肛直肠疾病英文讲稿.docVIP

Diseases of the Anorectum 辅助手段 时间分配 （讲 稿） Surgical Anatomy and Physiology The anatomic key to the anorectum is the pectinate line.Above it pain sensation is absent,blood drains to the portal and caval system,and lymph drains along the superior rectal vessels or lateral to the obturator or iliac nodes. Below the pectinate line,pain is notably present,blood drains to the inferior vena cava,and lymph to the inguinal nodes. Anal glands empty into anal crypts at the pectinate line.When obstructed or infected,these glands become the source of abscess and fistulas. Diseases of the Anorectum Hemorrhoids Anal fissure Anorectal abscess Anorectal fistulas Rectal prolapse Anorectal cancer Common positions for digital examination Side-lying position Knee-chest position Lithotomy position Squatting position Anterior flexion position Hemorrhoids Essentials of diagnosis:(emphasis) Rectal bleeding,protrusion,discomfort. Mucoid discharge from rectum. Possible secondary anemia. Characteristic findings on external anal inspection and anoscopic examination. General considerations Hemorrhoids (meaning flowing blood) represent a normal anatomic state and occur in all adults. Only when hemorrhoids become enlarged and symptomatic is treatment indicated. Hemorrhoids are classified as internal or external. Internal hemorrhoids are a plexus of superior hemorrhoidal veins above the mucocutane-ous junction which are covered by mucosa. External hemorrhoids (inferior hemorrhoidal plexus) occur below the mucocutaneous junction in the tissues beneath the anal epithelium of the anal canal and the skin of the perianal region. Hemorrhoids become symptomatic for many reasons.The most common cause is straining in the squatting position at the time of bowel movement. Other important causative factors of symptomatic hemorrhoids include chronic constipation,pregnancy,obesity,the low-fiber diet ,etc. Clinical Findings A.Symptoms and signs: 1.Bleeding 2.Protrude (prolapse) 3.Discomfort and p