tailieunhanh - Anal and rectal diseases explained - part 4

Giải phẫu Soi ruột già, barium enema (xem hình 4), soi đại tràng sigma linh hoạt, hoặc anoscopy. Sinh lý (đại tiện tắc nghẽn) proctography động, đo áp lực hậu môn trực tràng, thần kinh dẫn truyền vận tốc, electromyography, và nghiên cứu đánh dấu sitz (xem hình 5-7). Độ dày toàn khác trực tràng sinh thiết (ở những bệnh nhân bị bệnh nghi ngờ Hirschsprung). | Constipation Figure 3. Lateral rectoceles arrows demonstrated on dynamic proctography. Patient complained of difficulty with evacuation. Figure 4. Megarectum demonstrated on barium enema in a patient with chronic constipation. Anatomic Colonoscopy barium enema see Figure 4 flexible sigmoidoscopy or anoscopy. Physiologic obstructive defecation Dynamic proctography anorectal manometry nerve conduction velocity electromyography and sitz marker study see Figures 5-7 . Other Full thickness rectal biopsy in patients with suspected Hirschsprung s disease . Figure 5. Movement of sitz markers in the colon in normal subjects and patients with colonic inertia. Patients with colonic inertia have accumulation of markers throughout the cotoT hisinis n. trial version 61 Chapter 3 Figure 6. Sitz marker study on day 5 in a constipated patient demonstrates markers throughout the colon. Lines separate the right middle and left colon. Marker distribution patterns vary depending on the cause of constipation. Figure 7. Simulation of segmental colonic transit of sitz markers based on data from 20 normal volunteers 1 right colon 2 left colon 3 rectosigmoid colon 4 colon . This is trial version 62 Constipation Treatment Fiber therapy laxatives stool softeners lactulose and sorbitol polyethylene glycol plus electrolytes biofeedback therapy botulinum toxin Botox injections surgical repair of rectocele subtotal colectomy and ileorectal anastomosis for colonic inertia and lateral internal anal sphincterotomy. Clinical pearls Taking a careful history will assist in differentiating the various causes of constipation. In general an anatomic evaluation of the large intestine with a barium enema or colonoscopy should be included in the evaluation to screen for colon polyps colonic strictures and malignancies. This is trial version .