D / C2 ( LN > 4 )
Stage of Duke’s B2 -- ?
Dose:
According to the body surface

14. Endoscopic Examination
Anoscopy
Proctoscopy
Sigmoidscopy
Colonoscopy

15. 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